NCM 118 6F: Poisoning, Heat and Cold Injuries, and Other Emergencies

POISONING

Is the exposure of the body to toxic substances in an amount sufficient to

have a damaging effect

Poison

any substance that injures, kills and organism by its CHEMICAL action

Toxin

poison produced by some BIOLOGICAL function in nature

Venom

a toxin injected by bite or sting

-remove the poison

-supportive care

-antidote

-implement treatment

Emergency Treatment goal for Poison

Ingested

Types of poisoning

Causes harm to the digestive tract or may cause systemic damage if

absorbed in the blood stream

Alkaline products

lye, drain cleaners, non phosphate detergents, oven

cleaners and button batteries

Acid products

toilet bowl cleaners, pool cleaners, metal cleaners, rust

removers and battery acid

Acetylcysteine

antidote for acetaminophen

Flumazenil

antidote for benzodiazepine

Naloxone

antidote for opioid

Dimaval

antidote for lead

Sodium Thiosulfate

antidote for cyanide

Checking airway, breathing, and circulation (ABC)

What is the first priority when managing an unresponsive poisoning patient?

-DO NOT NEUTRALIZE

-place on NPO

-do not induce vomiting

interventions for ingesting corrosive substances

a) It can cause a chemical reaction and worsen tissue damage

What is the main reason why neutralizing a corrosive substance is not recommended?

a) It can cause a chemical reaction and worsen tissue damage

b) It delays absorption of poison

c) It neutralizes too slowly

d) It prevents gastric emptying

true

t/f

in poison cases gastric lavage can add injury and it must only be used when there is no antidote available

false-only adults

t/f

you can perform gastric lavage on children

Inhaled poison

Types of poisoning

-Also known as carbon monoxide poisoning

- May occur as a result of industrial household incidence or attempted suicide

Carbon monoxide

Types of poisoning

is an invisible tasteless, non-irritating and very lethal

chemical. It is produced by incomplete burning of organic materials such as gasoline, wood, paper, charcoal and natural gas

carboxy hemoglobin

when carbon monoxide is bound to hemoglobin it is called ____

blood sample

best test to detence CO poisoning

true

t/f

in carbon monoxide poisoning the SpO2 in pulse oximeter will read high

Furnace

Water heater

Dryer

Stove

Car

Common Sources of Carbon Monoxide

-Carry the patient to fresh air immediately; open all doors and windows

-Administer high flow O2

immediate management for carbon monoxide poisoning

100% oxygen in a hyperbaric chamber

main treatment for the reversal of hypoxia and acceleration of CO elimination, this is administered until carboxyhemoglobin is less than 5%

Contact poison

Types of poisoning

Acquired commonly from used pesticides and poisonous plants such as

poison ivy, poison oak, and poison sumac.

● Breading of the skin

● Blisters

● Burns and itchiness

Signs and symptoms of contact poisoning

Flush area with cool H20 thoroughly

immediate management for contact poisoning

Envenomation

is the injection of poisonous substance by stings, bites or other

methods.

Non venomous snake bite

What type of snake bite

displays a horseshoe shaped teeth that is marked

on skin.

Venomous snake bite

What type of snake bite

displays two small puncture wounds that are one inch.

In some cases the patient may also experience swelling that usually lasts in

five minutes, discoloration and blood fill blisters developing 6-10 hours.

● Edema

● Ecchymosis

● Hemorrhagic bullae leading to necrosis at the site of envenomation

Classical signs of Envenomation

● Fasciculations

● Hypotension

● Paresthesias

● Seizures

● Coma

without decisive treatment of snake bites these clinical manifestations may progress to:

not to stop the spread but to SLOW down the spread (immobilize to slow it down)

focus management for snake bites

ANTIVENIN aka antivenom

best administered within four hours of the snake bite incident.

marine life

Does not usually hurt except for marine life such as sea wasps, zoanthids,

sea anemone, and portuguese man o'war

scrape

Remove stingers with gloves, if possible. You can also ___ the stinger with

hard objects such as long fingernail, credit card or edge of the scissors

cold illness

Exposure to cold temperatures can cause localize freezing of the skin and

other tissues. It can also cause lowering of the whole body temperature.

Frost Bite

also called as congulation

Frost Nip

initial stage of frost bite; superficial cooling of tissues without

destruction.

Controlled yet rapid rewarming

Put on dry gauze or cloth between frostbitten areas such as fingers and toes

After dewarming, active motion is performed

immediate management for cold illness

● Do not massage the area

● Do not break the blisters

● Do not ambulate if lower extremities are affected

what should you NOT do in cold illnesses

Heat illness

A continuum of illness related to the body's inability to cope with heat

Heat Exhaustion

- Temperature is normal to 40 degrees celsius

- Prolonged exposure to heat with normal regulating mechanism.

Heat Stroke

- Temperature is 40 degrees celsius or higher

- Failure of the body's temperature regulating mechanism associated

with neurologic dysfunction

true

t/f

Skin that is very hard to touch in heat stroke

false-NO SWEATING

t/f

during a heat stroke you sweat

Burns

The denaturing of the cell membranes through contact with heat,

electricity, chemical and radiation.

Painful, costly, disfiguring, require intensive and extensive rehabilitation

therapy and may be associated with long-term disability.

Thermal

Burn injury by source

Individual is in contact with hot surfaces, objects of flammable or hot vapors, and hot liquids

Chemical

Burn injury by source

individual is in contact with chemical agents such as strong acids

or base

Electrical

Burn injury by source

caused by strong electrical current running through the body

causing an entrance and exit wound in the individual's body

Radiation

Burn injury by source

- caused by exposure to UV light radiation therapy, x-rays or even

with the use of a microwave

using rule of nine, palmer method & Lund and Brower

chart

methods to determine extent of burn

1st degree (Superficial)

Classification of burns by Depth

- Epidermis

- Dry skin, redness, tenderness, mild swelling, pain

- Heals with scarring, usually in about a week

- No grafts needed

2nd degree

Classification of burns by Depth

- Caused by scalds, flash flame and contact burns

Superficial partial thickness

Type of 2nd degree burn

- Epidermis and papillary dermis are affected

- Red with clear blisters, blanches with pressure, moist, painful

- Heals within 2-3 weeks

- No grafts needed

Deep partial thickness

Type of 2nd degree burn

- Epidermis and papillary reticular dermis are affected

- Red and white bloody blisters, less blanching, moist, painful

- Heals within 2-3 weeks but may progress to 3rd degree burns

- Grafts maybe required if healing is prolonged

3rd degree (Full thickness)

Classification of burns by Depth

- Causes include flame, prolonged exposure to hot liquids, electrical

current, chemical, and contact

3rd degree (Full thickness)

Classification of burns by Depth

- Extends through the entire dermis

- Stiff, white/brown, dry, leathery, painless

4th degree (deep full thickness)

Classification of burns by Depth

- Causes include prolonged exposure or high voltage electrical injury

- Extends through skin, subcutaneous tissue, muscle and bone

- Black, charred with eschar, dry, painless

Fluid resuscitation

done in 3rd degree burns to prevent shock by maintaining perfusion without

causing overload

Convulsions/seizures

abnormal overstimulation of brain cells that is caused by several

conditions such as epilepsy, heat stroke, poisoning, electric shock,

hypoglycemia, high fever in children, brain injury, tumor/stroke and alcohol

withdrawal

Aura

perceptual disturbance experienced by some before a seizure

such as perception of strange light, unpleasant smell and confusing

thoughts or experiences

Ictal phase

may experience loss of consciousness, blank stare,

cyanosis, apnea, distress, repetitive jerking movements and

urinary/fecal incontinence

Post-ictal phase

individual is already awake however may be

confused or disoriented

Acute Alcohol Intoxication

Is the excessive ethanol ingestion that may lead to a medical

emergency.

true

t/f

Ethanol is a CNS depressant

alcohol

withdrawal syndrome

Individuals who suddenly stop taking alcohol may experience_________which is the acute toxic state that occurs as a result of

sudden cessation of alcohol intake.

Delirium Tremens

most severe form of ethanol withdrawal.

Diabetes mellitus

a group of metabolic diseases characterized by

hyperglycemia due to inadequate production of insulin and or insulin

sensitivity of the cells which has type 1 and type 2 categories.

Hypoglycemia

Cold,clammy, tremor

It is caused by too much insulin or too little or delayed food intake, exercise or

alcohol intake. This is a sudden onset and manifestations would include:

Hyperglycemia

Hot and dry

Caused by insufficient insulin overeating, inactivity, illness or stress

- Manifestations: gradual onsent of