Ch. 22- toxicology

poison

any substance whose chemical action can damage body structures or impair body function

toxin

poisonous substance produced by bacteria, animals, or plants

Opioid and opiates: examples and overdose signs and symptoms

opioid: heroine, fentanyl, methadone, oxycodone

opiate: morphine, codeine

• hypoventilation

• pinpoint

• sedation or coma

• hypotension

sympathomimetics examples and signs and symptoms

mephdrone, cocaine, mathamphetamine

• hypertension

• tachycardia

• dilated pupils

• agitation or seizure

• hypothermia

sedative- hypnotics examples and signs and symptoms

diazepam, secobarbital, temazepam, midazolam

• slurred speech,

• sedation or coma,

• hypotension,

• hypoventilation

anticholinergics examples and signs and symptoms

atropine, doxylamine, diphenhydramine, etc)

• tachycardia,

• hyperthermia,

• hypertension

• dilated pupils

• dry skin and mucus membrane

• sedation, agitation, seizures, coma, or delirium

• decreased bowel sounds

cholinergica examples and signs and symptoms

pilocarpine, nerve gas, organophosphates

• airway compromise

• sludgem:

  salvation

• lacrimation

• urination

• defecation, drooling, diarrhea

• gastric upsets and cramps

• emesis

• muscle twitching/ miosis (pinpoint pupils)

is possible, ask the patient?

What substance did you take?
When did you take it (or become exposed to it)?
How much did you ingest?
Did you have anything to eat or drink before or after you took it?
Has anyone given you an antidote or any substance orally since you ingested it?
How much do you weigh?

what are the routes for poisonings

• injection

• inhalation

• absorption

• ingestion

inhaled poisons pt assessment

• move pt into fresh air and may require supplemental oxygen

• if toxic gas, call for specialized forces

• immediate transport

absorbed and surface contact poisons signs and symptoms

A history of exposure

Liquid or powder on a patient’s skin

Burns
Itching
Irritation
Redness of skin
Typical odors of the substance

absorbed and surface contact poisons emergency treatment

Avoid contaminating yourself or others.

Remove the substance from patient as rapidly as possible.

Remove all contaminated clothing.

Flush and wash the skin.

what to do if dry powder poison is spilled on you

brush off powder, flood area with water for 15 to 20 minutes, then wash skin with soap and water

what makes up most of poisonings? examples

ingestion through mouth

• liquids, house cleaners, contaminated food, plants, drugs

ingested poisons signs and symptoms

• burns around mouth

• gastrointestinal pain

• vomiting

• cardiac dysrhythmias

• seizures

ingested poisons emergency medicine

• some ems systems allow emts to administer activated charcoal

• always immediately assess the abc's of every pt who has been poisoned

injected poisons exposures

• drug abuse

• envenomation by insects, arachnids, reptiles

injected poisons signs and symptoms

• weakness

• dizziness

• fever/chills

• unresponsiveness

• excitability

what should you check for/ do to pt with injected poison, if swelling occurs?

• check/ remove rings, watches, bracelets from areas around injections site

what does alcohol intoxication cause

altered mental status, slowed reflexes, impaired reaction time

may experience frightening hallucinations or DTs

how is alcohol a powerful central nervous system depressant?

• Decreases activity and excitement

• Induces sleep

• Dulls the sense of awareness, slows reflexes, and reduces reaction time

• May cause aggressive and inappropriate behavior and lack of coordination

• Alcohol increases the effects of other drugs and is commonly taken with other substances.

what should you do if pt exhibits signs of serious CNS depression?

provide respiratory support, may cause vomiting

what are delirium tremors (DTs) characterized by?

• agitation and restlessness

• fever

• sweating

• tremors

• confusion/ disorientation

• delusions/ hallucinations

• seizures

what is an opioid? what can it cause?

• type of narcotic medicine used to relieve pain

• CNS depressants so can cause severe respiratory depression and cardiac arrest if not treated

• nausea, vomiting, may lead to hypotension and

• seizures are uncommon but can occur

common opioids and opiates

butophanol (stadol)

codeine

fentanyl (sublimaze)

heroin

hydrocodone (vicodin)

hydromorphone (dilaudid)

morphine

methadone (dolophine)

oxycodone hydrochloride (oxycontin)

oxymorphone (opana)

opioid characteristics

• subset of opioid family and refers to natural, non synthetic opioids

• named for the opium in poppy seeds, from which codeine and morphine are derived

• tolerance develops quickly and users may require massive doses to experience same high,

how do opioid pts appear?

sedated or unconscious and cyanotic with pinpoint pupils

what reverses effects of opioid or opiate od, what route of admin? when do you use it?

• naloxone/ narcan, intranasal

• when pt has agonal respirations or. apneic

sedative hypnotic drugs treatment

• ensure airway is patent, assist ventilation, and provide prompt transport

what are sedative hypnotic drugs? how are they taken and what are examples?

• CNS depressants

• agents taken by mouth and are given in spiked drinks, sometimes dissolved and injected

• barbiturates and benzodiazepines

how does pt who took sedative hypnotic appear?

• alter LOC

• pt may appear drowsy, peaceful, or intoxicated

abused inhalant examples and what are they found in? what age group?

• acetone, toluene, xylene, hexane

• found in glues, cleaning supplies, paint thinners, lacquers

• commonly teenagers

abused inhalant treatment

• can make heart hypersensitive to the pts own adrenaline so keep pt from struggling or exerting themselves

• give oxygen, transport

what is hydrogen sulfide? what does it affect in the body and what is it used for?

• highly toxic, colorless, flammable gas with distinctive rotten egg smell

• affects all organs, lungs and CNS impacted most

• used to commit suicide

what should you do if you suspect presence hydrogen sulfide?

if suspect toxic gas, wait for hazmat team to tell you scene is safe

hydrogen sulfide signs and symptoms

nausea and vomiting, confusion, dyspnea, loss of LOC, seizures, shock, coma, and cardiopulmonary arrest

sympathomimetic street and drug name examples

• amphetamines, methamphetamines, phentermine hydrochloride, benzedrine

angel dust- (PCP),

crank- heroine, methcathidone

coke- cocaine,

ecstacy, eve, adam, molly- MDMA

uppers- amphetamines

what are sympathomimetics? how are they taken?

• CNS stimulants that mimic the effects of sympathetic nervous system— produces excited state

• commonly by mouth, also injected

immediate effects of cocaine and duration, what form is most potents

excitement and euphoria, last less than hour

smoked crack

what do sympathomimetics cause? what are pts at risk for?

• hypertension, tachycardia, dilated pupils, may cause hallucinations or paranoia

• high risk of seizures, cardiac dysrhythmias, and stroke

what do synthetic cathinones (bath salts) produce in body? what is the drug similar to? what route and how long does it last?

• produces euphoria, increased mental clarity, sexual arousal

• MDMA

• most users snort powder nasally and lasts up to 48 hours

bath salts adverse effects

Teeth grinding, appetite loss, muscle twitching, lip-smacking, confusion, gastrointestinal conditions, paranoia, headache, elevated heart rate, and hallucinations

what does marijuana do to body?

• produces euphoria, relaxation, drowsiness

• impairs short term memory and capacity to complex think

• could progress to depression and confusion

what can ingesting marijuana lead to?

cannabinoid hyperemesis syndrome

synthetic marijuana (spice)

herbal incense/ smoking blends that resembler THC high

powerful and unpredictable side effects, ranging from simple euphoria to complete LOC

hallucinogens and common examples

• alters a persons sensory perception

• LSD, PCP, mushrooms, ketamine

what does hallucinogens do? signs and symptoms of pt having a bad trip

• cause visual hallucinations, intensifies vision and hearing, separates user from reality

• hypertension, tachycardia, anxiety, paranoia

anticholinergic agents and common drugs

• have properties that block parasympathetic nerve

• atropine, benadryl, jimsonweed

• some tricyclic antidepressants mimic effects

anticholinergic agents emergency medicine

• pt can go from normal to seizure to death within 30 minutes

• transport immediately

cholinergic agents

• overstimulate normal body functions that are controlled by parasympathetic nerves

• nerve gases designed for chemical warfare and organophosphate insecticides

• DUMBELS or SLUDGEM for signs and symptoms

DUMBELS

diarrhea

urination

miosis

bradycardia, bronchospasm, bronchorrhea

emesis

lacrimation

seizures, salvation, sweating

SLUDGEM

salvation, sweating

lacrimation

urination

defecation, drooling, diarrhea

gastric upset and cramps

emesis

muscle twitching/ miosis

cholinergic agents treatment

• decontamination priority over transport

• after, decrease secretions in mouth and trachea, provide airway support

antidote kit and what does it consist of

• for cholinergic agents

• duodote auto injector

• consists of 1 auto injector containing atropine and pralidoxime

what age group is commonly ingesting fatal poisons?

children and older pts

signs and symptoms of over ingesting aspirin

nausea

vomiting

hyperventilation

ringing in ears

what causes food poisoning? example

eating food contaminated with bacteria

signs and symptoms of salmonellosis

• salmonella food poisoning

severe GI symptoms within 72 hours of ingestion- nausea, vomiting, abdominal pain, diarrhea

more common cause of food poisoning and duration of symptoms

• leftovers, unrefrigerated foods, staphylococcus grows quick and produces toxins in food

• symptoms occur within 2-3 hours or up to 8-12 hours after ingestion

most severe form of toxin ingestion? how is it manifested? symptoms?

• botulism

• eating improperly canned food

• neurologic symptoms: blurred visions, weakness, difficulty speaking and breathing

plant poisoning treatment

assess pts airways and vitals, notify regional poison center, take plant to emergency department

common routes of plant poisonings

ingested or absorbed through skin