Toxicology

Prehospital Emergency Care: Toxicologic Emergencies and Infectious Diseases

Learning Readiness

  • EMS Education Standards

  • Chapter Objectives

  • Key Terms

  • Purpose of lecture presentation versus textbook reading assignments

Setting the Stage

  • Overview of Lesson Topics:

    • Poisons and Poisoning

    • Ingested, Inhaled, Injected, and Absorbed Poisons

    • Specific Types of Poisoning

    • Poison Control Centers

    • Drug and Alcohol Emergencies

    • Specific Substance Abuse Considerations

Case Study #1 Introduction

  • EMTs Trisha Trujillo and Brian Long assess a two-year-old boy named John, suspected of ingesting lamp oil.

  • John's condition is stable; he appears scared but alert.

Questions for EMTs

  • Additional questions to ask John and his mother.

  • Details needed about the specific substance involved.

  • Resource utilization, particularly regarding treatment decisions.

Introduction to Poisoning

  • Types of Poisoning:

    • May be accidental or intentional.

    • Many poison control center calls involve young children.

    • Special considerations for drug and alcohol emergencies.

Poisons and Poisoning

Definition and Nature

  • Poison: Any substance that impairs health or causes death due to chemicals.

  • Toxicology: The study of toxins and antidotes.

  • Overdose: A form of poisoning due to excessive intake of substances.

Routes of Exposure

  • Poisons can access the body through four primary routes:

    • Ingestion

    • Inhalation

    • Injection

    • Absorption

Symptoms of Poisoning

  • Signs and symptoms vary based on poison and entry route.

  • Patients may deteriorate; constant monitoring of mental status, airway, and breathing is crucial.

Management of Poisoning

  • Most intervention is supportive:

    • Address airway, breathing, oxygenation, and circulation needs.

    • Prepare for potential vomiting and conduct frequent reassessments.

Antidotes

  • Few antidotes are available.

  • Focus on limiting poison absorption and treating symptoms.

Ingested Poisons

Overview

  • Variability in stomach emptying and intestinal absorption post-ingestion.

  • Importance of identifying the timing of ingestion.

Commonly Ingested Substances

  • Types:

    • Over-the-counter medications

    • Illegal drugs

    • Household cleaning products

    • Spoiled or underprepared foods

    • Insecticides, petroleum, plants

  • Accidental ingestions: Medication misuse or combining with alcohol.

Statistics

  • Poisoning is the leading cause of accidental death among children.

Assessment Approach

  • Steps:

    • Size-up the situation.

    • Conduct a primary assessment.

    • Perform a secondary assessment: history, physical exam, signs, and symptoms.

    • Follow with reassessments.

Signs and Symptoms of Ingested Poisons

  • Key indicators include:

    • Oral Symptoms: Swelling of mucous membranes, discoloration, burns around the mouth.

    • Physical Symptoms: Abdominal pain, vomiting, altered mental status, changes in skin temperature.

    • Respiratory Symptoms: Distress, unusual breath odors, signs of shock.

Activated Charcoal

  • Occasionally used for certain ingestions:

    • Absorbs toxins, preventing further systemic absorption.

    • Lack of evidence supporting improvement in outcomes.

Emergency Medical Care

  • Maintain an open airway and help prevent aspiration.

  • Provide adequate ventilation and oxygenation.

  • Initiate transport immediately while documenting all relevant information.

Inhaled Poisons

Overview

  • Thousands die annually from inhalation of toxic fumes.

  • Many incidents occur in fire situations; exposure duration negatively affects prognosis.

Common Inhaled Poisons

  • Types: Ammonia, chlorine gas, carbon monoxide, industrial chemicals.

  • Intentional Inhalation: Known as "huffing"; leads to displacement of oxygen in lungs.

Assessment Approach

  • Steps:

    • Scene safety assessment.

    • Primary and secondary assessments covering history and symptoms.

Signs and Symptoms

  • Symptoms include difficulty breathing, chest pain, burns, confusion, and seizures.

Emergency Medical Care

  • Protect rescuer with SCBA or await specialized rescue.

  • Administer oxygen via a non-rebreather mask for adequate breathing.

Injected Poisons

Overview

  • Poisons enter through skin breaks; effects can be local or systemic.

  • Anaphylaxis possible with certain insect stings.

Assessment Approach

  • Steps:

    • Scene size-up, primary and secondary assessments to gauge signs and symptoms.

Signs and Symptoms

  • Includes dizziness, chills, fever, pain at injection site, and signs of systemic reaction.

Emergency Medical Care

  • Maintain an open airway, manage airway protection, and transport rapidly.

Absorbed Poisons

Overview

  • Enter through skin/mucous membranes; can cause skin irritation or burns.

Assessment Approach

  • Steps: similar to other poisoning approaches, focusing on history and symptoms.

Signs and Symptoms

  • Irritation, redness, rash, and signs of contact dermatitis.

Emergency Medical Care

  • Rinse exposed areas, remove contaminated clothing, and maintain hygiene protocols.

Summary of Specific Types of Poisoning

  • Discusses food poisoning, carbon monoxide, cyanide, and corrosive substances.

Food Poisoning

  • Result of harmful bacteria or toxins; common sources include seafood, chicken, and eggs.

  • Signs & symptoms: fever, abdominal cramping, and gastrointestinal discomfort.

Carbon Monoxide Poisoning

  • Odorless and potentially lethal; symptoms include headache and altered mental status.

Cyanide Poisoning

  • Can enter from smoke inhalation or chemical sources; emergency care must ensure oxygen administration.

Acids and Alkalis

  • Cause severe burns upon contact; safety measures in handling are paramount.

Drug and Alcohol Emergencies

Overview

  • Medical issues connected with drug overdose or withdrawal; patients can exhibit unpredictable behavior.

Assessment Approach

  • Establish scene safety, perform assessments, and identify signs/symptoms indicating priority care.

Common Drug Categories

  • Stimulants: Increased alertness, heart rate, potential for agitation.

  • Depressants: Drowsiness, respiratory depression, constricted pupils.

  • Hallucinogens: Acute psychological changes; potential violence.

  • Inhalants: Euphoria and rapid onset of serious side effects.

Common Signs of Intoxication

  • Altered mental status, respiratory difficulties, abnormal pulse, and changes in level of consciousness.

Summary of Substance Abuse Considerations

  • Focus on effects and management of various substances (e.g., opioids, stimulants).

Withdrawal Syndrome

  • Can follow drug cessation; includes a range of physical and psychological symptoms.

Alcohol Withdrawal Syndrome

  • Various stages ranging from tremors to hallucinations; delirium tremens is notably serious.

Infectious Diseases in EMS

Overview

  • Key diseases affecting EMS operations and patient interaction (e.g., HIV, Hepatitis B/C, Tuberculosis).

Protective Measures

  • Use of PPE to minimize risk during patient interactions.

Specific Diseases

  • Hepatitis B: Contracted through bodily fluids; signs include jaundice.

  • Tuberculosis (TB): Highly infectious, particularly in vulnerable populations.

  • COVID-19: Recent insights on transmission, symptoms and how to manage exposure in EMS settings.

Conclusion

  • Importance of recognizing types of poisons and effective management in the prehospital setting.

  • Highlight need for emergency medical services to stay informed on toxicologic emergencies and infectious disease handling strategies.