Adapted From Temple College

EMS Professions

Poisons Substance which when introduced into

body in relatively small amounts causes in structural damage or functional disturbances

Suspect with: GI signs/symptoms (nausea, vomiting,

diarrhea, pain) Altered LOC, seizures, unusual behavior Pupil changes, salivation, sweating, other

signs/symptoms of disturbed autonomic nervous system function

Respiratory depression Burns, blisters of lips, mucous membranes Unusual breath odors

Treat Patient, Not Poison Proper support of ABCs is first step in

management Contact with Poison Control Center Priority action plan Symptomatic treatments Time management

Try to determine: What? How much? How long ago? What has already been done? Psychiatric history? Underlying illness?

When in doubt. . .

Assume containers were full Entire contents were ingested Patient may not be telling you the truth

If several patients involved. . .

Assume each ingested entire container contents

Triage Additional resources

Always. . .

Bring sample of material if possible Save for analysis, if patient vomits

Poisoning Management

Based on route of entryIngestedAbsorbedInhaledInjected

Ingested Poisons

Prevent absorption of toxin from GI tract into bloodstreamPositioningRapid Transport to definitive treatment

center

Absorbed Poisons

Dry chemicalsdust skin, then wash

Liquid chemicalswash with large amounts of H20

avoid “neutralizing” agents

CAUTION Don’t accidentally expose

yourself!

Inhaled Poisons

Remove patient from exposure Maximize oxygenation, ventilation

CAUTION Don’t accidentally expose

yourself!

Injected Poisons

Attempt to slow absorption Venous constricting bands Dependent position Splinting of injected body part Cold packs (+) [May worsen local injury by

concentrating poison]

Substance Abuse

Self administration of a substance in a manner not in accord with approved medical or social practices

Substance Abuse

Psychological dependence Physical dependence Compulsive drug use Tolerance Addiction

Psychological Dependence Habituation Substance needed to support user’s

sense of well-being

Physical Dependence

Substance must be present in body to avoid physical symptoms (withdrawal)

Compulsive Drug Use

Use of drug and rituals/culture associated with its use become an overwhelming desire

Tolerance

Increasing amounts of drug needed to produce same effects

Tolerance contributes to addiction by keeping user “chasing the last high”

Addiction

Combination of psychological dependence, physical dependence, compulsive use, and tolerance

Patient becomes totally consumed with obtaining, using drug to exclusion of all other things

Ethyl AlcoholA CNS Depressant Drug

Decreased ReactionTime

Increased AccidentalTrauma Risk

Decreased SocialInhibitions

Increased IntentionalTrauma Risk

Potentiation of OtherCNS Depressants

Lethal Overdoses inCombination with OtherDrugs

Slowed GI TractActivity

Irritation, Gastritis,Ulcer Disease, GIBleeds

Toxic Overdose RespiratoryDepression, Shock

Ethanol Intoxication Signs

Breath odor Swaying, unsteadiness Slurred speech Nausea, vomiting Flushed face Drowsiness Violent, erratic behavior

Ethanol

Clouds signs, symptoms Complicates assessment Head trauma, diabetes, drug toxicity, CNS

infection can mimic EtOH intoxication and vice versa

Patient is NEVER “just drunk” until all other

possibilities are excluded

Experience alcohol withdrawal syndrome if they reduce intake: Restlessness, tremulousness Hallucinations Seizures Delirium tremens--all of above plus tachycardia,

nausea, vomiting, hypertension, elevated body temperature

Alcohol Addicts

Life threatening condition! Occurs 1 days to 2 weeks after intake is

decreased 5 to 15% mortality Control airway, prevent aspiration, monitor

for hypovolemia

Delirium Tremens

Narcotics

Opium Opium derivatives Synthetic compounds that produce opium-

like effects

Narcotics Opium Heroin Morphine Demerol Dilaudid

PercodanCodeineDarvonTalwin

Narcotics

Medical Usesanalgesicsanti-diarrheal agentscough suppressants

Narcotics

Overdose Coma Respiratory depression Constricted (pin-point) pupils

Narcotics Withdrawal

AgitationAnxietyAbdominal painDilated pupils

–Sweating–Chills–Joint pains–Goose flesh

Resembles severe influenza

Not a life-threat

Nembutal Seconal Pentobarbital Amytal Tuinal Phenobarbital

Barbiturates

Induce sleepiness, state similar to EtOH intoxication

Medical usesAnestheticsSedativeHypnotics

Barbiturates

Barbiturates

OverdoseComaRespiratory depressionShock

Extremely dangerous in combination with EtOH

Barbiturates

WithdrawalResembles EtOH withdrawal (DTs) Extremely dangerous

Barbiturate-like Non-barbiturates Doriden, Placidyl, Quaalude, Methyprylon Effects similar to barbiturates Overdose can cause sudden, very

prolonged respiratory arrest Withdrawal resembles ETOH; extremely

dangerous

Valium, Librium, Miltown, Equanil, Tranxene

Low doses relieve anxiety, produce muscle relaxation

High doses produce barbiturate-like effects

Tranquilizers

Overdose: Unlikely to cause respiratory arrest alone Extremely dangerous with EtOH

WithdrawalResembles EtOH withdrawalExtremely dangerous

Tranquilizers

CNS Stimulants: Amphetamines Dexedrine, Benzedrine, Methyl

amphetamine Relieve fatigue, promote euphoria,

reduce appetite

CNS Stimulants: Amphetamines Overdose

Restlessness, paranoiaTachycardiaHypertension CVA, Heart failureHyperthermia Heat stroke

WithdrawalLethargyDepression

Stronger stimulant effects than amphetamines

Can cause respiratory/cardiovascular failure, heat stroke, lethal arrhythmias

CNS Stimulants: Cocaine

“Snorting” can destroy nasal septum, cause massive nosebleed

Airway issue Withdrawal:

lethargydepression

CNS Stimulants: Cocaine

LSD, psilocybin, peyote, mescaline, DMT, MDMA

Enhance perception Wrong setting may induce “bad trips” with

extreme anxiety True toxic overdose rare

Hallucinogens

Phencyclidine

PCP, angel dust Produces bizarre, violent behavior Reduces pain sensation Patients may be capable of feats of

extreme strength Keep patient in quiet environment,

minimize stimulatin

Glue, paint, gas, light fluid, toluene Inhalation produces state similar to EtOH

intoxication Patient may asphyxiate if consciousness

lost while “sniffing”

Solvents

Increase risk of arrhythmias May cause liver damage, bone marrow

depression Chronic abuse causes CNS damage -

paranoia, violent behavior

Solvents