Poisoning and Overdose Emergencies Topic Overview Emergency Medical

Poisoning and Overdose Emergencies

Topic Overview • Emergency Medical Care of Poisoning / Overdose • Relationship to Airway Management

Poisoning and Overdoses Poisonings – There were over 2, 500, 000 reported poisonings reported in 1993 • Poison – Any substance that can harm the body – Can also involve living organisms that produce toxins

Poisoning and Overdoses • Ingested- This can include household and industrial chemicals, medications, improperly prepared foods, plant materials, petroleum products, and agricultural products • NOTE: Extreme care must be taken when ventilating a patient that has ingested any substance. Practice BSI!

Poisoning and Overdoses • Inhaled – Carbon monoxide, ammonia, chlorine, insect sprays, and gases produced by volatile chemicals • Absorbed – Usually through unbroken skin. Many corrosives and irritants can be absorbed after causing the skin to breakdown

Poisoning and Overdoses • Injected- The most common is illicit drugs but can include snakes fangs and insects stingers

Poisoning and Overdoses Patient Assessment-Ingested Poisons – What was the substance? • Get exact name • Bring container – When did the exposure occur? – How much was ingested? • If not known, estimate possible amount

Poisoning / Overdoses – Over how long a period did the ingestion take place? • If not known, estimate shortest and longest possible times – What interventions taken? – What is the patients estimated weight? – Is the patient experiencing any effects from the ingestion?

Poisoning / Overdoses • Ingested Poisons – Signs and Symptoms • • Altered mental status Abdominal pain Chemical burns around mouth Unusual breath odor History of ingestion Nausea / Vomiting Diarrhea

Poisoning and Overdoses Treatment for Ingested Poisons – ABCs- Correct any life-threatening problems – Call Poison Center 1 -800 -POISON 1 – 1 -800 -764 -7661 – Follow directions given by poison control • Activated Charcoal – It is designed to absorb large amounts – Does not work on all poisons

Poisoning / Overdoses • Trade Names: Super. Char, Insta. Char, Liqui. Char

Activated Charcoal • Indications – Poisoning by mouth • Contraindications – Altered mental status – Ingestion of acid or alkali – Patient unable to swallow • Follow directions of Poison Control Center

Poisoning and Overdoses Treatment- (Cont. ) – Check head, neck, chest and abdomen – SAMPLE history – Baseline vital signs – Transport any containers or bottles from the substance – On-going assessment

Poisoning and Overdoses Pediatric Poisonings – Are frequent victims – Very important to have the weight of the patient – Always assume a lethal dose has been ingested

Poisons / Overdoses • Inhaled Poisons – General Signs and Symptoms • • • History of inhalation Difficulty speaking Chest pain Cough Hoarseness Dizziness Headache / Confusion Seizures Altered Mental Status

Poisoning and Overdoses Patient Assessment- Inhaled Poisons – What substance? – When did the exposure occur? – Over how long a period was the exposure? – Any interventions? – What effects have been noted?

Poisoning and Overdoses Treatment - Inhaled Poisons – ABCs- Correct any life-threatening problems – Call Poison Center 1 -800 -POISON 1 – 1 -800 -764 -7661 – Follow directions given by poison control ABCs- Correct any life-threatening

Poisoning and Overdoses • Treatment – Check head, neck, chest and abdomen – SAMPLE history – Baseline vital signs – On-going assessment

Poisoning and Overdoses • Inhaled Poisons – Carbon Monoxide • • Most common inhaled poison Vehicle exhaust and fire suppression Odor-less and color-less Signs & Symptoms – – – Headache Dizziness Dyspnea Cyanosis Altered Mental Status

Poisoning and Overdoses – Smoke Inhalation – S and S • Shortness of Breath – Coughing – Smoky breath odor – Carbon residue around mouth and nose – Black residue in sputum – Nose hairs signed

Poisoning and Overdoses • Absorbed Poisons – Signs and Symptoms • • History of exposure Liquid or powder on skin Burns Itching, irritation, redness

Poisoning and Overdoses Patient Assessment- Absorbed Poisons – What substance? – When did the exposure occur? – Over how long a period of time? – Any interventions? – What effects?

Poisoning and Overdoses • Care – Absorbed Poisons – Remove patient from source – Remove clothing or substance from the patient which might be contaminated – Brush powders from patient – Irrigate with water for at least 20 minutes – Initial Assessment – SAMPLE History

Poisoning and Overdoses • Care – Absorbed Poisons – Eye • Irrigate with clean water for at least 20 minutes or until EMS arrives

Poisoning and Overdoses • GENERAL SAFETY For Inhaled and/or Absorbed Poisons – Need to know wind direction and speed – Park Uphill and Upwind of the incident

Poisons / Overdoses • Relationship to Airway Management – When treating a poisoned or overdoses patient whose airway is patent, be prepared for deterioration and need to secure airway

Poisoning and Overdoses Alcohol Abuse (ETOH) – Can be a real problem to assess – May require police assistance – Patient often has multiple problems in addition to the abuse of alcohol

Poisoning and Overdoses Patient Assessment – Odor of alcohol on the patient’s breath – Swaying and unsteady gait – Slurred speech, rambling, incoherent words – Flushed appearance to the face – Poor coordination

Poisoning and Overdoses Patient Assessment – Slowed reaction time – Blurred vision – Confusion – Hallucinations – Blackouts – Altered LOC

Poisoning and Overdoses Signs & Symptoms of ETOH Withdrawal (DTs) – Confusion and restlessness – Unusual behavior – Hallucinations – Gross tremors – Profuse sweating – Seizures – Watch for vital signs changes ETOH abuser often mix with recreational drugs

Poisoning and Overdoses Patient Care for ETOH Abuse – Watch for respiratory problems – Watch for altered LOC – Vital signs – Treat for shock – Protect the patient from self-injury – Watch for seizures – Activate EMS

Poisoning and Overdoses • Do Not Assume That All Patients You Suspect Of ETOH Abuse Do Not Have Any Underlying Medical Condition – Many persons are arrested for DWI and later found to be a diabetic with low blood sugar • Do a good patient assessment

Poisoning and Overdoses Substance Abuse – Stimulants • Amphetamines, Uppers, Cocaine, Methamphetamine – Depressants • Barbiturates, Downers, Valium, Heroin, Morphine, Codeine, Inhalants, Alcohol – Psychedelics (Hallucinogens) • LSD, PCP, Mescaline, Cannabis

Poisoning and Overdoses Patient Assessment- Substance Abuse • Stimulants – Excitement, increased alertness, euphoria – Increased pulse and breathing – Restlessness, irritability, Insomnia – Rapid Speech – Dry mouth – Dilated Pupils – Decreased appetite

Poisoning and Overdoses Patient Assessment- Substance Abuse • Depressants – Relaxation, decreased awareness – Drowsiness – Slowing pulse and respirations – Impaired coordination – Slurred speech – Stupor, death

Poisoning and Overdoses Patient Assessment-Substance Abuse • Hallucinogens – Breakdown of Inhibitions – Alteration of perceptions (hallucinations) • Visual and Auditory - Bugs crawling on the wall – Increased appetite – Rapid Pulse, Dilated Pupils, Flushed Face – Tremors, Death

Poisoning and Overdoses Patient Care- Substance Abuse – Initial Assessment – Watch for airway problems – Treat for shock – Try to gain the patient’s confidence – Perform a rapid trauma assessment – Check for track marks

Poisoning and Overdoses Patient Care- Substance Abuse – Protect the patient from self-injury – Transport ASAP and contract medical control – On-going Assessment

Poisoning and Overdoses ALWAYS CLOSELY MOINTER SUBSTANCE ABUSE PATIENTS FOR CHANGES IN CONDITION AND FOR TENDENCY TO BECOME VIOLENT

Bites and Stings • Assessment – Signs and Symptoms – History of spider / snake bite / insect / scorpion / marine animal sting • • • Pain, redness, swelling Dizziness and chills Fever Nausea and vomiting Bite marks or stinger

Bites and Stings • Bites and Stings – Emergency Care • • Wash area gently Remove jewelry distal to affected area Position injection site slightly below heart Observe for allergic reaction

Snakes, Spiders, Scorpions • Review information from Tri 5 Phar/Tox • To review go to Basic Sciences, Pharmacology/Toxicology, Dr. Giggleman’s lecture notes on Spiders and Snakes.

Ticks • Tick Removal – Using forceps grasp tick at apex of thorax (toward the head) and apply gently backward pressure until the tick releases. Remove the tick. – Scrub area vigorously with soap and water – Watch for signs of infection

Marine Life Injuries

Marine Life Injuries • Specific Injuries - Stingray Envenomations – Rinse wound vigorously with fresh water – Immerse in nonscalding hot water to tolerance (110 -113 o. F or 43. 3 -45 o. C) for 3090 minutes to reduce pain. Repeat if pain recurs. – Remove any visible pieces of the stinger or sheath. Scrub with soap and water, irrigate vigorously with fresh water – Do not tape wound, watch for infection

Marine Life Injuries • Specific Injuries - Sea Urchin Punctures – Immerse punctured area in nonscalding hot water (same as for stingray injury) – Remove any visible pieces of the spine(s) – Purple or black discoloration of the skin does not necessarily mean that a spine is present – Scrub with soap and water – Do Not crush a spine in the skin – If a spine has penetrated into or near a joint it may need to be removed surgically

Marine Life Injuries • Specific Injuries - Jellyfish Stings (including manof-war, box-jelly, sea nettle, Irukandji, anemone, hydroid) – Immediately rinse skin in sea water (DO NOT rinse with fresh water. Do NOT apply ice. DO NOT rub the skin. ) – Apply soaks of acetic acid 5% (vinegar) until pain is relieved. If acetic acid is not available use isopropyl alcohol, dilute (1/4 strength) ammonia, a paste of baking soda, a paste of unseasoned meat tenderizer, or mashed papaya.

Marine Life Injuries • Specific Injuries - Jellyfish Stings • Do Not apply aftershave, liquor, or organic solvents such as kerosene, turpentine or gas – Remove large tentacle fragments using forceps – Reapply vinegar – Soap affected area in nonscalding hot water (same as for stingray sting)

Marine Life Injuries • Coral Cuts – Irrigate with cleanest water available – Scrub vigorously with soap and water – Flush wound with 1/2 strength solution of hydrogen peroxide in water – Use topical antibiotic if infection develops – Use anti-itch cream if itching develops

Marine Life Injuries • Scorpion Fish, Stone Fish, Lion Fish – Envenomations – Immerse in non-scalding hot water to tolerance (110 -113 o. F or 43. 3 -45 o. C) for 3090 minutes to reduce pain. Repeat if pain recurs. – Keep extremity lower than heart level – Avoid excessive movement – Seek medical attention

Marine Life Injuries • Bites – Control bleeding and attend to other lifethreatening problems – Treat as you would any open soft tissue injury. – Seek medical attention as indicated.