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-POISON1 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: SuperChar, InstaChar, LiquiChar

Activated Charcoal Indications Contraindications 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-POISON1 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 (110-113oF or 43.3-45oC) for 30-90 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 man-of-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 (110-113oF or 43.3-45oC) for 30-90 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 life-threatening problems Treat as you would any open soft tissue injury. Seek medical attention as indicated.