Substance Abuse and Poisoning

Goals for the Chapter Physiology: How a substance moves through the body 4 Routes of Absorption Terms: o Substance Abuse o Withdrawal o Poison o Toxin Commonly Encountered Substances Signs and Symptoms Proper Care and Protocol

Definitions Substance Abuse: Intentional misuse of a substance that results in significant impairment. Withdrawal: Physical impairment that occurs when the substance is absent Poison: Substance that causes harmful effects when introduced in to the body Toxin: Poison that comes from an organism

Physiology Absorption o absorption, distribution, metabolism, elimination Distribution o Single Organ system or entire body o Once a substance is in the blood stream it will circulate rapidly. Metabolism o Break-down substances o Liver is primary site of metabolism Elimination o Purging of substance o Urine, GI tract, lungs, skin

Methods of Absorption 1.Ingestion o Intake of a substance through the mouth o Absorption through the GI tract 2.Inhalation o Absorption through the Lungs o Rich vascular network o Easily damaged 3.Transdermal o Absorption through the Skin o Largest body system 4.Injection o Needles or other sharp objects o Rapid absorption o Stinger from bee or scorpion

Distribution Distribution: transportation to site where substance has effect o Isolated effect OR o Systemic: entire body Body Systems commonly effected o Nervous system Central Nervous System: brain and spinal cord Peripheral Nervous System: nerves o Heart o Eyes o Blood Body systems may have extra barrier to distribution o Blood-brain barrier: separates circulating blood from brain extracellular fluid (BECF)

Metabolism and Elimination Metabolism: o Body breaks down substance o liver damage  metabolism takes longer Elimination: o Urine, GI tract, lungs, and/or skin (sweat) o Anything that impairs proper function of these organ systems means substance is in the body longer

Commonly Encountered Substances Recreational Drugs: Alcohol o Slows brain function, sensory input, and motor coordination o Lowers inhibition o Diuretic (may cause dehydration) Marijuana o Most commonly used (illegalish) drug o Distorts perception o Affects thinking, memory, and learning Designer Drugs (club drugs) o Drug constructed by a chemist to produce unique and specific effects Hallucinogens o Distort sensory perceptions, loss of judgment o LSD, PCP

Commonly Encountered Substances Medicine: OTCs o OTCs are accessible o Acetaminophen= Tylenol, Aspirin=acetylsalicylic acid, Benadryl=diphenhydramine Prescription Drugs o Antianxiety, antidepressants, antipsychotics o Overdose is often accidental– effective dose close to toxic dose “Polypharmacy” or “cocktails” can be very dangerous ___________________________________________________ Not meant for consumption: Acids & Bases o Commonly used in household products o Can cause direct tissue damage Inhalants o Chemical vapors from household products Carbon Monoxide “The Silent Killer” o Odorless, colorless, tasteless o Impairs oxygenation of tissues o By product of combustion o Consider Ventilation

Assessment Assess the scene o Pay Attention to potential Hazards o If necessary, request assistance Fire department HazMat team Law Enforcement o Evidence of substance or poison? Special attention to ABCDs LOR based on AVPU scale SAMPLE with paying attention to misuse of substances: what/dosage o WebMD pill identification tool Collect all items (as long as your not endangering yourself) Nausea and vomiting likely

Management o Personal Safety is Paramount o High Flow Oxygen In General, 1.Reduce further exposure Dilute ingested poisons with water Do NOT provide water if: o Nausea/vomiting (NEVER induce vomiting) o Low LOR/ potential for low LOR Remove transdermal irritants (remember PPE) Inhaled poisons – remove from source 2.Reduce absorption Activated Charcoal Ingestion if effective in decreasing absorption o must be authorized 3.Rapidly transport to a definitive-care facility At the bowl: MVAA (ambulance) National Capital Poison Center: