1. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter 12 Substance Abuse and Poisoning

2. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 12.1 List and describe the four ways a drug enters and moves through the body. 12.2 List the four routes of absorption. 12.3 Define the following terms: a.poison b.substance c.substance abuse d.toxin continued

3. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 12.4 List and describe three commonly abused substances. 12.5 List the signs and symptoms associated with commonly abused substances and with common poisonings. 12.6 Describe and demonstrate the proper care of a patient who has abused a substance or been poisoned. continued

4. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 12.7 List and describe two emergency sources for poison-related or chemical- related information.

5. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Topics Anatomy and Physiology Commonly Abused Substances and Poison Related Emergencies Assessment Management Chapter Summary

6. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Presentation You are doing some pre-season scouting in mountainous terrain and you notice an unkempt middle-aged man coming down the trail toward you. He is stumbling as he walks, has slurred speech and seems quite agitated.

7. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology Physiologic actions ◦ Absorption: the way the substance or poison enters the body. Ingestion – through gastrointestinal tract. Inhalation – through lung tissue. Transdermal absorption – through the skin. Injection – through placement of substance in or near bloodstream. continued

8. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology Physiologic actions ◦ Distribution: transport of substance to site where it will exert its effects. ◦ Metabolism: body breaks down the substance. ◦ Elimination: body purges itself of substance. continued

9. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology Affected body systems ◦ Nervous system: can affect central or peripheral nervous system; can be localized or general. ◦ Myocardial: can affect heart muscle – increase or decrease in contractility, change heart rate or conduction system. continued

10. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology Affected body systems ◦ Ocular: can affect pupillary dilation or constriction or muscles that coordinate eye movement. ◦ Hematological: can affect blood’s ability to clot or carry O 2, can destroy red cells, can inhibit or destroy bone marrow production of red cells.

11. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Commonly Abused Substances and Poison-Related Emergencies Substance abuse ◦ Intentional misuse resulting in impairment or distress continued

12. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Commonly Abused Substances and Poison-Related Emergencies Categories: ◦ Acids or bases – common in household and industrial cleaning solutions; can cause direct tissue damage. ◦ Antianxiety drugs (sedatives) – common use for excessive emotion, panic or social disorders; central nervous system depressant. continued

13. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Commonly Abused Substances and Poison-Related Emergencies continued

14. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Commonly Abused Substances and Poison-Related Emergencies Categories: ◦ Antidepressants – used to treat depression, anxiety and panic. ◦ Antipsychotics (tranquilizers) – used to treat psychosis; affects BP and heart. ◦ Depressants – used to decrease central nervous system activity; can cause respiratory depression and death. continued

15. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Commonly Abused Substances and Poison-Related Emergencies Categories: ◦ Designer drugs – impair brain function; can cause seizures and coma; combined with alcohol, causes sedation & amnesia. ◦ Hallucinogens – distort sensory perception and impair emotion, judgment and memory. continued

16. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Commonly Abused Substances and Poison-Related Emergencies Categories: ◦ Inhalants – chemical vapors from household products; mind-altering effects similar to alcohol use, loss of sensation, unresponsiveness, shock and death. ◦ Nerve agents – chemicals used in warfare and terrorism; interrupt nerve impulses; absorbed through lungs or skin. continued

17. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Commonly Abused Substances and Poison-Related Emergencies Categories: ◦ Opiates (narcotics) – affect central nervous system, relieve pain, and can affect mood, emotion and wakefulness; can cause respiratory depression and death. ◦ Organophosphate – affect similar to nerve agents; found in insecticides, pesticides and herbicides. continued

18. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Commonly Abused Substances and Poison-Related Emergencies Categories: ◦ Stimulants – increase central nervous system activity resulting in increased heart rate, BP, metabolism, excitement, agitation, erratic or dangerous behavior. ◦ Prescription drugs – ordered by a physician and increasingly misused; overdose often accidental when therapeutic dose close to toxic dose. continued

19. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Commonly Abused Substances and Poison-Related Emergencies Common Substances Encountered ◦ Acetaminophen (Tylenol) Ccommonly combined with other drugs and results in poisoning, causing irreversible liver damage. ◦ Alcohol Most commonly abused drug in the world, causing accidents, injuries and death; inhibits central nervous system function, affecting judgment, motor coordination, respiratory rate and depth. continued

20. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Commonly Abused Substances and Poison-Related Emergencies Common Substances Encountered ◦ Aspirin (acetylsalicylic acid) Common ingredient; can cause respiratory depression, acidosis and death. ◦ Carbon monoxide (CO) Odorless, colorless, tasteless gas is byproduct of incomplete combustion; displaces O2 carrying ability of red cells. continued

21. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Commonly Abused Substances and Poison-Related Emergencies Common Substances Encountered ◦ Cocaine (coke, crack, snow, rock, nose candy) Addictive stimulant of nervous and cardiovascular systems. ◦ Ethylene glycol Found in household and automotive products (antifreeze); can cause organ damage, shock and death. continued

22. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Commonly Abused Substances and Poison-Related Emergencies Common Substances Encountered ◦ Iron supplements Found in a variety of supplements; can cause liver and kidney failure and death. ◦ LSD (lysergic-diethylamide, acid) Causes mood-changes, delusions and visual hallucinations; increase in heart rate, BP and temperature, sleeplessness. continued

23. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Commonly Abused Substances and Poison-Related Emergencies Common Substances Encountered ◦ Marijuana (pot, weed, cannabis, THC, hashish) Most commonly used illegal drug in U.S.; affects perceptions, thinking, memory and learning; smoked/ingested. ◦ Methamphetamine (Speed, Meth) Addictive stimulant; heightened arousal and physical activity, decrease appetite; chronic use may lead to psychotic behavior, hallucinations and stroke. continued

24. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Commonly Abused Substances and Poison-Related Emergencies Common Substances Encountered ◦ Methane Highly flammable gas that displaces O2 in closed areas, leads to hypoxia. ◦ PCP (phencyclidine, angel dust) Veterinary tranquilizer; mixed with other drugs such as marijuana; overdose may cause violent or suicidal behavior or lead to serious traumatic injury. continued

25. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Commonly Abused Substances and Poison-Related Emergencies Common Substances Encountered ◦ Toxic plants Most commonly affects children, foragers, herbalists, pleasure seekers and suicidal patients. continued

26. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Update Patient appears confused. Responding to basic questions, you find he is oriented to his name and situation only. He has been camping for 2 days and consumed 2 fifths of whiskey, but none in last 10 hours. He denies injury or medical history. You find pupils dilated, warm skin, rapid pulse, shaky hands and unsteady on feet.

27. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment Scene size-up: assess hazards. Primary assessment: ABCDs, AVPU, GCS, reassess frequently. Secondary assessment: SAMPLE, Vital Signs,look for signs (containers, pill bottles, paraphernalia) at the scene, collect all signs, avoid contamination of self, determine quantity/time, physical exam.

28. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Summon assistance as needed, i.e. fire department, law enforcement, HAZMAT. Reduce substance exposure. ◦ Only dilute ingested poisons IF: Instructed to do so by your medical director or poison control center, and No contraindication to do so, i.e. Nausea/vomiting Depressed level of responsiveness ◦ NEVER induce vomiting in the field continued

29. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management For topical poisons, brush off dry particles and rinse away any remaining with water. For liquid poisons, thoroughly rinse with water. For ocular exposure, immediately irrigate with sterile water or irrigation solutions. continued

30. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management For inhaled poisons, immediately remove patient from source of poisoning. Maintain airway, high-flow O 2, consider ALS transport. continued

31. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management continued

32. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management continued

33. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management continued Copyright Edward McNamara

34. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management continued Copyright Edward McNamara

35. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Reduce substance absorption with activated charcoal IF: ◦ Authorized by your medical advisor, local or state EMS authority to administer. ◦ Poison was ingested < 60 minutes ago. ◦ Patient is awake and responsive. ◦ Transport time is prolonged. continued

36. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Arrange rapid transport to definitive care facility. Help is only a phone call away: ◦ National Poison Center (24/7 service) 1-800-222-1222 ◦ Chemical Transportation Emergency Center (CHEMTREC) 1-800-262-8200

37. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Disposition You suspect the patient is exhibiting signs of alcohol withdrawal. You make the patient comfortable and administer high-flow O 2. You arrange evacuation by rescue team. You calm the patient. Later, you hear that the patient had a seizure on the way to hospital but made a full recovery, entering rehabilitation.

38. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Personal safety is always first. Alcohol is the most abused drug. Carbon monoxide is a silent killer. Antidotes exist for many types of drugs Three most deadly for children – aspirin, acetaminophen and iron. continued

39. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Always try to identify the poison. National Poison Control: 1-800-222- 1222