1. Copyright © 2004, Mosby Inc. All rights reserved.

2. Poisoning and Overdoses Chapter 21 Copyright © 2004, Mosby Inc. All rights reserved. Slide 1

3. Case History You are dispatched to a poisoning and find a 5-year-old girl who is suspected of having ingested a large quantity of acetaminophen (Tylenol) tablets. The mother shows you an empty bottle, but the child appears perfectly normal and has normal vital signs. The child is alert and oriented. You are dispatched to a poisoning and find a 5-year-old girl who is suspected of having ingested a large quantity of acetaminophen (Tylenol) tablets. The mother shows you an empty bottle, but the child appears perfectly normal and has normal vital signs. The child is alert and oriented. Copyright © 2004, Mosby Inc. All rights reserved. Slide 2

4. Introduction Poison Poison  A substance that usually kills, injures, or impairs an organism through its chemical action Overdose Overdose  Drugs, taken in excess or in combination with other agents, to the point where poisoning occurs Copyright © 2004, Mosby Inc. All rights reserved. Slide 3

5. Incidence More than 5 million poisonings occur each year in U.S. More than 5 million poisonings occur each year in U.S.  Most occur in children <5 years of age. Poisonings cause more than 10,000 deaths. Poisonings cause more than 10,000 deaths. Other causes Other causes  Drug abuse  Suicide  Animal or insect bites Copyright © 2004, Mosby Inc. All rights reserved. Slide 4

6. Poison Control Centers Provide access to experts in toxicology. Provide access to experts in toxicology. Staffed 24 hours a day. Staffed 24 hours a day. Coordinate emergency response Coordinate emergency response  Provide advice to patients at home  Refer people to area hospitals with poisoning care capabilities  Advise EMTs, physicians, and nurses Copyright © 2004, Mosby Inc. All rights reserved. Slide 5

7. Types of Poisonings Ingested Ingested Injected Injected Inhaled Inhaled Absorbed Absorbed Copyright © 2004, Mosby Inc. All rights reserved. Slide 6

8. Cardinal Rules Treat the patient, not poison. Treat the patient, not poison. Protect self and bystanders. Protect self and bystanders. Look for clues of trauma. Look for clues of trauma. Maintain a high level of suspicion. Maintain a high level of suspicion. Copyright © 2004, Mosby Inc. All rights reserved. Slide 7

9. Scene Size-up Survey the scene to protect yourself and bystanders. Survey the scene to protect yourself and bystanders. Dangers Dangers  Toxic gases  Absorbed toxins Do not enter without adequate protection. Do not enter without adequate protection.  Only trained hazmat rescuers should enter. Copyright © 2004, Mosby Inc. All rights reserved. Slide 8

10. Initial Assessment What is your general impression? What is your general impression? Findings indicate any trauma? Findings indicate any trauma? Is the patient awake and responsive? Is the patient awake and responsive? Airway, Breathing, Circulation Airway, Breathing, Circulation Copyright © 2004, Mosby Inc. All rights reserved. Slide 9

11. Focused History What is the poison? What is the poison? How was it taken? How was it taken?  Was it ingested, inhaled, absorbed, or injected? When was it taken? When was it taken? How much was taken? How much was taken? Over what period of time? Over what period of time? Copyright © 2004, Mosby Inc. All rights reserved. Slide 10

12. Focused History Is there any other evidence at the scene (e.g., commercial products, pills)? Is there any other evidence at the scene (e.g., commercial products, pills)? Were any other interventions attempted? Were any other interventions attempted?  Vomiting  Dilution  Activated charcoal  Syrup of ipecac  Antidote How much does the patient weigh? How much does the patient weigh? Copyright © 2004, Mosby Inc. All rights reserved. Slide 11

13. Perform a Focused Physical Examination Skin Skin Pupils Pupils Breath sounds Breath sounds Abdomen Abdomen Mental status Mental status Vital signs Vital signs Copyright © 2004, Mosby Inc. All rights reserved. Slide 12

14. Emergency Medical Care Remove patient from poisonous environment. Remove patient from poisonous environment. Ensure patent airway and administer oxygen. Ensure patent airway and administer oxygen. Be alert for vomiting. Be alert for vomiting. Bring all poison agents to hospital. Bring all poison agents to hospital.  Containers  Bottles  Labels Copyright © 2004, Mosby Inc. All rights reserved. Slide 13

15. Ingested Poisons – Signs and Symptoms History of ingestion History of ingestion Nausea Nausea Vomiting Vomiting Diarrhea Diarrhea Copyright © 2004, Mosby Inc. All rights reserved. Slide 14

16. Ingested Poisons – Signs and Symptoms Altered mental status Altered mental status Abdominal pain Abdominal pain Chemical burns around the mouth Chemical burns around the mouth Different breath odors Different breath odors Copyright © 2004, Mosby Inc. All rights reserved. Slide 15

17. Odors SmellPossible Poison Acetone (sweet, fruity)Ethanol, isopropyl alcohol, diabetic AlcoholAlcohol, isopropyl alcohol DisinfectantsCreosol and phenol Rotten eggsHydrogen sulfide GarlicInsecticides Stale tobaccoNicotine WintergreenMethyl salicylate Copyright © 2004, Mosby Inc. All rights reserved. Slide 16

18. Emergency Medical Care Remove poison from patient’s mouth using gloves. Remove poison from patient’s mouth using gloves. Consult medical direction. Consult medical direction.  Activated charcoal Bring all containers (bottles, labels, etc.,) to hospital. Bring all containers (bottles, labels, etc.,) to hospital. Copyright © 2004, Mosby Inc. All rights reserved. Slide 17

19. Types of Ingestions Sedative-hypnotics Sedative-hypnotics Antianxiety agents Antianxiety agents Opioids Opioids Psychiatric medications Psychiatric medications Stimulants Stimulants Copyright © 2004, Mosby Inc. All rights reserved. Slide 18

20. Types of Ingestions – Sedative-Hypnotics Barbiturates Barbiturates  Secobarbital (Seconal)  Pentobarbital (Nembutal) Benzodiazepines Benzodiazepines  Diazepam (Valium)  Chlordiazepoxide (Librium)  Chlorazepate (Tranxene) Copyright © 2004, Mosby Inc. All rights reserved. Slide 19

21. Types of Ingestions – Sedative-Hypnotics Others Others  Methaqualone (Quaalude)  Ethchlorvynol (Placidyl)  Chloral hydrate (Noctec)  Mebrobamate (Miltown) Copyright © 2004, Mosby Inc. All rights reserved. Slide 20

22. Toxic Effects – Sedative-Hypnotics Altered mental status Altered mental status Respiratory depression and arrest Respiratory depression and arrest Most toxic when combined with alcohol Most toxic when combined with alcohol Support of ABCs is critical. Support of ABCs is critical. Copyright © 2004, Mosby Inc. All rights reserved. Slide 21

23. Types of Ingestions Opioids (Narcotics) Central nervous system depressant Central nervous system depressant  Examples »Heroin »Morphine »Percocet »Percodan Copyright © 2004, Mosby Inc. All rights reserved. Slide 22

24. Toxic Effects/Management – Opioids (Narcotics) Toxic effects and signs and symptoms Toxic effects and signs and symptoms  Altered (depressed) mental status  Respiratory depression  Pinpoint pupils  Track marks Management Management  Support ABCs  Administration of naloxone (Narcan) by ALS providers or hospital Copyright © 2004, Mosby Inc. All rights reserved. Slide 23

25. Ingested Substances Stimulants Stimulants  Cause increased excitability (e.g., amphetamines) Alcohol Alcohol Heart and lung drugs Heart and lung drugs Analgesics Analgesics Copyright © 2004, Mosby Inc. All rights reserved. Slide 24

26. Inhaled Poisons – Signs and Symptoms History of inhalation of toxic substance History of inhalation of toxic substance Difficulty breathing Difficulty breathing Chest pain Chest pain Cough Cough Hoarseness Hoarseness Dizziness Headache Confusion Seizures Altered mental status Copyright © 2004, Mosby Inc. All rights reserved. Slide 25

27. Poisonous Gases Simple asphyxiants Simple asphyxiants Carbon dioxide Carbon dioxide Small hydrocarbon molecules Small hydrocarbon molecules Chemical asphyxiants Chemical asphyxiants Irritant gases Irritant gases Organophosphates Organophosphates Copyright © 2004, Mosby Inc. All rights reserved. Slide 26

28. Toxic Injection – Signs and Symptoms Weakness Weakness Dizziness Dizziness Chills Chills Fever Fever Nausea Nausea Vomiting Vomiting Copyright © 2004, Mosby Inc. All rights reserved. Slide 27

29. Absorbed Poisons – Signs and Symptoms History of exposure History of exposure Liquid or powder on patient’s skin Liquid or powder on patient’s skin Burns Burns Itching Itching Irritation Irritation Redness Redness Copyright © 2004, Mosby Inc. All rights reserved. Slide 28

30. Emergency Medical Care Skin Skin  Remove contaminated clothing.  Protect self from contamination. Powder Powder  Brush powder off patient.  Irrigate for at least 20 minutes.  Continue en route to facility, if possible. Liquid Liquid  Irrigate for at least 20 minutes.  Continue en route to facility, if possible. Copyright © 2004, Mosby Inc. All rights reserved. Slide 29

31. Medication Name Generic Generic  Activated charcoal Trade Trade  SuperChar™  InstaChar™  Actidose™  LiquiChar™ Copyright © 2004, Mosby Inc. All rights reserved. Slide 30

32. Activated Charcoal Indications Indications  Poisoning by mouth Contraindications Contraindications  Altered mental status  Ingestion of acids or alkalis  Inability to swallow Copyright © 2004, Mosby Inc. All rights reserved. Slide 31

33. Medication Form Medication is pre-mixed in water. Medication is pre-mixed in water.  Plastic bottle containing 125 grams activated charcoal Powder should be avoided in field. Powder should be avoided in field. Copyright © 2004, Mosby Inc. All rights reserved. Slide 32

34. Dosage Adults and children Adults and children  1 gram activated charcoal/kg of body weight Usual adult dose Usual adult dose  25 - 50 grams Usual infant/child dose Usual infant/child dose  12.5 - 25 grams Copyright © 2004, Mosby Inc. All rights reserved. Slide 33

35. Actions Charcoal binds to certain poisons. Charcoal binds to certain poisons. Binding action prevents absorption. Binding action prevents absorption. Not all brands are the same. Not all brands are the same.  Some bind much more poison  Consult medical direction about the brand to use. Copyright © 2004, Mosby Inc. All rights reserved. Slide 34

36. Side Effects Black stool Black stool Some patients may vomit. Some patients may vomit.  If the patient vomits, repeat dose one time. Reassessment strategies Reassessment strategies  Prepare for vomiting and deterioration of patient’s condition. Copyright © 2004, Mosby Inc. All rights reserved. Slide 35