1. Adapted From Temple College EMS Professions

2. Poisons  Substance which when introduced into body in relatively small amounts causes in structural damage or functional disturbances

3. Suspect with:  GI signs/symptoms (nausea, vomiting, diarrhea, pain)  Altered LOC, seizures, unusual behavior  Pupil changes, salivation, sweating, other signs/symptoms of disturbed autonomic nervous system function  Respiratory depression  Burns, blisters of lips, mucous membranes  Unusual breath odors

4. Treat Patient, Not Poison  Proper support of ABCs is first step in management  Contact with Poison Control Center  Priority action plan  Symptomatic treatments  Time management

5. Try to determine:  What?  How much?  How long ago?  What has already been done?  Psychiatric history?  Underlying illness?

6. When in doubt...  Assume containers were full  Entire contents were ingested  Patient may not be telling you the truth

7. If several patients involved...  Assume each ingested entire container contents  Triage  Additional resources

8. Always...  Bring sample of material if possible  Save for analysis, if patient vomits

9. Poisoning Management  Based on route of entry Ingested Absorbed Inhaled Injected

10. Ingested Poisons  Prevent absorption of toxin from GI tract into bloodstream Positioning Rapid Transport to definitive treatment center

11. Absorbed Poisons  Dry chemicals dust skin, then wash  Liquid chemicals wash with large amounts of H 2 0 avoid “neutralizing” agents CAUTION Don’t accidentally expose yourself!

12. Inhaled Poisons  Remove patient from exposure  Maximize oxygenation, ventilation CAUTION Don’t accidentally expose yourself!

13. Injected Poisons  Attempt to slow absorption v Venous constricting bands v Dependent position v Splinting of injected body part v Cold packs (+) [May worsen local injury by concentrating poison]

15. Substance Abuse  Self administration of a substance in a manner not in accord with approved medical or social practices

16. Substance Abuse  Psychological dependence  Physical dependence  Compulsive drug use  Tolerance  Addiction

17. Psychological Dependence  Habituation  Substance needed to support user’s sense of well-being

18. Physical Dependence  Substance must be present in body to avoid physical symptoms (withdrawal)

19. Compulsive Drug Use  Use of drug and rituals/culture associated with its use become an overwhelming desire

20. Tolerance  Increasing amounts of drug needed to produce same effects  Tolerance contributes to addiction by keeping user “chasing the last high”

21. Addiction  Combination of psychological dependence, physical dependence, compulsive use, and tolerance  Patient becomes totally consumed with obtaining, using drug to exclusion of all other things

23. Ethyl Alcohol A CNS Depressant Drug

24. Ethanol Intoxication Signs  Breath odor  Swaying, unsteadiness  Slurred speech  Nausea, vomiting  Flushed face  Drowsiness  Violent, erratic behavior

25. Ethanol  Clouds signs, symptoms  Complicates assessment  Head trauma, diabetes, drug toxicity, CNS infection can mimic EtOH intoxication and vice versa

26. Patient is NEVER “just drunk” until all other possibilities are excluded

27.  Experience alcohol withdrawal syndrome if they reduce intake:  Restlessness, tremulousness  Hallucinations  Seizures  Delirium tremens--all of above plus tachycardia, nausea, vomiting, hypertension, elevated body temperature Alcohol Addicts

28.  Life threatening condition!  Occurs 1 days to 2 weeks after intake is decreased  5 to 15% mortality  Control airway, prevent aspiration, monitor for hypovolemia Delirium Tremens

29. Narcotics  Opium  Opium derivatives  Synthetic compounds that produce opium- like effects

30. Narcotics  Opium  Heroin  Morphine  Demerol  Dilaudid v Percodan v Codeine v Darvon v Talwin

31. Narcotics  Medical Uses analgesics anti-diarrheal agents cough suppressants

32. Narcotics  Overdose v Coma v Respiratory depression v Constricted (pin-point) pupils

33. Narcotics  Withdrawal Agitation Anxiety Abdominal pain Dilated pupils –Sweating –Chills –Joint pains –Goose flesh Resembles severe influenza Not a life-threat

34.  Nembutal  Seconal  Pentobarbital  Amytal  Tuinal  Phenobarbital Barbiturates

35.  Induce sleepiness, state similar to EtOH intoxication  Medical uses Anesthetics Sedative Hypnotics Barbiturates

36.  Overdose Coma Respiratory depression Shock  Extremely dangerous in combination with EtOH

37. Barbiturates  Withdrawal Resembles EtOH withdrawal (DTs) Extremely dangerous

38. Barbiturate-like Non-barbiturates  Doriden, Placidyl, Quaalude, Methyprylon  Effects similar to barbiturates  Overdose can cause sudden, very prolonged respiratory arrest  Withdrawal resembles ETOH; extremely dangerous

39.  Valium, Librium, Miltown, Equanil, Tranxene  Low doses relieve anxiety, produce muscle relaxation  High doses produce barbiturate-like effects Tranquilizers

40.  Overdose: v Unlikely to cause respiratory arrest alone v Extremely dangerous with EtOH  Withdrawal Resembles EtOH withdrawal Extremely dangerous Tranquilizers

41. CNS Stimulants: Amphetamines  Dexedrine, Benzedrine, Methyl amphetamine  Relieve fatigue, promote euphoria, reduce appetite

42. CNS Stimulants: Amphetamines  Overdose Restlessness, paranoia Tachycardia Hypertension CVA, Heart failure Hyperthermia Heat stroke  Withdrawal Lethargy Depression

43.  Stronger stimulant effects than amphetamines  Can cause respiratory/cardiovascular failure, heat stroke, lethal arrhythmias CNS Stimulants: Cocaine

44.  “Snorting” can destroy nasal septum, cause massive nosebleed  Airway issue  Withdrawal: lethargy depression CNS Stimulants: Cocaine

45.  LSD, psilocybin, peyote, mescaline, DMT, MDMA  Enhance perception  Wrong setting may induce “bad trips” with extreme anxiety  True toxic overdose rare Hallucinogens

46. Phencyclidine  PCP, angel dust  Produces bizarre, violent behavior  Reduces pain sensation  Patients may be capable of feats of extreme strength  Keep patient in quiet environment, minimize stimulatin

47.  Glue, paint, gas, light fluid, toluene  Inhalation produces state similar to EtOH intoxication  Patient may asphyxiate if consciousness lost while “sniffing” Solvents

48.  Increase risk of arrhythmias  May cause liver damage, bone marrow depression  Chronic abuse causes CNS damage - paranoia, violent behavior Solvents