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129 Cards in this Set
- Front
- Back
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The term poisoning usually refers to ____, while the term overdose refers to ____,
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Poisoning- Nonpharmacological substances
Overdose-pharmacological substances p1350 |
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Cyanide
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Found in rodenticides, silver polish, fruit pits, fires, burning plastic bags, silks, synthetic carpets. (extremely fast acting)
|
|
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The American Assoc. of Poison Control Centers estimates more than ___ million poisonings occur annually
|
4 million
p1351 |
|
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Cyanide S/S
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Burning sensationin mouth and throat
headache, cofusion, combative, HTN, Tahcy followed by Hypotension and dysrythmias, seizures, coma, pulmonary edema |
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|
___% of all ER visits and EMS response involve toxic exposures
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10%
p1351 |
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Cyanide Tx:
|
PPE
remove pt from area initiate supportive care cyanide kit |
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____% of accidental poisonings occur in children under 6 years old
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70%
p1351 |
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Cyanide kit
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It converts some hemoglobin into methemoglobin which cyanide binds to, then it's broken down to thiocyanate that is excreted renally.
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A child who has experienced an accidental ingestion has a __% chance of another, similar ingestion w/in 1 year
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25%
p1351 |
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CO poisoning
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Oderless and tasteless gas from the product of incomplete combustion. Causes effective hypoxia
|
|
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__% of all attempted suicides involve drug overdose
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80%
p1351 |
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CO poisoning S/S
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Early Signs are simular to the flu
Headache, n/v , confusion/AMS, tachy breathing |
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More than half of all poisonings occur in children ages 1-5, accounting for __% hospital admissions and __% fatalities
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10%
5% p1351 |
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CO poisoning Tx
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Definitive tx is hyperbarric chamber for high level of O2 therepy
PPE, remove pt, vent area, supportive care, high flow O2 |
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Adult poisonings account for __% hospital admissions and ___% fatalities
|
90%
95% p1351 |
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Cardiac Med
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Overdoses of these drugs are usually errors in dosages
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Name the 4 types of toxic exposure
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*Ingestion
*Inhalation *Surface absorption *Injection p1352 |
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Cardiac Med S/S
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N/V, headache, dizziness, confusion, profound hypotension, dysrythmias, heart blocks, bronchospasm, pulmonary edema
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Name the most common route of entry for toxic exposure
|
Ingestion
p1352 |
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Cardiac Med Tx
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Standard toxocology assessment
Severe bradycardia may not respond to atropine ABC's Contact med control for assist. |
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___ of a poison results in rapid absorption of the toxic agent through the alveolar-capillary membrane in the lungs.
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Inhalation
p1352 |
|
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Caustic Substances (acids)
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Ph less than 2 found in plumbing liquids and bathroom cleaners produces immediate severe pain due to tissue coagulation and necrosis. Contact injury will produce Eschar which will act like a shield and prevent further damage. Ingestion will cause local burns aroun the mouth and throat the stomach lining will be injured
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|
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This type of exosure occurs with contact of poisonous plants and toxic chemicals like organophosphates
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Surface absorption
p1352 |
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Caustic Substances (alkalines)
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Ph greater than 12.5 can be solid or liquid form like drano or liquid plumber. These agents cause injury by inducing liquefafcation necrosis, pain is delayed which allows for longer tissue contact and deeper tissue injury before exposure is recognized. Solid agents stick to the oropharynx or esophagus causing perferations, bleeding inflammation of the central chest structures. 2-3 days of exposure there is a loss of protective mucosal tissue.
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|
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This type of exposure results in both immediate and delayed effects, and is often entered under the skin, into the muscle, or into the blood vessel
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Injection
p1353 |
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Caustic Substances S/S
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Facial burns
pain in lips, tongue, thraot, gums, drooling trouble swallowing, hoarsness, stridor, SOB, vomiting, shock |
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|
Standard Toxicological Emergency Procedures
|
*Recognize a poisoning promptly
*Assess the pt thoroughly to identify the toxin and measures required to control it *Initiate standard treatment procedures (protect rescuer, remove pt from environment, ABC's, Decon, Administer antidote is exists) p1353 |
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Caustic Substances Tx
|
PPE
Toxocology emergency standards Airway managment ( might have to cric) Rapid transport |
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It is important to find out not only what the toxin the pt was exposed to but _____
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when the exposure took place
p1353 |
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|
Hydrofluoric Acid
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Extremely toxic can be lethal despite the apperence of only moderate burns, it penetrates into tissues and is inactivated only when it contacts cations like calcium. It settles in the tissues as salt and removes calcium from the cells causing a disruption of cell function, even causes bone destruction, by pulling calcium from the bones. (death has been reported in exposures of less than 2.5 % BSA)
|
|
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Name the 3 principles of decontamination
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*Reduce intake of toxin(remove from environment)
*Reduce absorption of toxin once in the body(syrup of ipecac, gastric lavage, activated charcoal) *Enhance elimination of toxin(increases gastric motility, whole bowel irrigation) p1354 |
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Hydrofluoric Acid S/S
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Burning at site of contact
Trouble breathing Confusion Palpatations Muscle Cramps |
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True or False
There are many antidotes available and will usually be 100% effective. |
False
There are not many antidotes and are rarely 100% effective p1355 |
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Hydroflouric Acid Tx
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PPE
Supportive care Remove exposed clothing Irrigate Immerse limbs in iced water and Mag Sulfate Transport immediatly |
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If you leave a suicidal pt who claims to be "just kidding", you could later be charged with___
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Patient abandonment
p1355 |
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Hydrocarbons
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Organic compounds, common names kerosene, naptha, turpentine, mineral oil, chloroform, paint , glue, lubricants, solvents. Routes include ingestion, inhalation, surface absorbtion
|
|
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The most common route of poisoning you will encounter in prehospital care is
|
Ingestion
p1356 |
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Hydrocarbons S/S
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Burns due to local contact, wheezing, dyspnea, hypoxia, headache, dizziness, slurred speech, ataxia, dulled reflexes, foot and wrist drop with numbness and tingling, dysrythias
|
|
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For ingested toxins, begin your history by trying to find out the __ of toxin ingested, ___ of the toxin, ___ elapsed since ingestion.
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Type
Quantity Time p1355 |
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Hydrocarbons tx
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Few poisonings are serious. If you know the exact chemical and pt is asymptomatic med control mayy aloow a refusal. If symptomatic supportive care utlize med control for assist. Activated Charcol will not bind with toxin. Gastric Lavage may be used
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|
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The physical examination of ingested toxins has 2 purposes
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1-to provide physical evidence of intoxication
2-to find any underlying illnesses that may account for the pts symptoms p1356 |
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Tricyclic Antidepressents
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Used for chronic pain or migranes, not so much for depression anymore. More deaths are from overdoses. Common agents: Elavil, Amoxopine, Doxepin, Imipramine, Nortriptyline
|
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Name the 6 different pt features that you want to pay attention to during your physical exam of ingested toxins
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1-skin
2-eyes 3-mouth 4-chest 5-circulation 6-abdomen p1356 |
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Tricyclic Antidepressents S/S
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Dry mouth, blurred vision, urinary retention, constipation
LATE SIGNS: Confusion, Hyperthermia, Resp. depression, Seizures, Tachy with Hypotension, Dysrythmias |
|
|
Ingested Poisons
Management |
*Top priority- Maintain ABC's
*Major objective- prevent aspiration RSI may be required, high-flow O2, IV TKO, cardiac monitor, *DO NOT GIVE COMA COCKTAIL (D50, naloxone, thiamine), instead treat what you find p1357 |
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Tricyclic Antidepressents Tx
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Immediate toxicology Standard
Cardiac monitoring, if suspected overdose with benzo's do not use flumazanil, Use Bicarb, contact med control |
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Inhaled toxic substances produce signs and symptoms primarily in the _____
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Respiratory system
p1358 |
|
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MAOI
|
Monomine Oxidase Inhibitors treat depression or obsessive compulsive disorder. These drugs inhibit the breakdown of nerotransmitters such as norepi and dopemine, Symptoms may not appear for up to 6 hrs
|
|
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Aerosol Inhalation
Signs and Symptoms |
*Central Nervous System-dizziness, headache, confusion, seizures, hallucinations, coma
*Respiratory-tachypnea, cough, hoarsness, stridor, dyspnea, retractions, wheezing *Cardiac- dysrhythmias p1358 |
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MAOI S/S
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Headache, aggitation, restless, tremor, nausea, palpatations, tachycardia, severe hypertention, hyperthermia, eventualy bradycardia, hypotension, coma, death
|
|
|
Inhalation
Management |
*safely remove the pt from the poisonous environment
*perform the primary assessment, history, and physical exam *initiate supportive measures *contact poison control center and medical director according to protocols p1358 |
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MAOI Tx
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No atidote exist
standard toxocolgy standard seizure control if needed, if vasopressors are needed use norepi |
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Signs and symptoms of absorbed poisons can vary depending on ____
|
toxin involved
p1358 |
|
|
Cithium
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Treatment for bipolar disorders. Has a narrow theraputic index (don't take much to kill you)
|
|
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When you suspect absorption of a toxin follow these steps
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*Safely remove the pt from the environment
* wear protective clothing * use appropriate respiratory protection * remove pts contaminated clothing * perform assessment, history, physical exam *initiate supportive measures * contact poison control and medical director according to protocols |
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Cithium S/S
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Thirst, dry mouth, tremors, muscle twitching, confusion, stupor, seizures, coma, N/V, diarrhea, bradycardia, dysrhythmia
|
|
|
Cithium Tx
|
Supportive measures, alkalinizing the urine w/ bicarb and mannitol may increase elimination,of lithium,severe cases reguire hemodialysis
|
|
|
Cyanide
|
Found in rodenticides, silver polish, fruit pits, fires, burning plastic bags, silks, synthetic carpets. (extremely fast acting)
|
|
|
Cyanide S/S
|
Burning sensationin mouth and throat
headache, cofusion, combative, HTN, Tahcy followed by Hypotension and dysrythmias, seizures, coma, pulmonary edema |
|
|
Cyanide Tx:
|
PPE
remove pt from area initiate supportive care cyanide kit |
|
|
Cyanide kit
|
It converts some hemoglobin into methemoglobin which cyanide binds to, then it's broken down to thiocyanate that is excreted renally.
|
|
|
CO poisoning
|
Oderless and tasteless gas from the product of incomplete combustion. Causes effective hypoxia
|
|
|
CO poisoning S/S
|
Early Signs are simular to the flu
Headache, n/v , confusion/AMS, tachy breathing |
|
|
CO poisoning Tx
|
Definitive tx is hyperbarric chamber for high level of O2 therepy
PPE, remove pt, vent area, supportive care, high flow O2 |
|
|
Cardiac Med
|
Overdoses of these drugs are usually errors in dosages
|
|
|
Cardiac Med S/S
|
N/V, headache, dizziness, confusion, profound hypotension, dysrythmias, heart blocks, bronchospasm, pulmonary edema
|
|
|
Cardiac Med Tx
|
Standard toxocology assessment
Severe bradycardia may not respond to atropine ABC's Contact med control for assist. |
|
|
Caustic Substances (acids)
|
Ph less than 2 found in plumbing liquids and bathroom cleaners produces immediate severe pain due to tissue coagulation and necrosis. Contact injury will produce Eschar which will act like a shield and prevent further damage. Ingestion will cause local burns aroun the mouth and throat the stomach lining will be injured
|
|
|
Caustic Substances (alkalines)
|
Ph greater than 12.5 can be solid or liquid form like drano or liquid plumber. These agents cause injury by inducing liquefafcation necrosis, pain is delayed which allows for longer tissue contact and deeper tissue injury before exposure is recognized. Solid agents stick to the oropharynx or esophagus causing perferations, bleeding inflammation of the central chest structures. 2-3 days of exposure there is a loss of protective mucosal tissue.
|
|
|
Caustic Substances S/S
|
Facial burns
pain in lips, tongue, thraot, gums, drooling trouble swallowing, hoarsness, stridor, SOB, vomiting, shock |
|
|
Caustic Substances Tx
|
PPE
Toxocology emergency standards Airway managment ( might have to cric) Rapid transport |
|
|
Hydrofluoric Acid
|
Extremely toxic can be lethal despite the apperence of only moderate burns, it penetrates into tissues and is inactivated only when it contacts cations like calcium. It settles in the tissues as salt and removes calcium from the cells causing a disruption of cell function, even causes bone destruction, by pulling calcium from the bones. (death has been reported in exposures of less than 2.5 % BSA)
|
|
|
Hydrofluoric Acid S/S
|
Burning at site of contact
Trouble breathing Confusion Palpatations Muscle Cramps |
|
|
Hydroflouric Acid Tx
|
PPE
Supportive care Remove exposed clothing Irrigate Immerse limbs in iced water and Mag Sulfate Transport immediatly |
|
|
Hydrocarbons
|
Organic compounds, common names kerosene, naptha, turpentine, mineral oil, chloroform, paint , glue, lubricants, solvents. Routes include ingestion, inhalation, surface absorbtion
|
|
|
Hydrocarbons S/S
|
Burns due to local contact, wheezing, dyspnea, hypoxia, headache, dizziness, slurred speech, ataxia, dulled reflexes, foot and wrist drop with numbness and tingling, dysrythias
|
|
|
Hydrocarbons tx
|
Few poisonings are serious. If you know the exact chemical and pt is asymptomatic med control mayy aloow a refusal. If symptomatic supportive care utlize med control for assist. Activated Charcol will not bind with toxin. Gastric Lavage may be used
|
|
|
Tricyclic Antidepressents
|
Used for chronic pain or migranes, not so much for depression anymore. More deaths are from overdoses. Common agents: Elavil, Amoxopine, Doxepin, Imipramine, Nortriptyline
|
|
|
Tricyclic Antidepressents S/S
|
Dry mouth, blurred vision, urinary retention, constipation
LATE SIGNS: Confusion, Hyperthermia, Resp. depression, Seizures, Tachy with Hypotension, Dysrythmias |
|
|
Tricyclic Antidepressents Tx
|
Immediate toxicology Standard
Cardiac monitoring, if suspected overdose with benzo's do not use flumazanil, Use Bicarb, contact med control |
|
|
MAOI
|
Monomine Oxidase Inhibitors treat depression or obsessive compulsive disorder. These drugs inhibit the breakdown of nerotransmitters such as norepi and dopemine, Symptoms may not appear for up to 6 hrs
|
|
|
MAOI S/S
|
Headache, aggitation, restless, tremor, nausea, palpatations, tachycardia, severe hypertention, hyperthermia, eventualy bradycardia, hypotension, coma, death
|
|
|
MAOI Tx
|
No atidote exist
standard toxocolgy standard seizure control if needed, if vasopressors are needed use norepi |
|
|
Cithium
|
Treatment for bipolar disorders. Has a narrow theraputic index (don't take much to kill you)
|
|
|
Cithium S/S
|
Thirst, dry mouth, tremors, muscle twitching, confusion, stupor, seizures, coma, N/V, diarrhea, bradycardia, dysrhythmia
|
|
|
Cithium Tx
|
Supportive measures, alkalinizing the urine w/ bicarb and mannitol may increase elimination,of lithium,severe cases reguire hemodialysis
|
|
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The most common source of injected poisons is the _______________.
|
Animal kingdom
P1372 |
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__________ includes wasps, bees, hornets and ants.
|
Hymenoptera
P1373 |
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Wasps, yellow jackets, hornets and fire ants ________ repeatedly until removal from contact.
|
Sting
P1373 |
|
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In most cases of insect bite, _________ treatment is all that is necessary.
|
Local
P1373 |
|
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Management for Hymenoptera stings?
|
Wash area
Gently remove stinger Apply cool compress Observe for and tx reactions/anaphylaxis P1373 |
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________ can be immobilized and killed with wettiing agents (surfactants) including comercial dishwashing soaps.
|
AHBs (Africanized honeybees)
P1373 |
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____________ spider bites are usually painless.
|
Brown recluse
P1374 |
|
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A brown recluse bite initially presents with a small erythematous macule surrounded by a ________ ring forms at the site. this usually appears within a __________ of the bite.
|
White
Few minutes P1374 |
|
|
Management of a brown recluse bite:
|
Supportive care
ER tx of antihistamines. No antivenin P1374 |
|
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The venom of the legendary _____________ is very potent, causing exessive neurotransmitter release at the ____________ junctions.
|
Black widow
Synaptic P1374 |
|
|
S/S of a black widow spider bites start as ___________ localized pain, redness and swelling.
|
Immediate
P1375 |
|
|
(Black widow bite)
Progressive muscle spasms of all ________ muscle groups can occur and are usually associated with _______ pain. |
Large
Severe P1375 |
|
|
Management of black widow bite:
|
Supportive care
Dr order - Diazepam (2.5-10mg IV or Calcium Gluconate (0.1-0.2/kg of 10% solution IV for severe spasms Watch for HNT Antivenin is available P1375 |
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All scorpions can sting, causing localized pain, but only one, the __________, has caused fatalities.
|
Bark scorpion
P1376 |
|
|
The bark scorpion's venom acts on the __________ system.
|
Nervous
P1376 |
|
|
Management of the bark scorpoin sting.
Apply a VCB above the wound site no tighter than a watchband to occlude _________ flow only. Avoid use of ___________, which may increase toxicity and poteniate the venom's effect on airway control. |
Lymphatic
Analgesics P1376 |
|
|
Common ____________ are cottonmouths (water moccasins), rattlesnakes and copperheads.
|
Pit vipers
P1376 |
|
|
Coral snake mnemonic:
|
red touch yellow, kill a fellow. red on black, venom lack.
P1377 |
|
|
Pit viper venom contains __________ enzymes that are capable of destroying proteins and most other tissue components.
|
Hydrolytic
P1377 |
|
|
A severe pit viper bite can result in death from shock within ________.
|
30 min
P1377 |
|
|
In treating a person who has been bitten by a pit viper, the primary goal is to ______________ of the venom.
|
Slow absorption
P1377 |
|
|
About ___% of all rattlesnake bites are "dry" and no venom is injected.
|
25%
P1377 |
|
|
Management of pit viper bites:
|
Keep pt supine
Immobilize the limb Maintain the extremity in a neutral position. Do not apply VCB Do not apply cold pack P1378 |
|
|
The classic, severe coral snake bite will result in ___________ and ___________ muscle paralyisis.
|
Respiratory
Skeletal P1378 |
|
|
After the bite of a coral snake, there may be no local manifestations or even any systemic effects for as long as _______ hours.
|
12-24 hours
P1379 |
|
|
Management of coral snake bites:
|
Wash wound with copious amounts of water
Apply compression bandage Keep extremity at level of heart Immobilize the limb Do not apply ice pack P1379 |
|
|
All venoms of marine animals contain substaces that produce pain out of _________ to the size of the injury.
|
Proportion
P1379 |
|
|
Marine animal poisonous toxins are unstable and ________ sensitive. Heat will relieve pain and ______________ the venom.
|
Heat
Inactivate P1379 |
|
|
Management of marine animal injections:
|
Apply VCB to occlude lymphatic flow only.
Apply heat or hot water (110-113F) Inactivate or remove any stingers P1380 |
|
|
Use of pharmacological substance for reason other than medical reason.
|
Substance abuse
|
|
|
Physiological or psychological dependance on substance.
|
addiction
|
|
|
Need to increase dose of drug to get original desired effect.
|
tolerance
|
|
|
Pt reacts severely when deprived of substance.
|
withdrawl
|
|
|
Crack head stats:
|
28 mill used drugs at least once
14.5 mill use regularly 20 mill tried cocaine 860,000 use coc weekly 11.6 mill use weed reg 770,000 use hallucinogens reg 2.5 mill have used heroin |
|
|
Poisoning from excess of substance.
|
drug overdose
|
|
|
Drugs and supportive TX:
|
Alcohol - thiamine and D50
Cocaine - Diazepam (seizure activity) NO BETA BLOCKERS Narcotics/Opiates - Naloxone Amphetamines - Diazepam and haloperidol (hyperactivity) Hallucinogens - Diazepam and haloperidol (hyperactivity) Benzodiazepines - Flumazenil Barbituates - Diuretics and alkalies |
|
|
___ % of Americans have an alcoholic drink a year.
___ % of all deaths in American related to alcohol. |
75%
5% |
|
|
Alcohol completely absorbed by intestinal tract between __ and ___ minutes.
|
30 - 120
|
|
|
Alcohol leads to the stopping of natural vasopressin in the body which is responsible for conservation of body fluids. This is why when you drink you:
|
PISS LIKE A RACEHOARSE
|
|
|
Chronic drinking leads to:
|
Poor nutrition
Hepatitis Cirrhosis Loss of peripheral sensation Hypoglycemia |
|
|
Withdrawal symptoms:
|
Last 5 - 7 days
seizures Delirium Tremens (DT) |
|
|
DTs
|
Seen 48 - 72 hours after last drink
Hallucinates Seizures Tremors |
|
|
TX of alcohol emergency:
|
IV
NS 25 g D50 is hypoglycemic 100 mg thiamine |
