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50 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Toxins
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-can be anything in the wrong dose
-many toxins affect specific organ systems |
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neurotoxin
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-typically paralytic, affects respiratory muscles
-botulism |
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cardiotoxin
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-affects the cardiac system
-tricyclic antidepressants |
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syrup of ipecac
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induces vomiting, disastrous for TCA OD
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gastric lavage
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tube is passed into the stomach to clear cotents
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poison control
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up in Portland, trained operators can look up substances quickly
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poison control centers
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-more then 60 in the US
-24 hour phone access to population bases of at least 1,000,000 1-800-222-1222 |
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6 elements of an and organized poison system
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1) treatment info and toxicological consultation with heal care providers (EMS/hospitals/MD) and public via phone
2) professional education to train those involved in care of poisoned patients 3) data collection on all poisonings in the region for epidemiological and evaluation purposes 4) public education and prevention 5) research 6) regional EMS poison system development (patient classification criteria, triage and management protocols, regional transfer agreements) |
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potential toxicity determinants
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-specific agent or agents
-amount ingested -time of exposure -weight and medical condition of the patient -treatment given before the arrival of EMS |
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3 main types of toxicological emergencies
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1) unintentional poisoning
-childhood poisoning -dosage errors -environmental exposure -idiosyncratic reactions -occupational exposure 2) Drug and Alcohol abuse 3) Intentional Poisoning/OD -assault/homicide -chemical warfare -suicide attempts |
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9 guidelines for prehospital poisoning management
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1) ABC's watch for aspiration
2) obtain HX and focused physical exam 3) consider hypoglycemia in ALOC and convulsions 4) administer narcan to patient with respiratory depression 5) If OD suspected, try to obtain a OD HX from patient, family or freinds 6) consult with MD or poison control for specific management 7) frequently reassess pt, monitor vitals, EKG 8) bring sample of substance, and vomit 9) transport the patient for physician exam |
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poisoning by ingestion
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-80% occurs in children 1-3 years of age (household products)
-ingestion by adults is generally intentional unless its a workplace exposure Effects Rapid -acids & alkalis (immediate damage, burns to lips, tongue, throat, upper GI tract Slow -Medications and toxic plants (require absorption and distribution via the blood stream) -minimal stomach absorption, most through small intestine. use drugs to take out of system or bind |
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respiratory complications
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-secure advanced airway
complications include -noncardiogenic pulmonary edema -development of ARDS -Bronchospasm |
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cardiovascular complications
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cardiac dysrhythmias most common
hypotension common may lead to acidosis & hypoxia hypertension may develop = cerebral vascular accident |
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neurological complications
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wide range from mild drowsiness and agitation to hallucinations, seizures, coma and death
may be direct (lead paint chips) or indirect (hypoxia from bradydysrhythmia) |
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Posioning HX questions
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-What was ingested?
-When was the substance ingested (may effect charcoal and lavage to induce emesis or to administer antidote) -how much substance ingested? -Attempt to vomit? -Charcoal administration? -Psychiatric HX pertinent to suicde attempts? any episodes of recent depression? |
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poisoning by ingestion
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-80% occurs in children 1-3 years of age (household products)
-ingestion by adults is generally intentional unless its a workplace exposure Effects Rapid -acids & alkalis (immediate damage, burns to lips, tongue, throat, upper GI tract Slow -Medications and toxic plants (require absorption and distribution via the blood stream) -minimal stomach absorption, most through small intestine. use drugs to take out of system or bind |
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respiratory complications
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-secure advanced airway
complications include -noncardiogenic pulmonary edema -development of ARDS -Bronchospasm |
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cardiovascular complications
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cardiac dysrhythmias most common
hypotension common may lead to acidosis & hypoxia hypertension may develop = cerebral vascular accident |
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neurological complications
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wide range from mild drowsiness and agitation to hallucinations, seizures, coma and death
may be direct (lead paint chips) or indirect (hypoxia from bradydysrhythmia) |
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Posioning HX questions
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-What was ingested?
-When was the substance ingested (may effect charcoal and lavage to induce emesis or to administer antidote) -how much substance ingested? -Attempt to vomit? -Charcoal administration? -Psychiatric HX pertinent to suicde attempts? any episodes of recent depression? |
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poisoning by ingestion
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-80% occurs in children 1-3 years of age (household products)
-ingestion by adults is generally intentional unless its a workplace exposure Effects Rapid -acids & alkalis (immediate damage, burns to lips, tongue, throat, upper GI tract Slow -Medications and toxic plants (require absorption and distribution via the blood stream) -minimal stomach absorption, most through small intestine. use drugs to take out of system or bind |
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respiratory complications
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-secure advanced airway
complications include -noncardiogenic pulmonary edema -development of ARDS -Bronchospasm |
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cardiovascular complications
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cardiac dysrhythmias most common
hypotension common may lead to acidosis & hypoxia hypertension may develop = cerebral vascular accident |
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neurological complications
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wide range from mild drowsiness and agitation to hallucinations, seizures, coma and death
may be direct (lead paint chips) or indirect (hypoxia from bradydysrhythmia) |
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Posioning HX questions
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-What was ingested?
-When was the substance ingested (may effect charcoal and lavage to induce emesis or to administer antidote) -how much substance ingested? -Attempt to vomit? -Charcoal administration? -Psychiatric HX pertinent to suicde attempts? any episodes of recent depression? |
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activated charcoal
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inert wood material heated to a high temperature
-absorbs up to 50% of material preventing it from entering the blood stream Do not use with -strong acids -strong alkali -ethanol -cyanide, ferrous sulfate, methanol -1 or more hours before EMS arrival Cathartic -soribital helps to speed bowel evacuation -vomiting common |
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activated charcoal dose
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1-2 g/kg body mass
30-100g in adults 15-30g in children prepared in a slurry and administered orally or by gastric tube |
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gastric lavage
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most effective if completed within 1 hour of substance ingestion
36-40 french adults 24-28 french children NG insertion may cause irritation to nasal mucosa 1) left lateral trandelenberg, intubation if no gag reflex or ALOC 2) insert tube through the mouth into patient's esophagus, continue to feed into stomach unless resistance felt 3) listen for air ascultation for correct placement 4) aspirate gastric contents for correct placement 5) tap water or NS 150-200ml adults 50-100ml kids (NS ONLY) 6) continue lavage until fluid appears clear, should return the same amount as administered |
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charcoal before lavage
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2-3 L of fluid recovery required
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gastric lavage contraindications
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-can't protect own airway AND ALOC
-low-viscosity hydrocarbons (gasoline, kerosine, furniture polish, mineral spirits) -caustic agents IF ALOC... -try to RSI and intubate prior to lavage |
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syrup of ipecac
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30% effective... not generally used, may interfere with activated charcoal
complications include -mallory-weiss tear of esophagus -pnuemomediastinum -fatal diaphragmatic or gastric rupture -aspiration pnuemonitis Contraindications -ingestion of caustic substances -loss of gag reflex -seizures -pregnancy -acute MI -ingestion of... a. acids b. alkalis c. ammonia d. non-toxic agents e. petroleum distillates unless advised by MD f. rapid acting CNS depressents (cyanide TCA OD) g. rapid acting CNS irritants (strychnine) h. hydrocarbons |
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dosage of ipecac
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patients 1-12
-contraindicated in pts less then 1 yr -15 mL of ipecac followed by 2-3 glasses of water, repeated in 20 min if no vomiting Patients older then 12 years -30 mL of ipecac followed by 2-3 glasse of water may be repeated in 20 min if vomiting does not occur |
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antidotes to common toxins
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acetaminophen = N-acetylcysteine
anticholergic agents = physostigmine benzodiazepines = flumazenil beta blockers = glucagon calcium channel blockers = calcium cyanide = amyl nitrate, sodium nitrate, sodium thiosulfate cyclic antidepressants = bicarb digioxin = digioxin immune fab iron = deferoxamine methanol = ethanol opiates = naloxone (narcan) organophosphates = atropine, pralidoxime |
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Activated charcoal
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-stains
-adults my not drink willingly DOSE 1G/KG or 10G per Gram of poison |
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gastric lavage
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can be used to vent air during CPR
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antidote
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specific to reducing the effects of a poison
acetominophen (tylenol) = mucomist |
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strong acids and alkali's
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toilet bowl cleaners, ammonia, rust removers, liquid drain cleaners
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hydrocarbons
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crude oil, coal, plant sources
characteristics -viscosity = big problem -volatility = ability to evaporate TX -assess for airway issues -coughing, sputtering = possible aspiration -NO activated charcoal -UNLIKELY gastric lavage -O2, IV, Monitor |
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methanol
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wood alcohol, varnishing, sterno (canned fuel)
metbolites convert to formic acid and fermaldehyde S/S -blindness -metabolic acidosis -CNS depression -takes 40min - 3 days TX -activated charcoal (controversial) -sodium bicarb -30-60 mL 80 proof mouth or gastric lavage (ETOH has 9X greater affinity for the enzyme that converts methanol to formic acid) -Gastric lavage |
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Ethylene Glycol
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antifreeze
tastes sweet Stage 1 = 1-12 hours CNS Stage 2 = 12-35 Cardiac Stage 3 = 24-72 Renal TX -gastric lavage if less then 1 hour -activated charcoal -IV fluid to maintain urine output, be cautious in stage 2 -sodium bicarb -30-60ml 80 proof |
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80 Proof origin
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shot was fired into whiskey barrel and should catch fire at 86 proof
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Isopropanol
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rubbing alcohol, converts to acetone while in the body
150-240 mL is potentially fatal 1/4-1 can of fluid vapor is also toxic and can be a means of exposure characteristics -30 min after ingestion -hematemesis -ABD pain -hypotension (possible metabolic acidosis) TX -supportive care -gastric lavage |
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Metals
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Iron
-iron pills/multivitamin OD (small red pil) -painless bloody diarrhea Lead -children chewing on painted fixtures before 1977 -adult inhalation exposures Mercury -preservative in innoculations - tied to autism -broken thermometers S/S mercury poisoning -SOB (inhaled) -ABD pn -N/V -diarrhea if absorbed through skin (mad hatter) TX -supportive care, transport (ID substance |
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Salmonella
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Food Poisoning
-Bird or fowl S/S -GI stress causing hypovolemia -Explosive diarrhea TX -fluids |
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Botulism
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Food Poisoning
-improperly canned foods S/S -respiratory arrest -Head to toe nuerotoxin efect caused by nerve paralysis -H/A -dysphagia -blurred double vision |
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E. Coli
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Animal Toxin
-common when animals and people are together -inhalation possible |
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Montezuma's Revenge
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Food on camping forks
S/S -screaming diarrhea -keyopectate = bowel obstruction |
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Food Poisoning management guidelines
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chemical poisoning = 30 min
bacterial toxin = 1-12 hours viral & bacterial = 12-48 hours TX -airway -fluids |
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Plant poisoning
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Cholinergic Vs Anticholinergic crisis
Anticholinergic -tachy -hot dry skin -dilated pupils Cholinergic "SLUDGE" Salivation Lacrimation Urination Defacation GI Emesis common in mushroom ingestion TX -poison control -gastric lavage possible -activated chacoal |
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