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56 Cards in this Set
- Front
- Back
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strong acids & alkalis
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found in toilet bowl cleaners, rust remover, ammonia, and most liquid drain cleaners
cause burns to mouth, pharynx, esophagus, UR & GI tracts LYE is most common ingestion Acids -damage within 1-2 minutes Alkalis -cause liquifaction and damage from minutes to hours TX -Adults 200-300 mL of milk ONLY -Peds 15 mL/kg max |
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Acids
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-acetic acid
-battery acid -beach disinfections -HCL -metal cleaners -Phenol -Sulferic Acid -Swimming Pool Cleaners -Toilet Bowl Cleaners |
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Alkalis
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-Ammonia
-Bleach -Disk (button) batteries -drain pipe and toilet bowl cleaners -hair dyes and tints -jewelry cleaners -metal cleaners or polishes -paint removers -sodium or potassium hydroxide (LYE) -washing powders |
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Hydrocarbons
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saturated or unsaturated compounds, devined from crude oil, coal, plant sources.
Viscosity & Volatility (vaporize) = determine toxicity Commonly ingested in children between may and september |
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CHAMP
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hydrocarbon toxicity that are treated by lavage
Camphor Halogenated Hydrocarbons Aromatic Hydrocarbons (heavy) Metal-containing hydrocarbons Pesticide-containing hydrocarbons |
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Hydrocarbon toxicity
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Viscosity is key, lower is worse (gasoline and turpentine)
-spreads over the surface of the mouth and become gases on contact with warm mucus membranes, irritating airways, causing coughing and potential aspirations High Viscosity Hydrocarbons -tar, grease, are very viscous and are not absorbed in the GI tract |
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Hydrocarbon treatment
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1. ABCs
2. ID the substance, contact medical direction or a poison control center 3. charcoal not effective, gastric emptying 4. IV therapy 5. EKG 6. Transport |
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Clinical Features of Hydrocarbon ingestion
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Immediate: up to 6 hours
GI -abdominal pn -belching -irritation -mucus membrane hyperemia -N/V Respiratory System -cough and choking -cyanosis -dyspnea -inspiratory stridor -tachypnea Neurological System -coma -fever -lethargy -malaise -seizure -systemic factors Delayed: Days to weeks GI -diarrhea -hepatic toxicity Respiratory System -atelectasis -bacterial pneumonia -dyspnea -hemolytic and aplastic anemis -pulmonary edema -spontaneous hemorrhage -sputum production -systemic factors |
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Methanol poisoning
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(wood alcohol) common industrial solvent obtained from the distillation of wood. gasline antifreeze, windshield washer fluid, paints, paint removers, varnishes, canned fuels sterno, shellacs
ingeston, absorption, inhalation -converted to formaldehyde and then formic acid in liver causing massive metabolic acidosis 40 min - 72 hours 4 mL can cause blindness |
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S/S methanol poisoning
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CNS depression
-lethargy -confusion -coma -seizures GI -N/V -ABD pain Visual Complaints -photophobia -blurred or indistinct vision -pupils that are dilated and reactive to light -spots before eyes, snow filled vision -blindness metabolic acidosis -SOB -tachypnea -shock -multishock failure -death |
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Methanol poisoning treatment
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1. supportive care ABC's, IV, EKG, ventilation to correct acidosis
2. gastric lavage if pt seen within 1 hour after ingestion 3. try to correct metabolic acidosis with sodium bicarb, large and repeated doses 4. Ethanol admin 30-60mL of 80 proof by mouth or or gastric lavage tube 5. Transport |
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Ethylene Glycol
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colorless, odorless, water soluble liquid. antifreeze, coolants, windshield deicers, detergent, paints
common ingestion due to color -60 mL is lethal buildup of acids in the liver and kidneys, glycolic and oxalic -hypocalcemia Stage 1 CNS 1-12 hours -slurred speech -ataxia -somnolence "sleepy" -N/V -focal or generalized convulsions -hallucinations -stupor -coma Stage 2: CV 12-36 hours -rapidly progressive tachypnea -cyanosis -pulmonary edema -cardiac failure Stage 3: Renal System 24-72 hours -flank pain -cluster of urological symptoms (oliguria, crystalluria, proteinuria, anuria, hematuia, uremia) |
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ethylene glycol TX
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1. ABC's EKG
2. gastric lavage if ingestion within 1 hour 3. activated charcoal 4. IV fluids for kidneys 5. 80 proof 30-60mL by mouth or gastric tube 6. Transport Other Drugs 1. Thiamine 2. Calcium gluconate 3. Diazepam or Lorazepam |
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Isopropanol
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disinfectants, degreasers, cosmetics, industrial solvents and cleaning agents
150-240mL potentially lethal majority is converted to acetone S/S -CNS depression, respiratory depression -Abd pain -gastritis -hematemesis -hypovolemia -30 minutes after ingestion -no associated metabolic acidosis unless hypotensive TX -ABC's -gastric levage -fluids -transport |
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Iron poisoning
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absorbed from diet, transported to liver, spleen, bone marrow for hemoglobin incorporation
too much iron, begins to circulate in blood. multivitamin OD most common S/S -GI hemorrhage -bloody vomit -painless bloody diarrhea -dark stools Severe cases 20mg/kg -cardiovascular collapse and death 12-48 hours TX -supportive care rapid transport |
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Lead poisoning
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children = paint chip ingestion
-behavior and developmental disordes common adults = inhalation S/S -malaise -mental disturbances -incoordination -abd pn -diarrhea -vomiting Acute -anemia -weakness -paralysis of limbs -seizure and death Supportive care, xray for diagnosis |
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mercury poisoning
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liquid mercury = extremely volatile, leading to inhalation
absorption also common either through skin, or via ingestion builds up in brain and kidneys S/S -SOB/lung damage -N/V/D -abd pn -malaise -incoordination -excitability -tremors -numbness in the limbs -vision impairment -AMS TX -GI decontamination -chelating agents -hemodialysis |
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Food Poisoning
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infectious = results from bacteria or virus
noninfectious = toxins or pullutants |
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Infectious Bacterial
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salmonella
-fowl -excrement from animals Botulism bacteria found in the soil, or fish guts, resists killing S/S -head to toe progression -H/A -blurred or double vision -dysphagia -respiratory paralysis -quadriplegia --death due to respiratory failure |
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food poisoning (viral types)
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Infectious
Norwalk virus -common in shellfish rotovirus -food contaminated with human poop Non-infectious mushrooms or toadstools -also from foods with pesticides -drugs or meds |
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food poisoning management guidelines
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symptoms within 30 minutes
1-12 hours bacterial toxins 12-48 viral and bacterial infections TX -PPE -ABCs -complete HX -IV therapy -transport |
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common plant poisons
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house plants
-dieffenbcachia -hyacinth -misteltoe -narcissus -oleander -poinsetta Flower-garden plants -daffodil -foxglove -iris -larkspur -lily of the valley Ornamental plants -azaleas -daphne -jasmine -rhododendreon -wisteria other plants -buttercups -jack-in-the-pulpit -mayapple -nightshdae -water and poison hemlock trees and shrubs -elderberry -oaks -wild and cultivated cherries |
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Plant Poisoning S/S
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-several hours after ingestion, however some may be delayed 1-3 days
Anticholinergic (Jimson weed and lantana) -tachycardia -dilated pupils -hot/dry skin -decreased bowel sounds -altered vision -abnormal mental status Cholinergic (certain mushrooms) -bradycardia -miosis -salivation -hyperactive bowl sounds -diarrhea Nicotinic Alkaloids (poison hemlock & delphinium) -first as stimulants -next depressions and weakness |
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Plant Poisoning Management
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1. ABCs
2. Intubate pts with decreased gag reflex, unresponsiveness, seizures. 3. Activated charcoal 4. IV fluids 5. Vital signs & EKG 6. Transport |
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Inhalation poisoning physical properties
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Factors
1) concentration of chemical in the air 2) duration of exposure 3) solubility of the inhaled chemical Water Soluble (upper damage) -Chlorine & anhydrous ammonia -become HCL and ammonia hydroxide when contacting water damaging naso/oropharynx and conducting pathways Water insoluble (lower airway) -phosgene and nitrogen dioxide -affect alveoli and respiratory bronchiols |
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Inhalation poisoning chemical properties
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reactivity = the ability of a chemical to top interact with other chemicals and body tissues (highly reactive = highly bad)
4 properties 1) chemical pH less then 2 or greater then 11.5 2) direct-acting potential of chemicals. -do not need to be changed before they do damage (hydroflouric acid) 3) Indirect acting potential of chemicals -must be transformed before they can produce injury (phosgene is converted to HCL and damages alveoli) 4) Allergic potential of chemicals -some chemicals bind with proteins and stimulate allergic reactions. related to reactivity -formaldehyde. |
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Inhalation poisoning classifications
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3 catagories
1) simple asphyxiants -methane, propane, inert gases -displace or lower amount of O2 in the air 2) chemical asphyxiants -carbon monoxide and cyanide -built-in system toxicity appears after absorption into the circulation 3) irritants/corrosives -chlorine and ammonia -cause cellular destruction and inflammation as they come into contact with moisture |
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Inhalation management
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1. scene safety
2. PPE 3. rapid removal of pt from poison environment 4. surface decontamination 5. ABCs 6. Initial assessment and physical exam 7. Irrigation of eyes (as needed) 8. IV NS 9. Vital signs EKG 10. Rapid transport |
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Cyanide poisoning
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limited applications include
-electroplating -ore extraction -fumigation of buildings -fertilizer -byproduct of nylon and polyurethane sources -inhalation of cyanide gas -ingestion of cyanide salts, nitriles or cyanogenic glycosides (seeds of cherries, apples, pears, apricots) -Laetrile (mexico cancer treatment) mechanism of action -inhibits cellular oxygenation |
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Cyanide poisoning S/S
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Early effects
-agitation -anxiety -confusion -dyspnea -hypertension with reflex bradycardia Advanced Effects -acidosis -dysrhythmias -hypotension -intractable hypotension -lactic acidosis -pulmonary edema -seizures -coma |
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Cyanide antidote kit
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2 amyl nitrite inhalants in gauze
-administer by inhalation 15 of every 30 seconds 3% sodium nitrite (stop amyl nitrite) -Adults: 10 mL sow IV over 2-4 minutes -Children: 0.2 mL/kg (up to 10ml) slow IV over 5 minutes -if hypotension, stop and treat for shock 25% sodium thiosulfate -Adults: 50-mL IV bolus -Children: 5 mL sodium thiosulfate per 1 mL sodium nitrite given |
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Cyanide treatment
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1. PPE
2. Remove patient from cyanide source, remove contaminated clothing 3. Ensure patent airway and adequate ventilatory support 4. administer O2 5. consult MD with pasadena kit 6. No kit? crush pearl of amyl nitrate hold for 15 out of every 30 seconds 7. IV fluids 8. EKG 9. rapid transport DO NOT give with cyanide poisoning from inhalation due to carbon monoxide gorking hemoglobin CYANOKIT -5 gm treats all types of cyanide poisoning |
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Ammonia Inhalation
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-pulmonary complications after inhalation
-severe cases result in destruction of of the mucuosal tissue of all respiratory structures (when ammonia combines with water forming an alkaline compound) S/S -coughing -choking -congestion -burning -tightness in chest -feeling of suffocation -burning eyes & tearing -bronchospasm and pulmonary edema may develop TX -positive pressure ventilation -diuretics and bronchodilators |
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Hydrocarbon inhalation
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greatest risk
-low viscosity -high volatility -high surface tension or adhesion of molecules along a surface Result in aspiration pneumonia common sources -huffing carbon tet, methylene chloride, armomatic hydrocarbons benzene and tuolene S/S -burning sensation on swallowing -N/V -ABD cramps -weakness -anesthesia -hallucinations -changes in color perception -blindness -seizures -coma TX -ABCs -IV -vitals and EKG -transport |
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Hymenoptera
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Wasps, Bees, Ants
Head/Neck = most common Foot/Leg/Hand/Arm = 2nd common general reaction -instant pain -wheal and flare reaction with variable edema -large local reactions can spread more then 15cm beyond sting site -24 hours persistnce |
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fire ant
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alkaloid venom
-necrotic activity -may produce systemic reactions -secondary infection may occur (requiring antibiotics) |
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Hymenoptera management
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-closely observe for S/S of allergic reaction
-immobilize and elevate affected extremity -antihistamine may be prescribed |
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Arachnida
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Spiders, Scorpions, Ticks
2 major effects -neurotoxic reactions (black widow) -local tissue necrosis (most other spiders |
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Black widow spider
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female = hourglass
-2.5cm, males half size -found in undisturbed areas, under stones, logs and clumps of vegitation -most bites occur in rural and suburban areas of southern and western states between april and october S/S -single bite mark (slight pinprick) 2 fangs 1 mm apart -1 hour of bite muscle spasms and cramps (abdominal rigidity, no tenderness) intense pain -paresthesisa (burning sensation in soles of the feet or entire body) -pain in the muscles of the shoulders, back or chest -H/A -dizziness -N/V -edema of the eylids -increased perspiration and salivation |
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Black Widow TX
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1. ABC's
2. Clean affected area with saline, cover with a sterile dressing, intermittantly apply ice 3. per medical direction, manage muscle spasm with diazepam/lorazepam and pain meds, and HTN with HTN meds 4. transport for physician eval, most recover within 36-72 hours greatest risk for morbidity -very young -very old -HTN and other med problems |
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Brown Recluse Spider
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"fiddleback"
-mississippi, ohio, missouri, southwest states -vacant buildings & clothing closets -fawn to dark brown 1-2cm long -6 eyes -most active bites april to october S/S -little pain, overlooked by victim -1-2 hours localized pain and erythema develop -1-2 days blister or vesicle -ischemic ring and irregular red halo -24-72 hours area becomes larger, necrosis occurs, black eschar in center -2-5 weeks eschar sloughs leaving ulcer -fever -chills -malaise -N/V -generalized rash -hemolytic anemia -hemoglobinurea -hypotension |
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Brown Recluse TX
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-cold compress and sterile dressing applied to legion
-transport for physician eval |
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Scorpion Stings
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sculptured or bark scorpion is the only species dangerous to humans
-found in southwestern US and Mexico -nocturnal -2-7.5 cm and yellow to brown -april to august -works on presynaptic terminal release acetylcholine If swelling, ecchymosis, or redness is present, the scorpion was not of the neurotoxic type |
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Scorpion Stings S/S & TX
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S/S
-hyperesthesia at the site of the bite -pain, tingling and burning at site -SLUDGE -initial bradycardia followed by tachycardia -cardiac dysrhythmias -muscle twitching -conulsions -roving eye movements (cranial nerve dysfunction) TX -mild analgesics -cold compresses -in hospital observation |
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Pit Vipers
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rattlesnakes, cottonmouth (water moccasin), copperhead, pigmy rattlesnake, massasauga rattlesnake
-depressed heat sensing pit on nose -vertical elliptical pupils -triangular head S/S MILD -presence of one or more fang marks -local swelling and pain -lack of systemic symptoms MODERATE -1 or more fang marks -pain and edema beyond site -systemic S/S -weakness -diaphoresis -N/V -paresthesias SEVERE -1 or more fang marks -massive edema -subQ ecchymosis -severe systemic symptoms -shock |
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Coral Snakes
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Arizona Coral Snake, Eastern Coral Snake
RED ON YELLOW KILL A FELLOW -round pupils, small fixed fangs -3 color band with black snout -small mouth makes it hard to bit anything larger then finger, toe, or fold of skin -hangs on and chews -neurotoxic venom blocks acetalcholine receptor sites S/S -no or little pain -no necrosis or edema -slurred speech -dilated pupils -dysphagia (several hours after bite) -flaccid paralysis and death 8-24 hrs by respiratory failure |
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Snake envenomation
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1. Stay clear of striking range of the snake (length of the snake), if dead bring snake in closed container
2. ABCs, vitals and EKG, IV with fluids 3. immobilize the bitten extremity in a nuetral position (to help slow spread of toxin), keep the patient at rest IF ELAPID (CORAL) snake bit, wrap a bandage around the entire extremity 4. prepare for transport 5. no hot or cold packs |
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Organophosphates
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-common group of fertilizers
-generally abosrbed through the skin S/S -SLUDGE -Acetalcholinesterace binds with poison and can not break down ACH, flooding system with atropine causes nicotinic (sympathetic effects) TX -atropine fits in receptors blocking ACH connection -pralidoxime temporarily binds to ACH esterace so that poison can not bind |
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Opiods
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Heroin, Codeine, Methadone, Opium, Oxycodeine
-the use of heroin can draw up particles that may sand blast the heart valves S/S -pin point pupils -decreased respiratory effort -poor color due to hypoxia -strong pulse TX -hold off on intubation -narcan 0.5 - 2.0 mg -respiratory effort will pick up followed by eyes opening |
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Benzodiazepines
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-sedative & hypnotic
-it might be impossible to die on valium only, but it is possible if you mix ETOH and valium because they have the same metabolites S/S -depressed LOC TX -romazacon at the hospital |
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Cocaine
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-snorted stimulant
-TACHYCARDIA MAY PRECIPITATE MI -spasm of coronary artery S/S -wired/paranoid -difficult to talk to -tachycardia TX -versed (call in) |
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PCP
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Horse tranquilizer
-snorted, eaten, ground into marijuana S/S Psychosis -reaction is psychotic -crazy feel no pain High Toxicity -coma -unresponsive Low Toxicity -normal recreational level |
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LSD
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-clear liquid drops
-blotter acid = paper tabs with donald duck -window pane = dip paper into acid, then cut -electric wine = community cup -12-18 hour trips S/S -out of it, easily distracted -may not communicate -paranoid -huge pupils -red oily appearance TX -hijack and take to ER |
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Mushrooms
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"psilocybin"
-frozen due to bad taste -hallucinogenic effect is not as bad as LSD -generally not a common ambulance call |
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Peyote
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-Southern US states
-mescaline from peyote button |
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Lithium
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-taken by manic depressive bi-polar patients
-mood balancer -narrow therapuetic range, OD common S/S -muscle weakness -slurred speech -severe trembling -blurred vision -confusion -seizure -apnea -coma TX -supportive |
