Poisoning and Overdose Emergencies

1. Poisoning and Overdose Emergencies

2. Emergency Medical Care of Poisoning/Overdose Poison Control Center - Phone number - 800-522-4611 Chemtrec Emergency - Phone number - 800-424-9300 Chemtrec Non-emergency - Phone number - 800-262-8200 What substance? Table 21-1 on p. 360 and TableWhat substance? Table 21-1 on p. 360 and Table

3. Emergency Medical Care of Poisoning/Overdose Important questions to consider asking patient What substance? When did you ingest/become exposed? If an ingestion, how much did you ingest? Over what time period?

4. Emergency Medical Care of Poisoning/Overdose Important questions to consider asking patient (Cont..) What Interventions? How much do you weigh? [What effects are you experiencing from the ingestion?]

5. Emergency Medical Care of Poisoning/Overdose Ingested Poisons Signs and Symptoms History of ingestion Nausea Vomiting Diarrhea Altered mental status Abdominal pain Chemical burns around the mouth Different breath odors Scan 2101 on p. 363Scan 2101 on p. 363

6. Emergency Medical Care of Poisoning/Overdose Ingested Poisons Emergency medical care Remove pills, tablets or fragments with gloves from patient�s mouth, as needed, without injuring oneself. Consult medical direction--activated charcoal. Bring all containers, bottles, labels, etc. of poison agents to receiving facility.

7. Emergency Medical Care of Poisoning/Overdose Inhaled Poison Signs and Symptoms History of inhalation of toxic substance Difficulty breathing Chest pain Cough Hoarseness Dizziness

8. Emergency Medical Care of Poisoning/Overdose Inhaled Poison Signs and Symptoms (Cont.) Headache Confusion Seizures Altered mental status

9. Emergency Medical Care of Poisoning/Overdose Inhaled Poison Emergency medical care Have trained rescuers remove patient from poisonous environment. Give oxygen, if not already done in the initial assessment. Bring all containers, bottles, labels, etc. of poison agents to receiving facility.

10. Emergency Medical Care of Poisoning/Overdose Toxic injection Signs and Symptoms Weakness Dizziness Chills Fever Nausea Vomiting

11. Emergency Medical Care of Poisoning/Overdose Toxic injection Emergency medical care Airway and oxygen Be alert for vomiting. Bring all containers, bottles labels, etc. of poison agents to receiving facility.

12. Emergency Medical Care of Poisoning/Overdose Absorbed Poisons Signs and Symptoms History of exposure Liquid or powder on the patient�s skin Burns Itching Irritation Redness

13. Emergency Medical Care of Poisoning/Overdose Absorbed Poisons Emergency medical care Skin--remove contaminated clothing while protecting oneself from contamination Powder--brush powder off patient, then continue as for other absorbed poisons. Liquid--irrigate with clean water for at least 20 minutes (and continue en route to facility if possible.) Eye--irrigate with clean water away from affected eye for at least 20 minutes and continue en route to facility if possible.

14. Emergency Medical Care of Poisoning/Overdose Alcohol and Substance Abuse Signs and Symptoms Altered mental status ranging from mild disorientation to complete unresponsiveness. Abnormal respiratory pattern including excessively slow or absent breathing or rapid, deep breathing. Abnormal or irregular pulse rate Fever Seizures Extremely low or high blood pressure

15. Emergency Medical Care of Poisoning/Overdose Alcohol and Substance Abuse Signs and Symptoms Sweating, tremors, and hallucinations (symptoms of alcohol withdrawal) Digestive problems that include abdominal pain, vomiting, bleeding, and dehydration Disturbances of vision, slurred speech, and muscular incoordination Disinterested behavior, loss of memory (blackout) Combativeness Paranoia

16. Emergency Medical Care of Poisoning/Overdose Alcohol and Substance Abuse Emergency medical care Establish and maintain a patent airway; concurrently establish spinal stabilization if the patient is unresponsive or has suffered an injury. Administer oxygen at 15 lpm by nonrebreather mask or positive pressure ventilation with supplemental oxygen, as needed. If the patient is responsive, try to get him to sit or lie on a stretcher.

17. Emergency Medical Care of Poisoning/Overdose Alcohol and Substance Abuse Emergency medical care Monitor the patient�s, mental status and vital; signs frequently. Try to maintain proper body temperature Take measures to correct or prevent shock Transport

18. Relationship to Airway Management Use information and skills learned in airway section of course to manage airway difficulties. A patient�s condition may deteriorate, so continue to assess patient for airway difficulties and manage as learned previously.

19. Medications Activated Charcoal Medication name Generic--Activated charcoal Trade SuperChar TM InstaChar TM Actidose TM LiquiChar TM

20. Medications Activated Charcoal (cont.) Indications--poisoning by mouth Contraindications Altered mental status Ingestion of acids or alkalis Unable to swallow

21. Medications Activated Charcoal (cont.) Medication form Pre-mixed in water, frequently available in plastic bottle containing 12.5 grams activated charcoal. Powder--should be avoided in field. Dosage Adults and children: 1gram activated charcoal/kg Usual adult dose: 25-50 grams Usual infant/child dose: 12.5-25 grams

22. Medications Activated Charcoal (cont.) Administration Obtain order from medical direction either on-line or off-line. Container must be shaken thoroughly. Since medications look like mud, patient may need to be persuaded to drink it. A covered container and a straw may improve patient compliance since the patient cannot see the medication this way.

23. Medications Activated Charcoal (cont.) Administration If patient takes a long time to drink the medication, the charcoal will settle and will need to be shaken or stirred again. Record activity and time.

24. Medications Activated Charcoal (cont.) Actions Binds to certain poisons and prevents them from being absorbed into the body. Not all brands of activated charcoal are the same; some bind much more poison than others, so consult medical direction about the brand to use.

25. Medications Activated Charcoal (cont.) Side effects Black stools. Some patient, particularly those who have ingested poisons that cause nausea, may vomit. If the patient vomits, the dose should be repeated once.

26. Medications Activated Charcoal (cont.) Re-assessment strategies--the EMT should be prepared for the patient to vomit or further deteriorate.

27. Medications Syrup of Ipecac Currently not part of EMT-B curriculum, But still use in some EMS services. It is said that reason for removal was that it takes to long to cause vomiting and that it does not remove enough of the poison from the stomach. Indications -- poisoning by mouth

28. Medications Syrup of Ipecac (cont.) Contraindications Ingestion of any of the following strychnine, corrosive, such as alkalies (lye), strong acids, petroleum distillates, such as kerosene, gasoline, coal oil, paint thinner, or cleaning fluid

29. Medications Syrup of Ipecac (cont.) Dosage for Responsive patients Adults and children over 1 year of age: 1 tablespoonful (15 mL) followed by 1to 2 glasses (8 to 16 ounces) of water, or as directed by medical direction. If vomiting does not occur within 30 minutes, repeat the dose. If previous attempts to contact a Poison Control Center, Emergency medical facility, or health professional were unsuccessful, continue trying. Keep patient active and moving. Save the container of poison.

30. Other Poisoning to think of: Food Poisoning Carbon Monoxide Poisoning Poisonous Plants

31. Allergic Reactions

32. Allergic Reaction Overwhelming response to a foreign substance Can be life threatening Can lead to death

33. Bodies defense mechanism Antigens are foreign substances Immune response Recognizes the antigen Produces antibody protein to destroy the antigen Immune System

34. Allergen Form of antigen Pollen, ragweed, dust Common and harmless to most individuals

35. Sensitization Antibodies combined with antigen before Occurs continuously and often goes unnoticed Usually for an allergic reaction to take place a person has to of had at least one exposure

36. Possible Causes Insect bites/stings-bees, wasps Food Plants Medications Others

37. Assessment Findings Skin Warm tingling, face, mouth, chest, feet, and hands Itching Hive Red skin Swelling

38. Respiratory System Tightness in the throat/chest Cough Rapid breathing Labored & noisy breathing Hoarseness Stridor Wheezing

39. Cardiac Increased heart rate Decreased blood pressure

40. Itchy, watery eyes Headache Sense of impending doom Runny nose Decreased mental status Findings that reveal shock Generalized Findings

41. Emergency Care Perform initial assessment Focused history & physical exam History of allergies What was patient exposed to How was patient exposed What effects Progression Interventions

42. Assess baseline vitals Big O�s if not already done in initial assessment Epinephrine/Medical control Reassess vital in 2 minutes Record findings No epinephrine/transport immediately Emergency Care

43. Airway Management Be prepared for airway compromise Can develop as reaction progresses

44. Medications Epinephrine auto-injector Generic name- Epinephrine Trade name - Adrenalin

45. Indications Assessment findings of an allergic reaction Medication is prescribed for this patient by a physician Medical direction authorizes use for the patient

46. Contraindications None when used in a life-threatening situation

47. Dosage Adult - one adult auto-injector (0.3 mg.) Infant and child - Infant or child auto-injector (0.15 mg.) Medication form liquid administered automatically intramuscularly

48. Actions Dilates the bronchioles Constricts blood vessels

49. Side effects Increased heart rate Pallor Dizziness Chest pain Headache Nausea/Vomiting Excitability, anxiousness

50. Reassessment Strategies Transport, continue initial assessment Patient condition worsens Additional dose of epi Treat for shock Prepare for CPR, AED Condition improves O2 treat for shock and supportive care.