Poisoning Emergencies

1. Chapter 21 Poisoning Emergencies

2. Topics to be Discussed • Poisoning and Airway Management • Assessment and Emergency Care of Poisoning/Overdose

3. Airway Management A patient’s condition may deteriorate, so continue to assess patient for airway difficulties and manage as necessary

4. Assessment and Emergency Medical Care The Poisoning/ Overdose Patient

5. Important Questions • What substance? • When did you become exposed? • How much was ingested? • Over what time period? • Interventions? • What is the weight of the patient?

6. Routes of Exposure INGESTION INJECTION Meds Cleaners Bites Drugs Plants Toiletries Stings INHALATION ABSORPTION Sprays Plants Insecticides CO Solvents Chemicals

7. Poisoning by Ingestion • Signs and Symptoms • History of ingestion • Nausea/vomiting/diarrhea • Altered mental status • Abdominal pain • Chemical burns around mouth • Different breath odors

8. Poisoning by Ingestion • Emergency Medical Care • Remove pills, tablets or fragments with gloves from patient’s mouth • Consult medical direction – activated charcoal • Bring all containers (bottles, labels etc.) to receiving facility

9. Poisoning Emergencies Medication Activated Charcoal

10. Medication Name Trade Name Generic Name ActivatedCharcoal SuperChar™, InstaChar™, Actidose™, LiquiChar™, Others

11. Indications • Poisoning by mouth

12. Contraindications • Any of the following: • Altered mental status • Ingestion of acids or alkalis • Unable to swallow

13. Medication Form/Dose • Form – Pre-mixed in water; Powder should be avoided in the field • Dose • 1 gram activated charcoal/kg of body weight • Usual Adult Dose – 25-50 grams • Usual Child Dose – 12.5-25 grams

14. Administration • Obtain order from medical direction either on-line or off-line. (Continued)

15. Container must be shaken thoroughly Since medication looks like mud, patient may need to be persuaded to drink it. (Continued)

16. If patient takes a long time to drink medication, the charcoal will settle and will need to be shaken or stirred again Record administration of medication and time.

17. Activated Charcoal Side Effects Actions Black stools, nausea, vomiting. * If patient vomits, the dose should be repeated once. Binds to certain poisons and prevents them from being absorbed into the body

18. Reassessment Strategies • The EMT should be prepared for the patient to vomit or further deteriorate. • Not all brands of activated charcoal are the same; some bind much more poisons than others, consult medical direction about the brand to use

19. Poisoning by Inhalation • Signs and Symptoms • History of inhalation of toxic substance • Difficulty breathing • Chest pain, cough, hoarseness • Dizziness, headache, confusion, seizures • Altered mental status

20. Poisoning by Inhalation

21. Poisoning by Inhalation • Emergency Medical Care • Have trained rescuers remove patient from poisonous environment • Give oxygen, if not already done so • Bring all containers (bottles, labels, etc) to receiving facility

22. Toxic Injection • Signs and Symptoms • Weakness • Dizziness • Chills, fever • Nausea, vomiting

23. Toxic Injection • Emergency Medical Care • Airway and oxygen • Be alert for vomiting • Bring all containers (bottles, labels, etc.) to receiving facility

24. Absorbed Poisons • Signs and Symptoms • History of exposure • Liquid or powder on patient’s skin • Burns • Itching, irritation • Redness

25. Absorbed Poisons • Emergency Medical Care • Skin – remove contaminated clothing while protecting oneself from contamination • Brush Powder off patient • Irrigate with clean water for at least 20 minutes – continue en route to facility, if possible

26. Absorbed Poisons • Emergency Medical Care Eyes – irrigate with clean water away from affected eye for at least 20 minutes and continue en route to facility, if possible

27. Poisoning Emergencies Food Poisoning ENRICHMENT

28. Food Poisoning • Caused by ingestion of food that contains bacteria or toxins. • One of the most rapidly increasing sources of food poisoning is seafood.

29. Signs and Symptoms • Can be difficult to detect because signs and symptoms vary greatly. • Abdominal pain • Nausea and vomiting • Gas • Diarrhea • Loud or frequent bowel sounds

30. Emergency Medical Care • Do not give the patient anything by mouth. • Transport as soon as possible.

31. Poisoning Emergencies Carbon Monoxide Poisoning ENRICHMENT

32. Carbon Monoxide Poisoning • Formed by the incomplete combustion of gasoline, coal, kerosene, plastic, wood, or natural gas. • Completely nonirritating, tasteless, colorless, and odorless.

33. Common Sources • Home-heating devices • Automobile exhaust fumes • Tobacco smoke • Barbecue grills/Charcoal briquettes • Kitchen stoves • Propane-powered industrial equipment • Faulty water heaters • Faulty kerosene heaters • Faulty space heaters

34. Signs and Symptoms • Can easily be mistaken for flu or other problems • Suspect carbon monoxide when symptoms are shared by others in the environment.

35. Emergency Medical Care • Evacuate everyone from the enclosed space, at least 150 feet from the suspected sources of carbon monoxide. • Transport patient immediately with a tight-fitting non- rebreather mask with oxygen at 15 lpm.

36. Poisoning Emergencies Poisonous Plants ENRICHMENT

37. Common Causes • Poison ivy • Poison oak • Poison sumac • Others (stinging nettle, crown of thorns, butter cup, May apple, marsh marigold, candelabra cactus, brown-eyed Susan, Shasta daisy, Chrysanthemum)

38. Emergency Medical Care • Routine treatment for this type of absorbed poisoning is mainly supportive until arrival at the hospital. • Keep the patient from scratching the site as this may cause a break in the skin which may allow for infection.

39. Poisoning Emergencies Poison Control Centers ENRICHMENT

40. Poison Control Centers • Established across the United States and Canada to assist in the treatment of poison victims. • Officials at the center can help you set priorities and formulate an effective treatment plan. (Continued)

41. Poison Control Centers • Be prepared to give poison center officials the patient’s approximate age and weight. • Any directions from a poison center should be verified by your medical direction. • Follow local protocol.