POISONING, DRUG & MEDICATION ABUSE

1. POISONING,DRUG &MEDICATION ABUSE

2. Types of Poisoning • Ingested Poisons • Orally (swallowed) • Inhaled Poisons • Respiratory system (breathedin) • Most common cases -carbon monoxide poisoning • Injected Poisons • Break in the skin • Absorption (Surface Contact)Poisons • Through the skin, often with no visible sign ofentry

3. Danger of Further Injury • Poison may enter your body the same way itenteredyour patient's body • Especially true in cases ofabsorption or inhalation poisoning • Always attempt to establish the nature of thepoisoning agent before taking action that couldendanger yourself or others

4. Pesticides Herbicides Gaseous compounds Medicines Household cleaning products Plants Paints Burning plastics Specific poisons Perfumes Food Common Examples

5. Nausea Vomiting Abdominal pain Constriction or dilation of pupils, Excessive salivation Excessive sweating Abnormal respirations or pulse Loss of consciousness Convulsions Signs and Symptoms

6. Poison Control Centre • What is the poisoning agent? • How much was taken? • The mechanism of poisoning? • The patient’s vital signs? • Was the poison: ingested, inhaled, injected, or absorbed through the skin? • How long ago was the poison taken? • What is the present status of the patient?

7. Poison Control Centre - 911 • Alberta 1-800-332-1414 • British Columbia 1-800-567-8911 • Manitoba 911 • New Brunswick 911 • Newfoundland (709) 722-1110 • Northwest Territories (867) 669-4100 • Nova Scotia 1-800-565-8161 • Ontario 1-800-268-9017 • PEI 1-800-565-8161 • Quebec 1-800-463-5060 • Saskatchewan 1-866-454-1212 • Yukon (867) 393-8700

8. General Treatment - Unresponsive • Do not give fluids or induce vomiting • Check vital signs • If vitals signs are normal or stable • Determine the poisoning agent • Call the Poison Control Centre • Monitor the vital signs frequently • Transport as a Load and Go • If ABC are compromised • Perform AR or CPR (with appropriate barrier device) • Collect any vomitus and any containers that may have held the suspected poisoning agent with the patient

9. General Treatment - Responsive • Check vital signs • Determine the poisoning agent • Call the Poison Control Centre • If directed, induce vomiting • Monitor the vital signs frequently • Transport as a Load & Go • Collect any vomitus and any containers that may have held the suspected poisoning agent with the patient

10. Ingested Poison • Induce vomiting only if directed by the Poison Control Centre • Do not induce vomiting if: • The patient is unresponsive or convulsing • The poison is a known corrosive agent such as: acid, lye, drain cleaner, or if it has caused burns to the lips, mouth or throat. a poison that contains petroleum distillates

11. Inhaled Poisons • Additional signs and symptoms: • Respiratory distress • Coughing • Pain and burning in the throat • Pain in the chest • Cyanosis

12. Treatment • Remove the patient from the contaminated atmosphere • Check and monitor vital signs • Ensure that the airway, breathing and circulation are maintained • Initiate AR/CPR as necessary • Administer oxygen, if available • Identify the poisoning agent • Contact the Poison Control Centre and follow their instructions • Transport to medical aid If the environment is unsafe, do not intervene, call the EMS and inform them of the situation

13. Injected Poisons • Signs and symptoms • Confusion • Disorientation • Delusions • Pain • Tenderness/swelling at the site of entry • Unresponsive • Diminished function or failure of the respiratory or circulatory systems

14. Treatment • If swelling is apparent, remove all rings, watches and jewellery from the affected limbs • Apply a constriction band • Check, maintain and monitor vital signs • Identify the poisoning agent • Call the Poison Control Centre and follow the directions • Transport the patient to medical aid

15. Pressure Immobilization Bandage • is a tourniquet-like (venous tourniquet) device • applied proximally (closer to the heart) to the injured or poisoned region of an extremity.

16. Pressure Immobilization Bandage • A pressure immobilization bandage must: • completely encircle the extremity • be narrow enough to impede circulation • be wide enough that the skin is not damaged • Impedes circulation sufficiently to impede venous return to the heart, but not to completely eliminate arterial supply • Peripheral pulse should still be palpable

17. Absorbed Poison • Common absorption poisons include: • Pesticides • Herbicides • Corrosives • Acids • Alkalis • Some petroleum distillates

18. Signs and Symptoms • Nausea • Sweating • Skin irritation • Burns • Abdominal and substernal tightness • Abdominal cramps • Profuse salivation • Respiratory distress • Muscle twitching • Seizures • Paralysis

19. Treatment • Protect yourself from skin contamination • Remove the agent from continued skin contact by: • Removing any contaminated clothing from the patient • If substance is not reactive to water, wash the area including directing a stream of water • If the poison is solid or in granular form, remove as much of it as possible by brushing before washing with water • Identify the poison • Call the Poison Control Centre and follow the directions given • Transport the patient to medical aid

20. Insect Stings • Stings from insects such as bees, wasps, and hornets are prevalent particularly during the warmer months and are more common among children • The body reacts to insect stings on two different levels, local and systemic

21. Local Pain Redness Itching Swelling Systemic Breathing difficulty Swelling around throat Skin welts or hives General itching Weakness Headache Abdominal pain Anxiety Restlessness Reaction to stings

22. Local For bee stings: scrape surface to remove stinger and venom sack Apply ice Systemic Monitor and be prepared to provide critical intervention Scrape surface to remove stinger and venom sack Apply ice to the area If possible, collect insect for identification Transport to next level of EMS Treatment

23. Snake Bite • North American poisonous snakes : • Coral Snakes • Rattlesnakes • Copperheads • Water Moccasins • The venom of rattlesnakes, copperheads andwater moccasins alters normalcharacteristics of blood, particularly its ability toclot • Coral snake's venom affects the nervous system

24. Bleeding under the skinand purplishdiscolouration afterseveral hours Blood blisters Sweating Vomiting Rapid pulse Limb numbness Weakness Faintness Low blood pressure Severe burning pain and immediate swellingat the bite site, increasing over the nextsix-to-eight hours If no swelling has occurred after one hour,injection of venom is unlikely to haveoccurred Signs and Symptoms

25. Treatment • Calm and reassure the patient • Have them lie down and keep them quietthroughout transportation to hospital • Do not give them any alcohol • Rings, watches and constricting clothing should be removed • Clean the bite site with soap and water or anantiseptic solution, if available

26. Treatment • Locate the fang marks and place a pressure immobilization bandage around the entire length of the bitten extremity • Immobilize the extremity in a splint to reducecirculation in the limb • Check and monitor vital signs • Ensure that the ABCs are maintained

27. Treatment • Under no circumstances should an ice pack orcold pack be applied to the area. Some typesof snake venom are activated by cold • Transport to medical aid • If possible, advise the medical facility prior tothe patient's arrival in order that anti-venommay be awaiting them

28. Drug Abuse • Drug • any chemical that modifiesthe function of living tissues resulting inphysiological or behavioural changes • Drug use • usage of therapeutic or non-therapeutic substances to produce a desired effect with minimum hazard • Drug abuse • whenever drugs are takenor administered under circumstances and atdoses that significantly increase their hazardpotential

29. Commonly Abused Drugs • Tranquilizers • Antidepressants • Analgesics • Alcohol • Prescription medication • Solvents

30. Breath odour Nausea Vomiting Lack of coordination Slurred of speech Emotional instability Loss of inhibitions Aggressive, violent behaviour and abusive language Deep respiration Facial flushing Dilated pupils Alcohol - Signs and Symptoms

31. Solvents - Signs and Symptoms • Characteristic strong odour of glue or of other chemicals • Symptoms of intoxication similar to alcohol • Euphoria • Uncoordinated gait • Slurred speech

32. Barbiturates - Signs and Symptoms • Decreased blood pressure • Decreased respiration rate • Slurred speech • Involuntary horizontal eye movement • Lack of physical coordination • Absence of alcohol odour

33. Narcotics-Signs and Symptoms • Nausea • Vomiting • Constricted pupils • Constipation • Decreased respiration rate • Unresponsiveness to pain • Lethargy • Numerous injection sites along veins of the arms or legs

34. Dilated pupils Loss of appetite Over- or hyperactivity Rapid speech Belligerence Suspiciousness Confusion Rapid and strong pulse Shallow respiration Dry mouth Profuse perspiration Stimulants - Signs and Symptoms

35. Cannabis - Signs and Symptoms • Intoxication and euphoria without drastic change in judgement or gait • Reddening of the eyes • Increased pulse rate • Unusual hilarity • Increased appetite

36. Markedly-dilated pupils Unusual hilarity Emotional swings Suspiciousness Bizarre behaviour Nausea and vomiting Increased pulse rate and blood pressure, Sweating Anxiety Hallucinogens - Signs and Symptoms

37. Treatment - Conscious • Introduce yourself; attempt to carry on a conversation • Attempt to establish their current state of mind • If possible, attempt to "talk them down" and place them in a quiet, dimly lit room • Try to establish the causative drug for the patient's current state • Be aware of sudden changes in personality or behaviour • Transport to medical aid

38. Treatment - Unconscious • Establish the presence of vital signs • Maintain and monitor vital signs • Question bystanders and/or search the surroundings to establish the patient's past medical and drug history • Transport the patient to medical aid • Transport any findings to hospital with the person

39. Assume the Worst • Never assume that any altered level of consciousness or personality changes are the result of drug ingestion • Treat as per any other casualty with an altered level of consciousness

40. Remember • Further danger • Protect yourself and others from the poison • Use barrier devices • Control / avoid the source of the poison