1 / 35

Poisoning and Overdoses

Chapter 21. Poisoning and Overdoses. Case History.

kylynn-foley
Download Presentation

Poisoning and Overdoses

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Chapter 21 Poisoning and Overdoses

  2. Case History You are dispatched to a poisoning and find a 5-year-old girl who is suspected of having ingested a large quantity of acetaminophen (Tylenol) tablets. The mother shows you an empty bottle, but the child appears perfectly normal and has normal vital signs. The child is alert and oriented.

  3. Introduction • Poison • A substance that usually kills, injures, or impairs an organism through its chemical action • Overdose • Drugs, taken in excess or in combination with other agents, to the point where poisoning occurs

  4. Incidence • More than 5 million poisonings occur each year in U.S. • Most occur in children <5 years of age. • Poisonings cause more than 10,000 deaths. • Other causes • Drug abuse • Suicide • Animal or insect bites

  5. Poison Control Centers • Provide access to experts in toxicology. • Staffed 24 hours a day. • Coordinate emergency response • Provide advice to patients at home • Refer people to area hospitals with poisoning care capabilities • Advise EMTs, physicians, and nurses

  6. Types of Poisonings • Ingested • Injected • Inhaled • Absorbed

  7. Cardinal Rules • Treat the patient, not poison. • Protect self and bystanders. • Look for clues of trauma. • Maintain a high level of suspicion.

  8. Scene Size-up • Survey the scene to protect yourself and bystanders. • Dangers • Toxic gases • Absorbed toxins • Do not enter without adequate protection. • Only trained hazmat rescuers should enter.

  9. Initial Assessment • What is your general impression? • Findings indicate any trauma? • Is the patient awake and responsive? • Airway, Breathing, Circulation

  10. Focused History • What is the poison? • How was it taken? • Was it ingested, inhaled, absorbed, or injected? • When was it taken? • How much was taken? • Over what period of time?

  11. Focused History • Is there any other evidence at the scene (e.g., commercial products, pills)? • Were any other interventions attempted? • Vomiting • Dilution • Activated charcoal • Syrup of ipecac • Antidote • How much does the patient weigh?

  12. Perform a Focused Physical Examination • Skin • Pupils • Breath sounds • Abdomen • Mental status • Vital signs

  13. Emergency Medical Care • Remove patient from poisonous environment. • Ensure patent airway and administer oxygen. • Be alert for vomiting. • Bring all poison agents to hospital. • Containers • Bottles • Labels

  14. Ingested Poisons – Signs and Symptoms • History of ingestion • Nausea • Vomiting • Diarrhea

  15. Ingested Poisons – Signs and Symptoms • Altered mental status • Abdominal pain • Chemical burns around the mouth • Different breath odors

  16. Odors Smell Possible Poison Acetone (sweet, fruity) Ethanol, isopropyl alcohol, diabetic Alcohol Alcohol, isopropyl alcohol Disinfectants Creosol and phenol Rotten eggs Hydrogen sulfide Garlic Insecticides Stale tobacco Nicotine Wintergreen Methyl salicylate

  17. Emergency Medical Care • Remove poison from patient’s mouth using gloves. • Consult medical direction. • Activated charcoal • Bring all containers (bottles, labels, etc.,) to hospital.

  18. Types of Ingestions • Sedative-hypnotics • Antianxiety agents • Opioids • Psychiatric medications • Stimulants

  19. Types of Ingestions – Sedative-Hypnotics • Barbiturates • Secobarbital (Seconal) • Pentobarbital (Nembutal) • Benzodiazepines • Diazepam (Valium) • Chlordiazepoxide (Librium) • Chlorazepate (Tranxene)

  20. Types of Ingestions –Sedative-Hypnotics • Others • Methaqualone (Quaalude) • Ethchlorvynol (Placidyl) • Chloral hydrate (Noctec) • Mebrobamate (Miltown)

  21. Toxic Effects –Sedative-Hypnotics • Altered mental status • Respiratory depression and arrest • Most toxic when combined with alcohol • Support of ABCs is critical.

  22. Types of Ingestions Opioids (Narcotics) • Central nervous system depressant • Examples • Heroin • Morphine • Percocet • Percodan

  23. Toxic Effects/Management – Opioids (Narcotics) • Toxic effects and signs and symptoms • Altered (depressed) mental status • Respiratory depression • Pinpoint pupils • Track marks • Management • Support ABCs • Administration of naloxone(Narcan) by ALS providers or hospital

  24. Ingested Substances • Stimulants • Cause increased excitability (e.g., amphetamines) • Alcohol • Heart and lung drugs • Analgesics

  25. History of inhalation of toxic substance Difficulty breathing Chest pain Cough Hoarseness Dizziness Headache Confusion Seizures Altered mental status Inhaled Poisons – Signs and Symptoms

  26. Poisonous Gases • Simple asphyxiants • Carbon dioxide • Small hydrocarbon molecules • Chemical asphyxiants • Irritant gases • Organophosphates

  27. Toxic Injection – Signs and Symptoms • Weakness • Dizziness • Chills • Fever • Nausea • Vomiting

  28. Absorbed Poisons – Signs and Symptoms • History of exposure • Liquid or powder on patient’s skin • Burns • Itching • Irritation • Redness

  29. Emergency Medical Care • Skin • Remove contaminated clothing. • Protect self from contamination. • Powder • Brush powder off patient. • Irrigate for at least 20 minutes. • Continue en route to facility, if possible . • Liquid • Irrigate for at least 20 minutes. • Continue en route to facility, if possible.

  30. Medication Name • Generic • Activated charcoal • Trade • SuperChar™ • InstaChar™ • Actidose™ • LiquiChar™

  31. Activated Charcoal • Indications • Poisoning by mouth • Contraindications • Altered mental status • Ingestion of acids or alkalis • Inability to swallow

  32. Medication Form • Medication is pre-mixed in water. • Plastic bottle containing 125 grams activated charcoal • Powder should be avoided in field.

  33. Dosage • Adults and children • 1 gram activated charcoal/kg of body weight • Usual adult dose • 25 - 50 grams • Usual infant/child dose • 12.5 - 25 grams

  34. Actions • Charcoal binds to certain poisons. • Binding action prevents absorption. • Not all brands are the same. • Some bind much more poison • Consult medical direction about the brand to use.

  35. Side Effects • Black stool • Some patients may vomit. • If the patient vomits, repeat dose one time. • Reassessment strategies • Prepare for vomiting and deterioration of patient’s condition.

More Related