Chapter 22 Toxicologic Emergencies for EMT

EMT

1. Chapter 22 Toxicologic Emergencies Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care , Ninth Edition Joseph J. Mistovich • Keith J. Karren

2. Poisons and Poisonings

3. Poisons and Routes of Exposure

4. Poison Toxicology Toxins Antidotes Overdose Certain toxins may not be poisonous when used properly (i.e. prescribed narcotic medications)

5. Ingestion Definition Location Effect

6. Inhalation Definition Location Effect

7. Injection Definition Types Location Effect

8. Absorption Definition Location Effect

9. Managing the Poisoning Patient

10. Supportive care Reassessment Preventing aspiration

11. Antidotes

12. Availability ALS unit medications (You don’t have to memorize ALL of these) ALS BLS

13. Ingested Poisons

14. Length of time Amount ingested Common types

15. Assessment-Based Approach: Ingested Poisons Scene Size-Up

16. Scene Size-Up Look for clues.

17. Assessment-Based Approach: Ingested Poisons Primary Assessment

18. Primary Assessment Mental status ABCs Skin temperature, color, condition

19. Assessment-Based Approach: Ingested Poisons Secondary Assessment

20. Secondary Assessment History Signs and symptoms Vital signs

21. Assessment-Based Approach: Ingested Poisons Emergency Medical Care

22. Emergency Medical Care Maintain airway Provide O 2 Assist ventilation Prevent further injury Consult medical direction Bring possible poison

23. Assessment-Based Approach: Ingested Poisons Reassessment

24. Reassessment Monitor ABCs Monitor vital signs Monitor mental status

25. Activated Charcoal

26. Use Action Dose Brands

27. Inhaled Poisons

28. Common poisons “ Huffers ” Effect

29. Assessment-Based Approach: Inhaled Poisons Scene Size-Up

30. Scene Size-Up SAFETY for all May need assistance Fire More ambulances

31. Assessment-Based Approach: Inhaled Poisons Primary Assessment

32. ABCs Ventilation O 2 Skin color, temperature, condition Primary Assessment

33. Assessment-Based Approach: Inhaled Poisons Secondary Assessment

34. Secondary Assessment History Vital signs Signs and symptoms

35. Assessment-Based Approach: Inhaled Poisons Emergency Medical Care

36. Emergency Medical Care Remove patient from environment Position patient Open airway Provide O 2 supplement Bring containers

37. Assessment-Based Approach: Inhaled Poisons Reassessment

38. Reassessment Reassess ABCs Reassess vital signs

39. Injected Poisons

40. Points of entry Most common types Anaphylactic shock

41. Scene Size-Up Assessment-Based Approach: Injected Poisons

42. Scene Size-Up Look for possible paraphernalia Consider possible bite or sting

43. Primary Assessment Assessment-Based Approach: Injected Poisons

44. Primary Assessment ABCs Ventilation O 2 Signs and symptoms Mental status

45. Secondary Assessment Assessment-Based Approach: Injected Poisons

46. Secondary Assessment History Vital signs Signs and symptoms

47. Reassessment Assessment-Based Approach: Injected Poisons

48. Reassessment Reassess ABCs Reassess vital signs Monitor for anaphylactic reaction

49. Absorbed Poisons

50. Causes Reactions

51. Assessment-Based Approach: Absorbed Poison Scene Size-Up

52. Scene Size-Up Note any open containers Wear gloves Consider additional help Remove patients from scene

53. Assessment-Based Approach: Absorbed Poison Primary Assessment

54. Primary Assessment ABCs Ventilation Look for poison on clothes

55. Assessment-Based Approach: Absorbed Poison Secondary Assessment

56. Secondary Assessment History Vital signs Signs and symptoms

57. Assessment-Based Approach: Absorbed Poison Emergency Medical Care

58. Emergency Medical Care Remove the patient from source Remove contaminated clothing Provide O 2 Brush dry chemical from skin If liquid, flush skin If in eye, flush eye

59. Assessment-Based Approach: Absorbed Poison Reassessment

60. Reassessment Reassess the patient ’ s airway and breathing.

61. Specific Types of Poisonings

62. Food Poisoning

63. Carbon Monoxide Poisoning

64. How it is formed Signs and symptoms Emergency medical care

65. Cyanide

66. Where it is found Signs and symptoms Emergency medical care

67. Acids and Alkalis

68. Where they are found Effect on body Signs and symptoms Emergency medical care

69. Hydrocarbons

70. Where they are found Route s/s can vary – (coughing, SOB, N/V, fever, AMS) Emergency medical care

71. Methanol (Wood Alcohol)

72. A poisonous form of alcohol found in many common products Gasoline, antifreeze, paints, canned fuels Route: ingestion, inhalation, absorption s/s – (AMS, szs, N/V, blurred vision, dilated pupils) Emergency medical care Methanol (Wood Alcohol)

73. Isopropanol (Isopropyl Alcohol)

74. Isopropyl Alcohol Most common form is rubbing alcohol Also found in cosmetics, disinfectants, and other cleaning agents Route: most commonly by ingestion s/s – (resp depression, AMS, hematemesis, shock) Emergency medical care

75. Ethylene Glycol

76. Ethylene Glycol Found in detergents, antifreeze, windshield deicers, and coolants Route: most commonly by ingestion Signs and symptoms Emergency medical care Neuro stage- appears intoxicated Cardiopulmonary stage- 12-24 hrs later Renal stage- 24-72 hrs later

77. Poisonous Plants

78. Route Where they are found Emergency medical care

79. Suicide Bags and Chemical Suicide by Toxic Inhalation

80. Method SCENE SAFETY Emergency medical care

81. Poison Control Centers

82. Available across the U.S. Toll-free calls Utilize in poisonings

83. Drug and Alcohol Emergencies

84. Drug abuse Overdose Withdrawal

85. Assessment-Based Approach: Drug and Alcohol Emergencies Scene Size-Up

86. Safety Watch for weapons Rule out medical causes Stroke Hypoglycemia Scene Size-Up

87. Assessment-Based Approach: Drug and Alcohol Emergencies Primary Assessment

88. Primary Assessment General impression Mental status ABCs Priority

89. Assessment-Based Approach: Drug and Alcohol Emergencies Secondary Assessment

90. Secondary Assessment Check for trauma History Vital signs “ Pharming ” s/s of different drugs (CNS Stimulants, CNS Depressants, Narcotics, Hallucinogens, Inhalants)

91. Assessment-Based Approach: Drug and Alcohol Emergencies Emergency Medical Care

92. Emergency Medical Care ABCs O 2 Positioning Keep patient warm Blood glucose level Restrain only if necessary

93. Assessment-Based Approach: Drug and Alcohol Emergencies Reassessment

94. Reassessment ABCs Vital signs Reassess Every five minutes for unstable Every 15 for stable

95. Managing a Violent Drug or Alcohol Abuse Patient

96. The Talk-Down Technique Make the patient feel welcome Identify yourself clearly Reassure the patient Help the patient verbalize Reiterate simple and concrete statements Forewarn the patient about the effect of the drug wearing off Once patient is calm, transport

97. Specific Substance Abuse Considerations

98. Drug Withdrawal

99. Tolerance Dependence Preoccupation Signs and symptoms of withdrawal

100. The Alcoholic Syndrome

101. Signs and symptoms are unrelated to the effects alcohol Wernicke-Korsakoff syndrome (paralysis of eyes, AMS, dementia, coma) Alcoholic prone illnesses

102. The Withdrawal Syndrome

103. The Withdrawal Syndrome Delirium Tremens

104. Delirium Tremens Life-threatening (5-15% mortality rate) Occurs 1 to 14 days after last drink Can last days s/s – (confusion, restless, high fever, dilated pupils, N/V, hallucinations)

105. Opioids

106. Opioids Effect Types Life-threatening Signs and symptoms

107. Narcan (Naloxone) When to use BVM first, if needed Route Dose (“0.4 mg – 2mg”?)

108. PCP, Cocaine, Amphetamines, Methamphetamines, PABS, and MDMA

109. PCP Cocaine (various forms) Amphetamines Methamphetamines PABS (Bath Salts) MDMA

110. PCP, Cocaine, Amphetamines, Methamphetamines, PABS, and MDMA Signs and Symptoms of PCP, Cocaine, Amphetamines, Methamphetamines, PABS, and MDMA

111. Signs and Symptoms (can vary by drug) Agitation or excitation Unresponsiveness to pain Dilated pupils Seizures Myocardial infarction Aortic dissection Severe headache

112. PCP, Cocaine, Amphetamines, Methamphetamines, PABS, and MDMA Emergency Medical Care

113. Tetrahydrocannabinol (Synthetic cannabinoids)

114. Signs and Symptoms Decrease in short term memory Impaired motor skills Reddened sclera Tachycardia Poss decreased BP Hallucinations Ataxia ( uncoordination ) Violent behavior Vomiting Emergency Care Names

115. Emergency Medical Care Safety Restrain if needed Check for injuries ABCs Vital signs

116. Medication Overdose

117. Types of medications Signs and symptoms Emergency medical care