1. Poisoning and Overdose Emergencies

2. Topic Overview Emergency Medical Care of Poisoning / Overdose
Relationship to Airway Management

3. Poisoning and Overdoses
Poisonings
There were over 2,500,000 reported poisonings reported in 1993
Poison
Any substance that can harm the body
Can also involve living organisms that produce toxins

4. Poisoning and Overdoses
Ingested- This can include household and industrial chemicals, medications, improperly prepared foods, plant materials, petroleum products, and agricultural products
NOTE: Extreme care must be taken when ventilating a patient that has ingested any substance. Practice BSI!

5. Poisoning and Overdoses
Inhaled
Carbon monoxide, ammonia, chlorine, insect sprays, and gases produced by volatile chemicals
Absorbed
Usually through unbroken skin. Many corrosives and irritants can be absorbed after causing the skin to breakdown

6. Poisoning and Overdoses
Injected- The most common is illicit drugs but can include snakes fangs and insects stingers

7. Poisoning and Overdoses
Patient Assessment-Ingested Poisons
What was the substance?
Get exact name
Bring container
When did the exposure occur?
How much was ingested?
If not known, estimate possible amount

8. Poisoning / Overdoses
Over how long a period did the ingestion take place?
If not known, estimate shortest and longest possible times
What interventions taken?
What is the patients estimated weight?
Is the patient experiencing any effects from the ingestion?

9. Poisoning / Overdoses Ingested Poisons Signs and Symptoms
Altered mental status
Abdominal pain
Chemical burns around mouth
Unusual breath odor
History of ingestion
Nausea / Vomiting
Diarrhea

10. Poisoning and Overdoses
Treatment for Ingested Poisons
ABCs- Correct any life-threatening problems
Call Poison Center POISON1
Follow directions given by poison control
Activated Charcoal
It is designed to absorb large amounts
Does not work on all poisons

11. Poisoning / Overdoses
Trade Names: SuperChar, InstaChar, LiquiChar

12. Activated Charcoal Indications Contraindications
Poisoning by mouth
Contraindications
Altered mental status
Ingestion of acid or alkali
Patient unable to swallow
Follow directions of Poison Control Center

13. Poisoning and Overdoses
Treatment- (Cont.)
Check head, neck, chest and abdomen
SAMPLE history
Baseline vital signs
Transport any containers or bottles from the substance
On-going assessment

14. Poisoning and Overdoses
Pediatric Poisonings
Are frequent victims
Very important to have the weight of the patient
Always assume a lethal dose has been ingested

15. Poisons / Overdoses Inhaled Poisons General Signs and Symptoms
History of inhalation
Difficulty speaking
Chest pain
Cough
Hoarseness
Dizziness
Headache / Confusion
Seizures
Altered Mental Status

16. Poisoning and Overdoses
Patient Assessment- Inhaled Poisons
What substance?
When did the exposure occur?
Over how long a period was the exposure?
Any interventions?
What effects have been noted?

17. Poisoning and Overdoses
Treatment - Inhaled Poisons
ABCs- Correct any life-threatening problems
Call Poison Center POISON1
Follow directions given by poison control ABCs- Correct any life-threatening

18. Poisoning and Overdoses
Treatment
Check head, neck, chest and abdomen
SAMPLE history
Baseline vital signs
On-going assessment

19. Poisoning and Overdoses
Inhaled Poisons
Carbon Monoxide
Most common inhaled poison
Vehicle exhaust and fire suppression
Odor-less and color-less
Signs & Symptoms
Headache
Dizziness
Dyspnea
Cyanosis
Altered Mental Status

20. Poisoning and Overdoses
Smoke Inhalation
S and S
Shortness of Breath
Coughing
Smoky breath odor
Carbon residue around mouth and nose
Black residue in sputum
Nose hairs signed

21. Poisoning and Overdoses
Absorbed Poisons
Signs and Symptoms
History of exposure
Liquid or powder on skin
Burns
Itching, irritation, redness

22. Poisoning and Overdoses
Patient Assessment- Absorbed Poisons
What substance?
When did the exposure occur?
Over how long a period of time?
Any interventions?
What effects?

23. Poisoning and Overdoses
Care – Absorbed Poisons
Remove patient from source
Remove clothing or substance from the patient which might be contaminated
Brush powders from patient
Irrigate with water for at least 20 minutes
Initial Assessment
SAMPLE History

24. Poisoning and Overdoses
Care – Absorbed Poisons
Eye
Irrigate with clean water for at least 20 minutes or until EMS arrives

25. Poisoning and Overdoses
GENERAL SAFETY For Inhaled and/or Absorbed Poisons
Need to know wind direction and speed
Park Uphill and Upwind of the incident

26. Poisons / Overdoses Relationship to Airway Management
When treating a poisoned or overdoses patient whose airway is patent, be prepared for deterioration and need to secure airway

27. Poisoning and Overdoses
Alcohol Abuse (ETOH)
Can be a real problem to assess
May require police assistance
Patient often has multiple problems in addition to the abuse of alcohol

28. Poisoning and Overdoses
Patient Assessment
Odor of alcohol on the patient’s breath
Swaying and unsteady gait
Slurred speech, rambling, incoherent words
Flushed appearance to the face
Poor coordination

29. Poisoning and Overdoses
Patient Assessment
Slowed reaction time
Blurred vision
Confusion
Hallucinations
Blackouts
Altered LOC

30. Poisoning and Overdoses
Signs & Symptoms of ETOH Withdrawal (DTs)
Confusion and restlessness
Unusual behavior
Hallucinations
Gross tremors
Profuse sweating
Seizures
Watch for vital signs changes ETOH abuser often mix with recreational drugs

31. Poisoning and Overdoses
Patient Care for ETOH Abuse
Watch for respiratory problems
Watch for altered LOC
Vital signs
Treat for shock
Protect the patient from self-injury
Watch for seizures
Activate EMS

32. Poisoning and Overdoses
Do Not Assume That All Patients You Suspect Of ETOH Abuse Do Not Have Any Underlying Medical Condition
Many persons are arrested for DWI and later found to be a diabetic with low blood sugar
Do a good patient assessment

33. Poisoning and Overdoses
Substance Abuse
Stimulants
Amphetamines, Uppers, Cocaine, Methamphetamine
Depressants
Barbiturates, Downers, Valium, Heroin, Morphine, Codeine, Inhalants, Alcohol
Psychedelics (Hallucinogens)
LSD, PCP, Mescaline, Cannabis

34. Poisoning and Overdoses
Patient Assessment- Substance Abuse
Stimulants
Excitement, increased alertness, euphoria
Increased pulse and breathing
Restlessness, irritability, Insomnia
Rapid Speech
Dry mouth
Dilated Pupils
Decreased appetite

35. Poisoning and Overdoses
Patient Assessment- Substance Abuse
Depressants
Relaxation, decreased awareness
Drowsiness
Slowing pulse and respirations
Impaired coordination
Slurred speech
Stupor, death

36. Poisoning and Overdoses
Patient Assessment-Substance Abuse
Hallucinogens
Breakdown of Inhibitions
Alteration of perceptions (hallucinations)
Visual and Auditory - Bugs crawling on the wall
Increased appetite
Rapid Pulse, Dilated Pupils, Flushed Face
Tremors, Death

37. Poisoning and Overdoses
Patient Care- Substance Abuse
Initial Assessment
Watch for airway problems
Treat for shock
Try to gain the patient’s confidence
Perform a rapid trauma assessment
Check for track marks

38. Poisoning and Overdoses
Patient Care- Substance Abuse
Protect the patient from self-injury
Transport ASAP and contract medical control
On-going Assessment

39. Poisoning and Overdoses
ALWAYS CLOSELY MOINTER SUBSTANCE ABUSE PATIENTS FOR
CHANGES IN CONDITION AND FOR TENDENCY TO BECOME VIOLENT

40. Bites and Stings Assessment – Signs and Symptoms
History of spider / snake bite / insect / scorpion / marine animal sting
Pain, redness, swelling
Dizziness and chills
Fever
Nausea and vomiting
Bite marks or stinger

41. Bites and Stings Bites and Stings Emergency Care Wash area gently
Remove jewelry distal to affected area
Position injection site slightly below heart
Observe for allergic reaction

42. Snakes, Spiders, Scorpions
Review information from Tri 5 Phar/Tox
To review go to Basic Sciences, Pharmacology/Toxicology, Dr. Giggleman’s lecture notes on Spiders and Snakes.

43. Ticks
Tick Removal
Using forceps grasp tick at apex of thorax (toward the head) and apply gently backward pressure until the tick releases. Remove the tick.
Scrub area vigorously with soap and water
Watch for signs of infection

44. Marine Life Injuries

45. Marine Life Injuries Specific Injuries - Stingray Envenomations
Rinse wound vigorously with fresh water
Immerse in nonscalding hot water to tolerance ( oF or oC) for minutes to reduce pain. Repeat if pain recurs.
Remove any visible pieces of the stinger or sheath. Scrub with soap and water, irrigate vigorously with fresh water
Do not tape wound, watch for infection

46. Marine Life Injuries Specific Injuries - Sea Urchin Punctures
Immerse punctured area in nonscalding hot water (same as for stingray injury)
Remove any visible pieces of the spine(s)
Purple or black discoloration of the skin does not necessarily mean that a spine is present
Scrub with soap and water
Do Not crush a spine in the skin
If a spine has penetrated into or near a joint it may need to be removed surgically

47. Marine Life Injuries
Specific Injuries - Jellyfish Stings (including man-of-war, box-jelly, sea nettle, Irukandji, anemone, hydroid)
Immediately rinse skin in sea water (DO NOT rinse with fresh water. Do NOT apply ice. DO NOT rub the skin.)
Apply soaks of acetic acid 5% (vinegar) until pain is relieved. If acetic acid is not available use isopropyl alcohol, dilute (1/4 strength) ammonia, a paste of baking soda, a paste of unseasoned meat tenderizer, or mashed papaya.

48. Marine Life Injuries Specific Injuries - Jellyfish Stings
Do Not apply aftershave, liquor, or organic solvents such as kerosene, turpentine or gas
Remove large tentacle fragments using forceps
Reapply vinegar
Soap affected area in nonscalding hot water (same as for stingray sting)

49. Marine Life Injuries Coral Cuts Irrigate with cleanest water available
Scrub vigorously with soap and water
Flush wound with 1/2 strength solution of hydrogen peroxide in water
Use topical antibiotic if infection develops
Use anti-itch cream if itching develops

50. Marine Life Injuries Scorpion Fish, Stone Fish, Lion Fish
Envenomations
Immerse in non-scalding hot water to tolerance ( oF or oC) for minutes to reduce pain. Repeat if pain recurs.
Keep extremity lower than heart level
Avoid excessive movement
Seek medical attention

51. Marine Life Injuries Bites
Control bleeding and attend to other life-threatening problems
Treat as you would any open soft tissue injury.
Seek medical attention as indicated.