Poisoning and Overdose Emergencies

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Poisoning and Overdose Emergencies
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Emergency Medical Care of Poisoning/Overdose

• Poison Control Center - Phone number -
  800-522-4611
• Chemtrec Emergency - Phone number - 800-424-9300
• Chemtrec Non-emergency - Phone number -
  800-262-8200

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Emergency Medical Care of Poisoning/Overdose

• Important questions to consider asking patient
• What substance?
• When did you ingest/become exposed?
• If an ingestion, how much did you ingest?
• Over what time period?

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Emergency Medical Care of Poisoning/Overdose

• Important questions to consider asking patient
  (Cont..)
• What Interventions?
• How much do you weigh?
• What effects are you experiencing from the
  ingestion?

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Emergency Medical Care of Poisoning/Overdose

• Ingested Poisons
• Signs and Symptoms
• History of ingestion
• Nausea
• Vomiting
• Diarrhea
• Altered mental status
• Abdominal pain
• Chemical burns around the mouth
• Different breath odors

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Emergency Medical Care of Poisoning/Overdose

• Ingested Poisons
• Emergency medical care
• Remove pills, tablets or fragments with gloves
  from patients mouth, as needed, without injuring
  oneself.
• Consult medical direction--activated charcoal.
• Bring all containers, bottles, labels, etc. of
  poison agents to receiving facility.

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Emergency Medical Care of Poisoning/Overdose

• Inhaled Poison
• Signs and Symptoms
• History of inhalation of toxic substance
• Difficulty breathing
• Chest pain
• Cough
• Hoarseness
• Dizziness

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Emergency Medical Care of Poisoning/Overdose

• Inhaled Poison
• Signs and Symptoms (Cont.)
• Headache
• Confusion
• Seizures
• Altered mental status

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Emergency Medical Care of Poisoning/Overdose

• Inhaled Poison
• Emergency medical care
• Have trained rescuers remove patient from
  poisonous environment.
• Give oxygen, if not already done in the initial
  assessment.
• Bring all containers, bottles, labels, etc. of
  poison agents to receiving facility.

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Emergency Medical Care of Poisoning/Overdose

• Toxic injection
• Signs and Symptoms
• Weakness
• Dizziness
• Chills
• Fever
• Nausea
• Vomiting

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Emergency Medical Care of Poisoning/Overdose

• Toxic injection
• Emergency medical care
• Airway and oxygen
• Be alert for vomiting.
• Bring all containers, bottles labels, etc. of
  poison agents to receiving facility.

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Emergency Medical Care of Poisoning/Overdose

• Absorbed Poisons
• Signs and Symptoms
• History of exposure
• Liquid or powder on the patients skin
• Burns
• Itching
• Irritation
• Redness

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Emergency Medical Care of Poisoning/Overdose

• Absorbed Poisons
• Emergency medical care
• Skin--remove contaminated clothing while
  protecting oneself from contamination
• Powder--brush powder off patient, then continue
  as for other absorbed poisons.
• Liquid--irrigate with clean water for at least 20
  minutes (and continue en route to facility if
  possible.)
• Eye--irrigate with clean water away from affected
  eye for at least 20 minutes and continue en route
  to facility if possible.

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Emergency Medical Care of Poisoning/Overdose

• Alcohol and Substance Abuse
• Signs and Symptoms
• Altered mental status ranging from mild
  disorientation to complete unresponsiveness.
• Abnormal respiratory pattern including
  excessively slow or absent breathing or rapid,
  deep breathing.
• Abnormal or irregular pulse rate
• Fever
• Seizures
• Extremely low or high blood pressure

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Emergency Medical Care of Poisoning/Overdose

• Alcohol and Substance Abuse
• Signs and Symptoms
• Sweating, tremors, and hallucinations (symptoms
  of alcohol withdrawal)
• Digestive problems that include abdominal pain,
  vomiting, bleeding, and dehydration
• Disturbances of vision, slurred speech, and
  muscular incoordination
• Disinterested behavior, loss of memory (blackout)
• Combativeness
• Paranoia

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Emergency Medical Care of Poisoning/Overdose

• Alcohol and Substance Abuse
• Emergency medical care
• Establish and maintain a patent airway
  concurrently establish spinal stabilization if
  the patient is unresponsive or has suffered an
  injury.
• Administer oxygen at 15 lpm by nonrebreather mask
  or positive pressure ventilation with
  supplemental oxygen, as needed.
• If the patient is responsive, try to get him to
  sit or lie on a stretcher.

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Emergency Medical Care of Poisoning/Overdose

• Alcohol and Substance Abuse
• Emergency medical care
• Monitor the patients, mental status and vital
  signs frequently.
• Try to maintain proper body temperature
• Take measures to correct or prevent shock
• Transport

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Relationship to Airway Management

• Use information and skills learned in airway
  section of course to manage airway difficulties.
  
• A patients condition may deteriorate, so
  continue to assess patient for airway
  difficulties and manage as learned previously.

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Medications

• Activated Charcoal
• Medication name
• Generic--Activated charcoal
• Trade
• SuperChar TM
• InstaChar TM
• Actidose TM
• LiquiChar TM

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Medications

• Activated Charcoal (cont.)
• Indications--poisoning by mouth
• Contraindications
• Altered mental status
• Ingestion of acids or alkalis
• Unable to swallow

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Medications

• Activated Charcoal (cont.)
• Medication form
• Pre-mixed in water, frequently available in
  plastic bottle containing 12.5 grams activated
  charcoal.
• Powder--should be avoided in field.
• Dosage
• Adults and children 1gram activated charcoal/kg
• Usual adult dose 25-50 grams
• Usual infant/child dose 12.5-25 grams

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Medications

• Activated Charcoal (cont.)
• Administration
• Obtain order from medical direction either
  on-line or off-line.
• Container must be shaken thoroughly.
• Since medications look like mud, patient may need
  to be persuaded to drink it.
• A covered container and a straw may improve
  patient compliance since the patient cannot see
  the medication this way.

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Medications

• Activated Charcoal (cont.)
• Administration
• If patient takes a long time to drink the
  medication, the charcoal will settle and will
  need to be shaken or stirred again.
• Record activity and time.

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Medications

• Activated Charcoal (cont.)
• Actions
• Binds to certain poisons and prevents them from
  being absorbed into the body.
• Not all brands of activated charcoal are the
  same some bind much more poison than others, so
  consult medical direction about the brand to use.

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Medications

• Activated Charcoal (cont.)
• Side effects
• Black stools.
• Some patient, particularly those who have
  ingested poisons that cause nausea, may vomit.
• If the patient vomits, the dose should be
  repeated once.

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Medications

• Activated Charcoal (cont.)
• Re-assessment strategies--the EMT should be
  prepared for the patient to vomit or further
  deteriorate.

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Medications

• Syrup of Ipecac
• Currently not part of EMT-B curriculum, But still
  use in some EMS services.
• It is said that reason for removal was that it
  takes to long to cause vomiting and that it does
  not remove enough of the poison from the stomach.
• Indications -- poisoning by mouth

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Medications

• Syrup of Ipecac (cont.)
• Contraindications
• Ingestion of any of the following
• strychnine,
• corrosive, such as alkalies (lye), strong acids,
• petroleum distillates, such as kerosene,
  gasoline, coal oil, paint thinner, or cleaning
  fluid

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Medications

• Syrup of Ipecac (cont.)
• Dosage for Responsive patients
• Adults and children over 1 year of age 1
  tablespoonful (15 mL) followed by 1to 2 glasses
  (8 to 16 ounces) of water, or as directed by
  medical direction.
• If vomiting does not occur within 30 minutes,
  repeat the dose.
• If previous attempts to contact a Poison Control
  Center, Emergency medical facility, or health
  professional were unsuccessful, continue trying.
  Keep patient active and moving.
• Save the container of poison.

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Other Poisoning to think of

• Food Poisoning
• Carbon Monoxide Poisoning
• Poisonous Plants

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Allergic Reactions
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Allergic Reaction

• Overwhelming response to a foreign substance
• Can be life threatening
• Can lead to death

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Immune System

• Bodies defense mechanism
• Antigens are foreign substances
• Immune response
• Recognizes the antigen
• Produces antibody protein to destroy the antigen

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Allergen

• Form of antigen
• Pollen, ragweed, dust
• Common and harmless to most individuals

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Sensitization

• Antibodies combined with antigen before
• Occurs continuously and often goes unnoticed
• Usually for an allergic reaction to take place a
  person has to of had at least one exposure

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Possible Causes

• Insect bites/stings-bees, wasps
• Food
• Plants
• Medications
• Others

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Assessment Findings Skin

• Warm tingling, face, mouth, chest, feet, and
  hands
• Itching
• Hive
• Red skin
• Swelling

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Respiratory System

• Tightness in the throat/chest
• Cough
• Rapid breathing
• Labored noisy breathing
• Hoarseness
• Stridor
• Wheezing

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Cardiac

• Increased heart rate
• Decreased blood pressure

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Generalized Findings

• Itchy, watery eyes
• Headache
• Sense of impending doom
• Runny nose
• Decreased mental status
• Findings that reveal shock

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Emergency Care

• Perform initial assessment
• Focused history physical exam
• History of allergies
• What was patient exposed to
• How was patient exposed
• What effects
• Progression
• Interventions

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Emergency Care

• Assess baseline vitals
• Big Os if not already done in initial assessment
• Epinephrine/Medical control
• Reassess vital in 2 minutes
• Record findings
• No epinephrine/transport immediately

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Airway Management

• Be prepared for airway compromise
• Can develop as reaction progresses

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Medications

• Epinephrine auto-injector
• Generic name- Epinephrine
• Trade name - Adrenalin

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Indications

• Assessment findings of an allergic reaction
• Medication is prescribed for this patient by a
  physician
• Medical direction authorizes use for the patient

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Contraindications

• None when used in a life-threatening situation

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Dosage

• Adult - one adult auto-injector (0.3 mg.)
• Infant and child - Infant or child auto-injector
  (0.15 mg.)
• Medication form liquid administered automatically
  intramuscularly

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Actions

• Dilates the bronchioles
• Constricts blood vessels

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Side effects

• Increased heart rate
• Pallor
• Dizziness
• Chest pain
• Headache
• Nausea/Vomiting
• Excitability, anxiousness

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Reassessment Strategies

• Transport, continue initial assessment
• Patient condition worsens
• Additional dose of epi
• Treat for shock
• Prepare for CPR, AED
• Condition improves
• O2 treat for shock and supportive care.