20)Poisoning And Overdose
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20)Poisoning And Overdose

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20)Poisoning And Overdose Presentation Transcript

  • 1. Poisoning and Overdose
  • 2. Poisoning and Overdose
    • Poison/Toxin
      • Any substance that usually kills, inures, or impairs an organism through its chemical actions.
    • Toxicology
      • Study of poisons
    • Toxic
      • Poisonous
    • Overdose
      • Self administration of a drug in excess OR in combination with other agents to the point where poisoning occurs.
    • DTs
      • “ Delirium Tremens”
      • A severe form of alcohol withdrawal that involves sudden and severe mental or neurological changes
  • 3. Introduction
    • Regional Poison Center
      • 1-800-222-1222
    • Second leading COD 2004
      • Exposure every 14 seconds
      • 2,482,041 exposures in 2007
      • 51.2% in childrem < 6 yo
      • 73.3% fatalities bt 20-59 yo
      • 32,691 poisoning deaths in 2005
  • 4.  
  • 5.  
  • 6. Types of Exposure
    • Ingestion
      • Swallowing
        • Suicidal pt with pills, Alcoholic with methanol, toddler/animal with antifreeze
    • Injection
      • Opioids – Insulin – Envenomation
    • Inhalation
      • CO is most common
      • Glue sniffing
      • Freebasing cocaine
    • Absorption
      • Organophosphate poisoning
      • Corrosives (acids/alkali)
  • 7.  
  • 8. Poisoning and Overdose S/S per Route
    • Ingested
      • Hx of ingestions
      • Nausea
      • Vomiting
      • Diarrhea
      • AMS
      • Abd pain
      • Chemical burns around the mouth
      • Different breath odors
    • Emergent care
      • Remove pills, tablets, fragments from pt mouth with gloved hands as needed, without injuring yourself
      • Consult medical direction – Activated Charcoal
      • Bring ALL containers, bottles, labels, etc of poison agent to hospital
  • 9. S/S per Route: Inhalation
    • S/S
      • Hx of inhalation of toxic substance
      • SOB
      • Chest pain
      • Cough
      • Hoarseness
      • Dizziness
      • Headache
      • Confusion
      • Seizures
      • AMS
      • Singed nasal hairs
    • Emergent care
      • Have trained rescuers remove pt from scene
      • Supplemental O2
      • Bring ALL containers, bottles, labels, etc of poison agent to hospital
    Smoke inhalation
  • 10. S/S per Route: Absorbed
    • S/S
      • Hx of exposure
      • Liquid or powder on pt skin
      • Burns
      • Itching
      • Irritation
      • Redness
    • Emergent Care
      • Remove contaminated clothing while protecting yourself
      • Brush powders off pt
      • Irrigate for at least 20 minutes of liquid exposure
      • If in eyes, irrigate for at least 20 minutes and while en route away from unaffected eye
  • 11. S/S per Route: Injection
    • S/S
      • Weakness
      • Dizziness
      • Chills
      • Fever
      • Nausea
      • Vomiting
      • Tack marks
    • Emergent Care
      • Airway patency and ventilation
      • Be alert for vomiting
      • Bring ALL containers, bottles, labels, etc of poison agent to hospital
  • 12. Sedatives, Hypnotics, Anti-Anxieties
    • Sedatives/Hypnotics/Anti anxiety
      • Sedatives
        • Calming, decrease activity
      • Hypnotics
        • Induce Sleep
      • Examples:
        • Barbiturates
        • Benzodiazepines
          • Ativan, Valium, Xanax, Sleeping Pills
        • GHB
        • Rohypnol
    • S/S
      • Resp depression
      • Depressed LOC
      • Coma
      • Death
  • 13. Opiods
    • Opioids
      • Narcotics
      • CNS depressants
      • Made from the Opium Poppy ( Papaver somniferum)
    • Examples
      • -Morphine – Codeine – Heroin – Oxycodone (Oxycontin)– Methadone – Meperidine (Demerol) – Fentanyl - Opium
    • S/S
      • CNS depression
      • Depressed LOC
      • Depressed Resp
      • PINPOPINT PUPILS
  • 14. Meperidine (Demerol) Methadone Morphine Morphine Opium Heroin
  • 15. Stimulants
    • Stimulants
      • Stimulates CNS
      • Increase alertness and physical activity
    • Examples
      • Amphetamines/Speed, Methamphetamine, Ritalin, Ecstasy, Cocaine, PCP, Nicotine
    • S/S
      • Excitability
      • Seizures
      • Increased heart rate
      • Increased BP
      • Chest pain
      • Dysrhythmia
      • Death
      • Ischemia
      • CVA
      • MI
      • Hyperthermia
  • 16. Amphetamines- Adderall Cocaine Methamphetamine- Crystal Meth. Ritalin Ecstasy Nicotine
  • 17. Ecstacy
  • 18.  
  • 19. Alcohol
    • Alcohol
      • Intoxicating agent in
      • fermented and distilled
      • liquors
    • S/S
      • AMS
      • Motor deficit
      • Coma
      • Resp failure
      • Vomiting
      • Aspiration
      • Death
  • 20. Analgesics
    • Analgesic
      • Pain killers
    • Examples
      • Aspirin
      • Acetaminophen
      • Motrin
      • Advil
    • S/S
      • Few early on
      • Liver damage within 48 hrs
  • 21. Organophosphates
    • Organophosphates
      • Inhibit acetylcholinesterase activity
      • Initial overstimulation followed by disruption of nerve transmission
    • Examples
      • Insecticides
      • Fertilizer
      • Nerve gases
    • S/S
      • Over stimulation of secretions
      • Bronchocontrsiction
      • Weakness
      • SLUDGE
  • 22.  
  • 23. Food
    • Food
      • Botulism
    • Suspect
      • When 2 of more people are ill after eating same food
    • S/S
      • Flu like S/S
      • Double vision
      • Trouble moving eyes/swallowing
      • Head-to-toe weakness
      • Paralysis
      • Resp arrest
    Clostridium botulinum
  • 24. Assessment
    • HIGH level of suspicion
    • Not always obvious
    • Suspect when large number of people become ill at once
      • i.e. Multiple people in a building with c/o headache, nausea, ALOC = CO poisoning
    • Bring containers and labels with you
    • Report noticeable odors
    • Consider trauma
    • ABC’s
  • 25. General Approach
    • Pt Hx
      • ESSENTIAL
      • High suspicion
        • Date of prescription vs medication left
      • ID/Quantity/Time of exposure/How/ Where exposed/Any treatments tried
      • Transport pills/bottles
    • Approach
      • Vitals, Oxygen, Monitor, IV, Transport (VOMIT)
      • Supportive care
        • Aspiration?
      • Consider AEIOU-TIPS
      • Traditional approach
        • Syrup of Ipecac (Airway compromise)
        • Gastic lavage (Manpower, esophageal rupture)
        • Activated charcoal (Relatively safe option)
  • 26. Scene Size Up/Initial Assessment
    • Scene Size-Up
      • Scene safety/BSI
      • Decontaminate pt
        • Remove contaminated clothing
        • Irrigate 20 minutes
        • Brush off powders
    • Initial Assessment
      • General impression
      • ABC’s
      • LOC/AVPU
      • Trauma?
      • Most deaths are due to Respiratory Compromise
        • Aggressively manage airway
  • 27. Focused Hx/Px
    • Hx
      • What substance?
      • When did pt ingest/become exposed?
      • How much did the pt ingest?
      • Over what time period?
      • Interventions?
      • How much does the pt weigh?
    • Px
      • Baseline Vitals
      • Track marks?
      • Some poisons present with a classical patter
        • Opiods – PINPOINT pupil, AMS, Decreased/Shallow Resps
        • Organophosphates – SLUDGE
          • - Salivation – Lacrimation – Urination – Defecation – GI complaints – Emesis
  • 28. Toxidromes
    • Set of clinical S/S that are diagnostic of certain toxins/class of toxins
    • Narcotics
      • Decreased LOC, Res Depression, Constricted pupils
        • Morphine, Codeine, Demerol (no pupil change), etc
    • Anticholinergics
      • “ Hot as Hades, blind as a bat, dry as a bone, red as a beet, mad as a hatter”
    • Cholinergics
      • Organophosphate poisoning
      • SLUDGE
        • Salivation, Lacrimation, Urination, Defecation, GI complaints, Emesis
  • 29. Opioid Overdose
  • 30. Salivation Lacrimation Urination Defecation GI Complaints Emesis Organophosphate Poisoning
  • 31. Management
    • Ensure Open Airway
    • Ensure proper ventilation
    • Prevent further absorption
      • Activated Charcoal
    • Treat S/S
      • O2
      • Supportive Care
      • ALS
        • Naloxone
          • Opioids
        • Atropine
          • Organophosphate
  • 32. Re Assessment
    • Re assessment
      • Be alert for vomiting
      • Be alert for further deterioration due to poisoning
      • ABC’s
      • Vitals
      • LOC
  • 33. Activated Charcoal Pharmacology
    • Generic
      • Activated Charcoal
    • Trade
      • SuperChar – InstaChar – Actidose – LiquiChar
    • Indications
      • Poisoning by toxic ingestion
    • Contraindications
      • AMS
      • Inability to swallow
      • Ingestions of alkali/acids
    • Form
      • Pre mixed in water with various amounts of charcoal. (12.5 g normal)
    • Dose
      • Adults/Children = 1g/kg of body weight
      • Usual Adult dose = 25-50 g
      • Usual child/infant dose= 12.5-25 g
    • Route
      • PO
    • Actions
      • Binds to certain poisons and blocks absorption
    • Side Effects
      • Black Stools
      • Vomiting
      • If pt vomits, repeat dose once
  • 34. Activated Charcoal Administration
    • Obtain order from medical control
    • Shake container thoroughly
    • Pt may need to be persuaded to drink medication since it looks like mud
    • Cover container and supply a straw to aid in administration
    • If pt takes a long time to drink the charcoal shake again as it will settle out of solution
    • DOCUMENT activity and time
    • Transport
    • Re assess pt
  • 35. Refusals
    • Encourage pt to go to hospital
    • Call police if needed
    • Pt cannot be assumed to be acting in best intent if OD/Suicidal/AMS.
  • 36.