ATS - poisoning

Emergency Medical Technician
16 – Poisoning Emergencies
© 2014
• It is not uncommon for
people to die or become
extremely ill from
accidental or intentional
poisoning
• Poisonings occur from a
variety of sources such
as:
– Chemicals
– Gases
– Plants
– Insects
– Spiders
– Marine life
3

© 2014
• Quick recognition and
the delivery of
appropriate care will
increase the likelihood
of a successful outcome
for patients
4

© 2014
1. Poisons & Routes of Exposure
2. Poisoning Emergency Care
3. Carbon Monoxide Poisoning
4. Envenomation Injuries

© 2014
• Poisons are defined by
the CDC as:
“Substances that are
harmful to the body when
inhaled, ingested,
injected or absorbed into
the into the body”
7

© 2014
• Two types:
– Natural
– Manufactured
8

© 2014
• Plants
• Insects
• Reptiles
• Animals
• Marine life
9

© 2014
• Industrial chemicals
• Household chemicals
• Medications
10

© 2014
• Accidental exposure
• Accidental
consumption
• Improper combining
of cleaning products
• Use of chemicals in
poorly ventilated
areas
• Accidental use of
prescription drugs
• Accidental overdose
of recreational drugs
11

© 2014
• Intentional
poisoning is caused
when a substance is
given or taken with
the intention of
causing harm
12

© 2014
• Four routes:
– Inhalation
– Ingestion
– Injection
– Absorption
13

© 2014
Inhalation involves the
breathing in of poisonous
substances:
– Toxic vapors
– Dust
– Gases
Once poisons enter the
respiratory system:
– They cause irreversible
lung damage
– Are absorbed directly
into the bloodstream
14

© 2014
The consumption of
poisons:
• Signs and symptoms can
often be delayed
Ingested poisons can
include:
• Overdose of alcohol or
medications
• Household chemicals
• Inadvertently swallowed
pesticides and herbicides
Ingestion of some
chemicals can cause burns
to the mouth and airway
15

© 2014
• Injection is the delivery
of a toxin directly into
body
• Common causes
include:
– Insect stings or bites
– Accidental punctures
– Use of needles
16

© 2014
• Absorption involves
direct contact with a
poison on the surface of
the body:
– Skin
– Eye tissue
– Mucous membranes
• The eyes are especially
vulnerable - mucous
membranes quickly
absorb liquid and vapors,
which are directly
transmitted to the
central nervous system
17

© 2014
• The American
Association of Poison
Control Centers
• A resource for
poisoning emergencies
• Non-profit organization
supports regional
poison centers and
hosts the Poison Help
Hotline
• 1 (800) 222-1222
19

© 2014
• Consult protocols or
with medical control
• Do not administer any
poisoning remedy
unless instructed by
medical direction
20

© 2014
• Some remedies will
cause vomiting; this may
be recommended in some
cases and
contraindicated in others
• First assess and manage
the ABCs
• Obtain baseline vital
signs
• Administer oxygen based
on patient signs and
symptoms or per
protocols
21

© 2014
• Evaluate the scene and
try to determine what
substance was ingested
and how much
• Keep in mind age-
related differences for
both pediatric and
geriatric patients
• Contact medical
direction or poison
control as directed by
protocol
22

© 2014
• Information that will be
helpful to on-line
medical direction:
– Time of ingestion
– If interventions or
home remedies were
administered
– Approximate weight of
patient
– Effects or symptoms
the patient is
experiencing
– How long the patient
has shown symptoms
23

© 2014
• When using an airway
adjunct on an
unresponsive patient, be
careful not to stimulate
the gag reflex during
insertion
• Be aware that secretions
can be profuse depending
on the poison that has
been ingested
• Vomiting is common
• Position the patient to
protect from aspiration
and be prepared to
suction
24

© 2014
• Activated charcoal is
not an antidote
• Activated charcoal
works through
adsorption
– Adsorption is the
process of one
substance attaching to
the surface of another
– It prevents or reduces
the amount of poison
the body could
continue to absorb
25

© 2014
• Not all poisons are
adsorbed by activated
charcoal
• Depending on the
substance, you will be
advised by medical
control as to whether or
not activated charcoal is
appropriate
26

© 2014
• Contraindications for
administering activated
charcoal include:
– Altered mental status
– Ingestion of acids or
alkalis
– The inability to
swallow
27

© 2014
• Administer activated
charcoal as directed
• May be administer on
scene or en route
• Determine the dosage
per protocols
– Typically 1 gram per
kilogram of body
weight
– Average adult dose:
25-50 grams
– Average pediatric dose
12 .5-25 grams
28

© 2014
• Medication looks
unappealing
• Provide a covered
container and straw
• Shake or stir if it has
been allowed to settle
29

© 2014
• Nausea and vomiting
are common with
ingested poison
emergencies
• If vomiting occurs,
repeat the dose once or
follow instructions from
MD
• Record the product
name, dose and time of
administration
30

© 2014
• Transport the container,
bottles or label from the
ingested poison with
the patient
• If a plant was ingested,
bring any remaining
roots, leaves, stems,
flowers or fruit
31

© 2014
• Carbon monoxide (CO) is a
deadly gas
• By-product of burning fuel
such as:
– Oil
– Gas
– Wood
• Found in fumes produced
by:
– Fire
– Operation of vehicles
– Small engines
– Stoves
– Grills and heating systems
33

© 2014
• Commonly occurs from
improper or faulty
heating sources or
blocked exhaust
systems
• Builds up in enclosed or
semi-enclosed spaces
and poisons people and
animals
• People who are asleep
or intoxicated can die
without experiencing
symptoms
34

© 2014
• Carbon monoxide
molecules bond to red
blood cells - displaces
oxygen
• Causes sudden illness,
severe tissue damage
and death
• CO is odorless, colorless
and tasteless
– Commonly called “the
silent killer”
35

© 2014
• Carbon monoxide
poisoning can be
difficult to assess
because:
– The symptoms are
generally vague and
flu-like, or;
– The patient may be
found unconscious
36

© 2014
• Signs and symptoms
include:
– Headache that includes
a band-around-the-
head feeling
– Dizziness
– Nausea
– Breathing difficulty
– An altered mental
status
– Unconsciousness
37

© 2014
• Look for indicators at the
scene
– A source of combustion
fumes may alert you to
the presence of carbon
monoxide, especially if
the patient is in an
enclosed area
• Scene Safety:
– Never enter an unsafe
scene unless you have
the appropriate
protection
– Call for more resources
if needed
38

© 2014
• As quickly and carefully
as possible, remove the
patient from the
hazardous area
39

© 2014
• Assess ABC’s
• Patient’s level of
consciousness
• Administer oxygen and
follow local treatment
protocols
• Try to determine if the
patient suffered some
other medical
emergency, or if the CO
exposure is the cause of
his condition
40

© 2014
• Obtain baseline vitals
and a patient history
• The patient may feel
better once exposed to
fresh air or after
receiving oxygen
• Regardless extended
care with oxygen or
hyperbaric therapy may
be needed
• Examine the patient for
other injuries or medical
conditions
• Prepare for transport
41

© 2014
• The process by which
venom or toxin is
injected into a person
by a venomous animal
• Common causes
include:
– Bites from spiders or
snakes
– Stings from insects
– Marine life forms
43

© 2014
• Stings or bites from
venomous insects,
snakes, spiders, and
marine life are rarely
dangerous or serious
emergencies, but some
can be life threatening
44

© 2014
• General signs and
symptoms of a bite or
sting include:
– A history of a bite or
sting
– Obvious bite marks or
a stinger
– Pain that is immediate,
severe or burning
– Redness or other
discoloration around
injury site
45

© 2014
• General signs and
symptoms of a bite or
sting include:
– Swelling around the
injury
– Weakness or dizziness
– Muscle spasms
– Progressive paralysis
– Difficulty breathing
– Fever and chills
– Nausea or vomiting
46

© 2014
• Most snakebites are:
– Minor injuries
– Seldom life threatening
– Do require some
special care
• Each person reacts
differently
may take several hours
to appear
47

© 2014
• Bites that are closer to
the face, neck or head
are likely to be more
rapidly life threatening
if the snake is
poisonous
48

© 2014
• Unless you are dealing
with a known species of
snake, you should:
– Always assume the bite
from any snake to be a
serious emergency
– Consider it to be
poisonous
49

© 2014
• Signs and symptoms of
a snakebite may
include:
– A noticeable bite on
the skin
– Pain and swelling to
the area, which could
be a slow or rapid
development
– Rapid pulse
– Labored breathing
50

© 2014
continued:
– Progressive, general
weakness
– Dim or blurred vision
Nausea and vomiting
– Seizures
– Drowsiness or
unconsciousness
51

© 2014
• A normal reaction to an
envenomation injury—
such as a bee or other
insect sting—is a sharp,
stinging pain, followed
by itchy painful swelling
52

© 2014
• Unless there is rapid,
progressive swelling to
the injured area or
other serious
symptoms, it will be
considered a “local
reaction”
– This is rarely a critical
emergency
• The most serious
consequences is a life-
threatening
anaphylactic reaction
53

© 2014
• Unless anaphylaxis or
rapid progressive
swelling is indicated,
care will focus on soft-
tissue wound care
• A select few injuries
require venom-specific
hospital treatment
– Follow treatment
protocols for the
specific type of bite or
sting
54

© 2014
• Performing a general
scene size-up
• Identify any risks to
you or partner
• Take note of anything
unusual regarding the
scene or patient injuries
• Scan ground or area
around
• Look for evidence of
insects or what activity
might have led to the
injury
55

© 2014
• There are some anti-
venoms available for
some envenomation
injuries
– Identify the insect,
reptile or marine
animal when possible
– If it is dead and you
cannot identify it,
transport it with the
patient to the receiving
hospital
• Do not transport any
live creatures
56

© 2014
• Evaluate the ABCs
• Perform initial
assessment
• Treat any immediate
symptoms
• Administer oxygen
based on the SpO2
reading and patient
signs and symptoms
– Follow your local
protocols
57

© 2014
• If the injury was caused
by an insect and the
stinger is still present:
– Remove it gently by
scraping the skin in the
direction of the base of
the stinger
58

© 2014
• When treating other
bites or stings:
– Wash the area around
the injury with a strong
soap solution, or;
– Irrigate the area with
water or sterile saline
–
• Make sure the fluid
flows away from the
body to avoid
contaminating another
area
59

© 2014
• Follow your treatment
protocols;
– Some may recommend
applying a cold pack to
an insect bite or sting
to relieve pain and
swelling
• Cold packs should not
be used on snakebites
or injuries caused by
marine life
60

© 2014
• When treating a marine
life injury;
– Remove any material
that is sticking to the
injury site
– Do not attempt to
remove any deeply
embedded spines
• Some marine toxins are
destroyed by heat;
– Use warm water to rinse
or soak the wound, or
– Apply heat to the area
according to your
protocols
61

© 2014
• Injuries caused by
jellyfish, coral or
anemones can also be
irrigated with vinegar if
available
– Helps to neutralize the
effects of the toxins or
stingers
• Toxins from marine
animals often cause more
extensive tissue damage;
– Stings to the face,
especially near the lips
or eyes, will require care
from a physician
62

© 2014
• For snakebite injuries,
locate fang marks; there
may only be one
• Irrigate the wound using
sterile saline or water
• Any bleeding or open
wounds should be
dressed with sterile
gauze
• Remove any jewelry or
constricting objects near
the injury site in case
swelling occurs
63

© 2014
• Provide reassurance to the
patient to help keep him
calm
– Limit movement or activity
• When treating snakebites,
calling for medical direction
may be advised
• If antivenom is needed, you
will be directed to the
facility where it is available;
• Rapid transport and
administration of antivenom
are the most effective
interventions for snakebites
64

© 2014
• When possible, keep the
injury site below or level
with the heart
• Injuries on an extremity
should be immobilized
and monitored for
swelling
• When treating
envenomation injuries,
be alert for vomiting
• Continue to monitor the
ABCs and any changes to
your patient’s condition
• Transport according to
your protocols
65

© 2014
• Your first responsibility is to keep
yourself safe
• Poisonings and envenomation injuries
can occur from a variety of sources and
in different environments
• Your skilled and prompt assessment in
addition to the delivery of appropriate
care for these types of emergencies will
help provide the best possible outcome
for your patients

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