2. Introduction
• Rarely will you not encounter a drug addict
or abuser in a 12 hr shift.
• Licit- legal
• Illicit- illegal
• Alcohol- most common abuse
4. Ingestion
• Damage may be immediate or take place
over several hours
• Acid or alkali- immediate
• Household medications and cleaning supplies
are most common
9. Toxidromes (Toxic Syndrome)
It’s too damn hard to memorize all the
harmful substances, so let’s just put
them into some categories:
Narcotic
Sympathomimetic
Sedative-hypnotic
Cholinergic
Anticholinergic
16. Emergency Care
• Scene safety
• Airway
• Breathing
• Circulation
• Oxygen
• IV
• Antidote if possible
• Prepare to manage shock, seizure, coma, and
dysrhythmias.
• Transport in left lateral position.
21. Cocaine
• Naturally occurring alkaloid that is
extracted from the erythroxylon coca plant
• Processed into cocaine hydrochloride
22. Pathophysiology
• Local anesthetic and a CNS stimulant
• Release of NE, dopamine, and seratonin
• Water-soluble hydrochloride salt
• Look for widened QRS or prolonged QT
interval
• Crack cocaine- mix with baking soda and
water and enjoy
23. Treatment
• Valium or lorazepam for seizures
• Nitroglycerin for chest pain
• Chemical restraints may be needed
• No Beta Blockers
24. Amphetamines
• MDA and MDMA (Molly)
• Amphetamines are structurally similar to
the derivatives of phenylethylamine and
include methamphetamine (crank or ice)
• Most nasal decongestants and diet pills are
members of this family
25. methamphetamine
• Low cost and long acting stimulant that is
extremely addictive
• Meth labs
• Prehospital care is supportive care
26. BATH SALTS
• Synthetic cathinones
• Similar to MDMA
• Sudafed
• Snort, smoke, or ingest drug
• Side effects are eating people and similar to
methamphetamines
27. Excited Delerium
• Haldol and Benadryl !
• Ketamine
• 2 mg/kg IV
• 4 mg/kg IM
• Cool them down
• Treat seizures
• Possible rhabdomyolysis
31. Cannabidiol
• One of the main active ingredients
• antiseizure, neuroprotective, analgesia, and
antitumor
• Does not have euphoric, intoxicating effects
of THC.
47. Cardiac medications
• Class 1
• Class 2- consider glucagon
• Class 3
• Class 4- give calcium or glucagon
• Class 5
• Check BgL
• Call Poison Control early; Charcoal?
49. Organophosphates
• Major component in many insecticides
• Inhibits acetylcholinesterase
• Suicide attempts account for a considerable
share of organophosphates poisonings
•
51. TREATMENT
• Airway, suction as needed
• O2
• IV
• Atropine 1 mg every 3 to 5 minutes until
atropinization occurs
• Pralidoxime (2-PAM) up to 3 autoinjections
(600 mg each)
52. Nerve Agent Poisoning
• Chlorine gas
• When hypochlorite mixes with a strong acid
• Syrian Nerve Gas Attack
53. Carbon Monoxide Poisoning
• Causes more poisoning deaths than any
other toxic substance
• High affinity for hemoglobin
• Colorless, odorless, tasteless
55. COHb Half-life
• Room air – 4 hours
• 100% O2 – 1.5 hours
• Hyperbaric O2 – 15 to 20 minutes
• Consider cyanide poisoning also !
56. Chlorine
• Swimming pools and water treatment
plants
• Nebulize albuterol for wheezing
• Nebulize sodium bicarb for relief (per med
control)
57. Cyanide
• Used in industry for electroplanting, ore
extraction and fumigation of buildings
• bitter almond scent
• Cyanide binds with cytochrome oxidase
• Suffocates at the cellular level
