Poisoning & Overdose. Lesson Goal. Lesson Objectives 9/10/2012

Transcription

1 Poisoning & Overdose Lesson Goal Present commonly encountered poisons, their clinical effects, and appropriate management of poisoned patients Lesson Objectives Describe effects of several common types of poisonings Recognize several clinical effects caused by poisonings Explain emergency care for patient who may have overdosed 1

2 Lesson Objectives Explain emergency care of patient with suspected poisoning Describe situation in which patient suffering from poisoning or overdose would require airway management Lesson Objectives State generic & trade names, indications, contraindications, forms, dosages, administration, actions, side effects, and reassessment strategies for activated charcoal Identify need to seek medical direction in caring for overdose patient Lesson Objectives Explain the importance of contacting medical control early in course of patient management 2

3 Introduction Poisoning & overdoses are common Effects can be minor or may lead to death Outcome is affected by: Poison Patient Treatment Routes of Exposure Ingestion Inhalation Dermal absorption Injection Ingestion Poison is swallowed and absorbed into bloodstream from GI tract Onset of symptoms may be delayed 80% of accidental ingestions occur in children 1 to 3 yrs 3

4 Inhalation Vapors or gases are breathed in Pulmonary toxicity & systemic effects Includes ammonia, chlorine, carbon monoxide Scene safety is paramount Remove patient to fresh air Dermal Absorption Skin is usually an effective barrier Some substances can be absorbed through the skin Occupational exposure is common Includes organic mercury, organophosphates Decontamination is essential Injection Needle stick Skin puncture Bites Stings 4

5 Common Poisonings Ethanol Acetaminophen Carbon monoxide Acetylsalicylic acid Household products Drugs of abuse Bites & stings Ethanol Socially acceptable, often taken in excess CNS & respiratory depressant Chronic use leads to tolerance Binge drinking may lead to acute ethanol poisoning Ethanol Effects Euphoria Slurred speech Impaired coordination & judgment Decreased reaction time Altered mental status Effects Coma Respiratory depression Vomiting/aspiration Risk of injury Death 5

6 Ethanol Ethanol impairs judgment & masks signs of injury Use a low threshold for deciding to transport and use spinal precautions Acetaminophen Overdose OTC pain reliever/fever reducer Often found in combination with other drugs In overdosage, can cause fatal liver damage Symptoms within 24 hrs include nausea, abdominal pain, & jaundice Antidote must be given shortly after overdose and only in hospital Carbon Monoxide Produced during incomplete combustion of fuels Odorless, tasteless, colorless High levels can quickly lead to death Sources include vehicle exhaust, faulty heating equipment 6

7 Carbon Monoxide Signs & symptoms (mimic flu) Headache Confusion Nausea and vomiting Irritability Loss of coordination Cardiac disturbances Seizures Coma Death Carbon Monoxide Remove patient to fresh air High-flow O 2 Hyperbaric treatment may be used for high levels of CO Acetylsalicylic Acid Overdose Signs & symptoms Abdominal pain Nausea Tinnitus Hyperventilation Hyperpnea Altered mental status Pulmonary edema 7

8 Acetylsalicylic Acid Body responds to acidosis by increasing respiratory rate Caution: Not all hyperventilation is related to anxiety Laundry Bleach Ingestion Accidental ingestion usually asymptomatic Large amounts corrosive damage to GI tract Do not induce vomiting Inhalation Fumes created if bleach mixed with other products (e.g., ammonia) Remove patient to fresh air Dish & Laundry Detergents Can cause Nausea & vomiting Diarrhea Irritation of GI tract Electric dishwasher detergent can cause significant damage 8

9 Mothballs Naphthalene mothballs cause significant toxicity if ingested Agitation Lethargy Seizures Coma Manage ABCs Transport Other Chemicals Acids Low ph Damage through coagulum Damage more limited Alkalis High ph Damage through liquefaction necrosis Extensive damage can occur Other Chemicals: Treatment Take safety precautions Decontaminate exposed areas If eye injury, flush for >20 min en route to hospital Cover burns with dry, sterile dressing Administer O 2 for burns of face and airway 9

10 Antifreeze & Radiator Fluid May be found in puddles from vehicle leaks Attractive to children Children may seem asymptomatic for hours Antifreeze & Radiator Fluid May cause: Metabolic acidosis Kidney failure Death Signs & symptoms Abdominal pain Nausea & vomiting Altered mental status Drug Abuse Substances abused to produce altered mental state or feeling of euphoria Substances can include: Alcohol Tobacco Prescription medications Illicit drugs Herbs 10

11 Drug Dependence Psychological Reliance on pleasurable effects Physical Withdrawal symptoms if substance is not present Seizures Hallucinations Death Signs & Symptoms Be alert to potential violence Your safety comes first General signs & symptoms Loss of coordination Unsteady gait Inability to follow commands Altered mental status Unusual behavior Marijuana Most commonly used illegal drug of abuse Effects Sleepiness Red eyes Decreased reaction time Impaired judgment 11

12 Stimulants Examples Cocaine Amphetamines Methamphetamines Can be: Snorted Smoked Injected Stimulants Effects Euphoria Anxiety Paranoia Agitation Delirium Tachycardia Hypertension Diaphoresis Restlessness Dilated pupils Seizures Arrhythmias Hyperthermia Phencyclidine (PCP) Effects Agitation Dissociative state Insensitivity to pain Roving eye movements Constricted pupils Increased salivation Patients can be violent & difficult to restrain Your safety is the highest priority 12

13 Examples Heroin Morphine Codeine Hydrocodone Oxycodone Fentanyl Meperidine Opiates Other prescription painkillers Opiates Signs & symptoms Sleepiness Respiratory depression Constricted pupils Vomiting Coma Respiratory arrest Treament Airway, O 2, assist ventilations Hallucinogens Less commonly abused LSD, psilocybin Effects Altered sensory perception Feeling of depersonalization Possible bad trip 13

14 Huffing Concentration of aerosols or fumes for deliberate inhalation Effects Sleepiness Dizziness Euphoria Asphyxiation & cardiac arrhythmias may occur Common Bites & Stings Brown recluse spider Black widow spider Scorpions Pit vipers Coral snakes Jellyfish Echinoderms (sea urchins and starfish) Stingrays Brown Recluse Spider Found in Midwest Fiddle-shaped mark on back Bites if threatened Initial bite is painless Venom causes extensive tissue necrosis 14

15 Black Widow Spider Adult females are venomous Red hourglass mark on abdomen Toxin causes muscle spasms, cramps, rigidity May cause dizziness, nausea, respiratory depression Bark Scorpion Found near deserts Venom is neurotoxic May cause salivation, watering eyes, urination, diarrhea, GI discomfort, bronchospasm, vomiting Treat ABCs Pit Vipers Rattlesnakes, cottonmouths, water moccasins, copperheads 15

16 Pit Vipers Signs & symptoms Edema Erythema Ecchymosis Diaphoresis Nausea & vomiting Impaired blood coagulation Kidney failure Seizures Hypotension Shock Pit Vipers Treatment Ensure scene safety ABCs Immobilize affected extremity Keep patient calm & still Do not incise wound Coral Snakes Venom is neurotoxic Red on yellow, kill a fellow; red on black, venom lack. 16

17 Signs & symptoms Slurred speech Dilated pupils Flaccid paralysis Death Treatment Scene safety Immobilize extremity Keep patient calm Coral Snakes Jellyfish Nematocysts contain venom Jellyfish Signs & symptoms Stinging sensation Raised, red lesions Numbness Tingling Itching Nausea & vomiting Abdominal pain Bronchospasm Hypotension Respiratory arrest 17

18 Jellyfish Treatment Treat symptoms Monitor VS Remove visible nematocytes Inactivate nematocysts with seawater, vinegar, or isopropyl alcohol Shave area to remove nematocysts Transport Echinoderms Sea urchins, starfish Inject venom with tiny spines that may break off in skin Local pain, bleeding, swelling; systemic reaction when numerous spines involved Stingrays Spines are located in tail Local pain, bleeding, swelling; systemic if severe can be fatal 18

19 Common Clinical Effects of Poisons Coma Seizure Agitation Hypoglycemia Hypotension Hypertension Bradycardia Tachycardia Consider: Alcohol Opiates Sedatives Muscle relaxants Anticonvulsants Antipsychotics Antidepressants Coma Seizure Most commonly associated with stimulant drugs Also caused by certain antidepressants May occur from drug or alcohol withdrawal 19

20 Agitation May be from drugs that act on sympathetic nervous system Cocaine, PCP, amphetamines Anticholinergics Jimson weed Antihistamines May be from alcohol, sedative, or narcotic withdrawal Hypoglycemia Insulin Oral diabetic medications Beta blockers Alcohol Salicylates Hypotension Mechanisms include: Cardiac arrhythmias Vasodilation Nitrates Antihypertensives Tricyclic antidepressants Decreased cardiac contraction Antihypertensives Tricyclic antidepressants Cyanide 20

21 Hypertension May be a direct effect of stimulant drugs May be due to agitation Treated in hospital with nitrates Bradycardia May be caused by: Antihypertensives Digoxin Cholinergics Sedatives Tachycardia May be caused by: Stimulants Antidepressants Anticholinergics 21

22 Evaluation of Poisoning Good history & physical exam are essential Patients may conceal information out of embarrassment or fear of consequences Provide nonjudgmental care Transport patients who may be danger to themselves Transport medication bottles & containers History & Physical Exam Pay close attention to: Mental status Respiratory effort Pupil size Skin findings Bowel sounds Neuro exam Continuously re-evaluate Specific Questions Chief complaint? Substance? How long ago was the exposure? How much did you ingest? How long were you in environment? How long was contact with skin? What have you done so far to treat poisoning? Have you called poison control center? If so, what were their recommendations? 22

23 Treatment Develop a plan Your safety comes first Was patient exposed to something that may affect you? Decontaminate Treatment Manage airway & breathing Patients with altered mental status may not be able to protect airway Ingestion or inhalation of substances that can affect the airway requires ALS airway management Assist ventilations if necessary Provide supplemental O 2 Treatment Monitor VS frequently Place hypotensive patients in supine position Manage seizures Maintain normal body temperature 23

24 Treatment Consider ALS intervention for: Unstable VS Potential or actual airway compromise Altered mental status Seizures Treatment Activated charcoal may be indicated Typical dosage Adults: g Children: g Skill 22-1: Administering Activated Charcoal 1. Administer per local protocol 2. Ensure medication has been properly suspended; pour into container 24

25 Skill 22-1: Administer Activated Charcoal 3. Inform patient of drug's action and potential side effects 4. Encourage patient to drink full dose. If charcoal settles, shake or stir back into suspension 5. Reassess patient, record time and any changes in patient s condition Activated Charcoal Administration Due to the large size of the file for this video clip, this file may be obtained from the Download folder on Evolve under PowerPoint Presentations with Video. Summary Poisons can enter the body by ingestion, inhalation, absorption, and injection Common poisons include: Ethanol Acetaminophen Carbon monoxide Acetylsalicylic acid Household products Drugs of abuse Bites and stings 25

26 Summary Treatment consists of providing supportive & symptomatic care Treat patient, not poison Many toxic substances can cause altered mental status and problems with ABCs 26