Poisons
Substance which when introduced into body in relatively small amounts causes in structural damage or functional disturbances
Suspect with: GI signs/symptoms (nausea, vomiting,
diarrhea, pain) Altered LOC, seizures, unusual behavior Pupil changes, salivation, sweating, other
signs/symptoms of disturbed autonomic nervous system function
Respiratory depression Burns, blisters of lips, mucous membranes Unusual breath odors
Try to determine: What? How much? How long ago? What has already been done? Psychiatric history? Underlying illness?
Always. . .
Bring sample of material if possible Save for analysis, if patient vomits Call poison center for advice on
management
Ingested Poisons
Prevent absorption of toxin from GI tract into bloodstream– Activated charcoal– Syrup of Ipecac
Activated Charcoal
Dosage– 1 gm/kg of patient body weight– Usual adult dose: 25 to 50 gms– Usual child dose: 12.5 to 25 gms
Activated Charcoal
Contraindications– Altered mental status– Inability to swallow– Ingestion of acids or alkalis
Does not bind– Alcohol– Petroleum products–Metals (iron)
Activated Charcoal
Administration– Shake container thoroughly– Use covered opaque container– Have patient drink through straw– If patient vomits dose may be repeated
Syrup of Ipecac
Induces vomiting by irritating stomach and stimulating vomiting center in brainstem
Seldom used anymore May be helpful if ingestion has
occurred within last 30 minutes
Syrup of Ipecac
Dose Children = 15 cc orally Adults = 30 cc orally
Repeat once after 20 minutes as needed
Be sure patient has H20 in stomach Should not be given at same time as
activated charcoal
Syrup of Ipecac
Contraindications– Decreased level of consciousness– Seizing or has seized– Caustic poison (acids or alkalis)– Petroleum based products
Absorbed Poisons
Dry chemicals– dust skin, then – wash
Liquid chemicals– wash with large amounts of H20
– avoid “neutralizing” agents
CAUTION Don’t accidentally expose
yourself!
Inhaled Poisons
Remove patient from exposure Maximize oxygenation, ventilation
CAUTION Don’t accidentally expose
yourself!
Injected Poisons
Attempt to slow absorption Venous constricting bands Dependent position Splinting of injected body part Cold packs (+) [May worsen local injury
by concentrating poison]
Substance Abuse
Self administration of a substance in a manner not in accord with approved medical or social practices
Substance Abuse
Psychological dependence Physical dependence Compulsive drug use Tolerance Addiction
Compulsive Drug Use
Use of drug and rituals/culture associated with its use become an overwhelming desire
Tolerance
Increasing amounts of drug needed to produce same effects
Tolerance contributes to addiction by keeping user “chasing the last high”
Addiction
Combination of psychological dependence, physical dependence, compulsive use, and tolerance
Patient becomes totally consumed with obtaining, using drug to exclusion of all other things
Ethyl AlcoholA CNS Depressant Drug
Decreased ReactionTime
Increased AccidentalTrauma Risk
Decreased SocialInhibitions
Increased IntentionalTrauma Risk
Potentiation of OtherCNS Depressants
Lethal Overdoses inCombination with OtherDrugs
Slowed GI TractActivity
Irritation, Gastritis,Ulcer Disease, GIBleeds
Toxic Overdose RespiratoryDepression, Shock
Ethanol Intoxication Signs Breath odor Swaying, unsteadiness Slurred speech Nausea, vomiting Flushed face Drowsiness Violent, erratic behavior
Ethanol
Clouds signs, symptoms Complicates assessment Head trauma, diabetes, drug toxicity,
CNS infection can mimic EtOH intoxication and vice versa
Experience alcohol withdrawal syndrome if they reduce intake: Restlessness, tremulousness Hallucinations Seizures Delirium tremens--all of above plus
tachycardia, nausea, vomiting, hypertension, elevated body temperature
Alcohol Addicts
Life threatening condition! Occurs 1 days to 2 weeks after intake
is decreased 5 to 15% mortality Control airway, prevent aspiration,
monitor for hypovolemia
Delirium Tremens
Narcotics Withdrawal– Agitation– Anxiety– Abdominal pain– Dilated pupils
–Sweating–Chills–Joint pains–Goose flesh
Resembles severe influenza
Not a life-threat
Induce sleepiness, state similar to EtOH intoxication
Medical uses– Anesthetics– Sedative– Hypnotics
Barbiturates
Barbiturates
Overdose– Coma– Respiratory depression– Shock
Extremely dangerous in combination with EtOH
Barbiturate-like Non-barbiturates
Doriden, Placidyl, Quaalude, Methyprylon
Effects similar to barbiturates Overdose can cause sudden, very
prolonged respiratory arrest Withdrawal resembles ETOH;
extremely dangerous
Valium, Librium, Miltown, Equanil, Tranxene
Low doses relieve anxiety, produce muscle relaxation
High doses produce barbiturate-like effects
Tranquilizers
Overdose: Unlikely to cause respiratory arrest
alone Extremely dangerous with EtOH
Withdrawal– Resembles EtOH withdrawal– Extremely dangerous
Tranquilizers
CNS Stimulants: Amphetamines
Dexedrine, Benzedrine, Methyl amphetamine
Relieve fatigue, promote euphoria, reduce appetite
CNS Stimulants: Amphetamines
Overdose– Restlessness, paranoia– Tachycardia– Hypertension CVA, Heart failure– Hyperthermia Heat stroke
Withdrawal– Lethargy– Depression
Stronger stimulant effects than amphetamines
Can cause respiratory/cardiovascular failure, heat stroke, lethal arrhythmias
CNS Stimulants: Cocaine
“Snorting” can destroy nasal septum, cause massive nosebleed
Withdrawal: – lethargy– depression
CNS Stimulants: Cocaine
LSD, psilocybin, peyote, mescaline, DMT, MDMA
Enhance perception Wrong setting may induce “bad
trips” with extreme anxiety True toxic overdose rare
Hallucinogens
Phencyclidine
PCP, angel dust Produces bizarre, violent behavior Reduces pain sensation Patients may be capable of feats of
extreme strength Keep patient in quiet environment,
minimize stimulatin
Glue, paint, gas, light fluid, toluene Inhalation produces state similar to
EtOH intoxication Patient may asphyxiate if
consciousness lost while “sniffing”
Solvents