Chapter 21: Poisoning and Overdose Emergencies

Question 1

Poison

Answer 1

any substance that can harm the body by altering cell structure or function

Question 2

Toxin

Answer 2

a poisonous substance secreted by bacteria, plants, or animals

Question 3

4 types of poisons

Answer 3

ingested, inhaled, absorbed, injected

Question 4

Adsorption

Answer 4

the process of one substance becoming attached to the surface of another

Question 5

Patient Assessment Qs for ingested poison

Answer 5

• what substance was involved
• when did the exposure occur?
• how much was ingested?
• over how long a period did injection occur?
• what interventions has the pt, family, or well-meaning bystanders taken?
• what is the pt’s estimated weight
• what effects is the pt experiencing from the ingestion

Question 6

Patient Care for ingested poison

Answer 6

1. Detect and treat immediately life-threatening problems in the primary assessment. Evaluate the need for prompt transport for critical pts
2. Perform a secondary assessment. Use gloved hands to carefully remove any pills, tablets, or fragments from the pt’s mouth; package the material and transport it with the pt
3. Assess baseline vital signs
4. Consult medical direction. As directed, administer activated charcoal to adsorb the poison, or water or milk to dilute it. This can usually be done en route
5. Transport the pt with all containers, bottles, and labels from the substance
6. Perform reassessment en route

Question 7

Antidote

Answer 7

a substance that will neutralize the poison or its effects `

Question 8

Patient Care for inhaled poison

Answer 8

1. If the pt is in an unsafe environment, have trained rescuers remove the pt to a safe area. Detect and treat immediately life-threatening problems in the primary assessment. Evaluate the need to promptly transport critical care patients
2. Perform a secondary assessment
3. Administer high concentration O2. This is the single most important treatment for inhaled poisoning after the pt’s airway is opened
4. Transport the pt with all containers, bottles, and labels from the substance
5. Perform reassessment en route

Question 9

Patient Care for absorbed poison

Answer 9

1. Detect and treat immediately life-threatening problems in the primary assessment
2. Perform a secondary assessment; obtain vital signs. This includes removing contaminated clothing while protecting oneself from contamination
3. Remove the poison by doing one of the following:
   - powders: brush powder off the pt; then continue as for other absorbed poisons
   - liquids: irrigate with clean water for at least 20 minutes and continue en route if possible
   - eyes: irrigate with clean water for at least 20 minutes and continue en route if possible
4. Transport the pt with all containers, bottles, SDSs, and labels from the substance
5. Perform reassessment en route

Question 10

delirium tremens

Answer 10

a severe reaction that can be part of alcohol withdrawal, characterized by sweating, trembling, anxiety, and hallucinations

Question 11

Patient Care for alcohol abuse

Answer 11

1. Stay alert for airway and respiratory problems. Be prepared to perform airway maintenance, suctioning, and positioning of the pt should the pt lose consciousness, seize, or vomit. Help the pt so vomitus will not be aspirated. Have a rigid-tip suction device ready. Provide O2 and assist respirations as needed
2. Assess for trauma the pt may be unaware of b/c of their intoxication
3. Be alert for changes in mental status as alcohol is absorbed into the blood stream. Talk to the pt in an effort to keep them as alert as possible
4. Monitor vital signs
5. Treat for shock
6. Protect the pt from self-injury. Use restraint as authorized by your EMS system. Request assistance from law enforcement if needed. Protect yourself and your crew.
7. Stay alert for seizures
8. Transport the pt to a medical facility

Question 12

Uppers

Answer 12

• stimulants such as amphetamines that affect the CNS to excite the user
• ex: caffeine, amphetamines, and cocaine

Question 13

Downers

Answer 13

• depressants, such as barbiturates, that depress the CNS, which are often used to bring on a more relaxed state of mind
• ex: roofies, GHB, alcohol, etc.

Question 14

Narcotics

Answer 14

• a class of drugs that affect the nervous system and change many normal body activities. Their legal use is for the relief of pain. Illicit use is to produce an intense state of relaxation
• ex: codeine, OxyContin, heroin,

Question 15

Opiate triad

Answer 15

coma (or depressed level of consciousness), pinpoint pupils, and respiratory depression (slow, shallow respirations)

Question 16

Hallucinogens

Answer 16

• mind-affecting or mind-altering drugs that act on the CNS to produce excitement and distortion of perceptions
• LSD, PCP, mushrooms, XTC/MDMA

Question 17

Volatile Chemicals

Answer 17

vaporizing compounds, such as cleaning fluid, that are breathed in by the abuser to produce a “high”

Question 18

Patient Care for substance abuse

Answer 18

1. Perform a primary assessment. Provide BLS measures if required
2. Be alert for airway problems and inadequate respirations or respiratory arrest. Provide O2 and assist ventilations if needed
3. If the pt’s mental status is depressed enough to threaten his airway and he is in respiratory failure and your local protocols allow, administer naloxone intranasally
4. Treat for shock
5. Talk to the pt to gain his confidence and to help maintain his level of responsiveness. Use their name often, maintain eye contact, and speak directly to them
6. Perform a physical exam to assess for signs of injury to all parts of the body. Assess carefully for signs of head injury
7. Look for gross soft-tissue damage on the extremities resulting from the injection of drugs (tracks). Tracks usually appear as darkened or red areas of scar tissue or scabs over veins
8. Protect the pt from self-injury and their attempts to hurt others. Use restraint as authorized by your EMS system. Request assistance from law enforcement if needed.
9. Transport the pt as soon as possible
10. Contact medical direction according to local protocols
11. Perform reassessment w/ monitoring of vital signs. Stay alert for seizures, and be on guard for vomiting that could obstruct the airway
12. Continue to reassure the pt throughout all phases of care.