Posions And Toxics

Question 1

Ingestion

Answer 1

Most common type of poisoning
Drug or substance is swallowed
Absorbed in the GI tract
Slower onset

Important questions
1.What/how much did you take?
2. When did you take it?
3. Important to find this info early, in case the medications start to take effect and the patient has a decrease in LOC
Signs/Symptoms:
1. Swelling or burns around mouth
2. Nausea/vomiting/diarrhea
3. Altered mental status (ALOC)
4. Abdominal pain
5. Others, depending on what they took

Question 2

Activated charcoal – antidote

Answer 2

1. Trade names – Actidose, Actidose-aqua
   
   2. Indications
      a. Ingestions
      b. Within one hour of ingestion
   3. Contraindications
      a. Inability to swallow
      b. Altered mental status
      c. Acids or alkalis
      d. Cyanide
2. Dosage
   a. 1gm/kg
   b. Adults
   i. Generally 30-100g
   c. Children
   i. Generally 12.5-25g
3. Actions
   a. Binds to poisons in the stomach, not allowing them to get absorbed in the bloodstream
4. Side effects
   a. Vomiting
   i. If patient vomits, have them repeat the dose!
   b. Black stools

Question 3

Inhalation

Answer 3

i. Breathing in a poison
ii. Most rapid onset of signs/symptoms
iii. Signs/Symptoms
1. Difficulty breathing / chest pain
2. Airway or breathing sounds
3. Neurological issues

Question 4

Injection

Answer 4

i. Common injected poisons
1. Bites and stings
2. Drugs
ii. Signs/Symptoms
1. Injection site swelling
2. Euphoria
3. Nausea / vomiting

Question 5

Absorption

Answer 5

Poison enters through skin or mucous membranes
ii. Skin related signs/symptoms
1. Burns
2. Rashes
3. Blisters

Question 6

Carbon Monoxide Poisoning

Answer 6

a. Colorless, tasteless, odorless gas
b. Look for sources of incomplete combustion
i. Furnaces
ii. Water heaters
iii. Gas stoves
iv. Fire places
v. Car exhaust
c. Carbon monoxide binds to red blood cells at a much higher affinity than hemoglobin, therefore hemoglobin cannot bind to red blood cells. Leads to the signs/symptoms of hypoxia, but the skin will continue to be pink due to the RBC’s being fully saturated.
d. Signs/symptoms
i. Headache
ii. Nausea
iii. Confusion
iv. Cherry red lips/skin. This is a late sign

Question 7

Pesticide exposure / SLUDGEM

Answer 7

a. Also includes insecticides and nerve agents
b. Salivation
c. Lacrimation
d. Urination
e. Defecation
f. GI upset
g. Emesis
h. Miosis

Question 8

Drugs and Alcohol

Answer 8

a. Definitions
i. Drug abuse – Self admin of drugs or medications in a manner not approved by medical or social norms
ii. Overdose – poisoning with drugs or alcohol
iii. Withdrawal – period of abstinence from a drug to which the body has become accustomed
iv. Tolerance – Larger doses required to get the same effect

Question 9

Drug and alcohol withdrawals stages(4)

Answer 9

i. Stage one
1. 8 hours from last drink
2. Nausea, Insomnia, sweating, tremors
ii. Stage two
1. 8-72 hours from last drink
2. Worsening symptoms
3. Hallucinations start
iii. Stage three
1. 48 hours plus from last drink
2. Same S/S
3. Seizures can happen in stage three only
iv. Stage four
1. Delirium Tremens / DT’s
2. True medical emergency, life threatening
3. Loss of memory, hallucinations, fevers, sweating, insomnia, confusion, psychosis

Question 10

Opioids

Answer 10

Opioids
i. Drugs derived from opium, or synthetics
ii. Heroin, Fentanyl, Morphine, Vicoden/Hydrocodone, Percocet/Oxycontin/Oxycodone, Dilaudid
iii. Signs/Symptoms
1. Respiratory depression or arrest, pinpoint pupils, hypotension
iv. Treatment – May administer Naloxone

Question 11

Naloxone / Narcan

Answer 11

Indications
a. Suspected opioid OD with respiratory depression of less than 12, or respiratory arrest
2. Actions
a. Opioid antagonist
b. Binds to opioid receptor sites to reverse respiratory depression
3. Side effects
a. Possible acute withdrawal
4. Dosage
a. Intranasal – 2mgs. 1mg in each nostril.

Question 12

Cns stimulants

Answer 12

i. Cocaine, crack, meth, PCP, diet pills, MDMA/ecstasy
ii. Stimulate the central nervous system
iii. Signs/Symptoms
1. Excitable, nervous, hypertension, dilated pupils, tachycardia

Question 13

Cns depressants

Answer 13

CNS Depressants
i. Alcohol, Benzodiazipines (Xanax/Alprozolam, Ativan, Valium)
ii. Depress the CNS
iii. Signs/Symptoms
1. Euphoria, drowsy, dilated pupils, sluggish, bradypnea

Question 14

Hallucinogens

Answer 14

i. LSD, PCP, Bath Salts, MDMA
ii. Signs/Symptoms
1. Anxiety, paranoia, violent behavior, hallucinations, dilated pupils