Toxicology Flashcards
(182 cards)
1
Q
Chronic poisoning is often caused by ___
A
Long term abuse of medications, tobacco, and alcohol
2
Q
The term poisoning includes ___
A
Acute and chronic poisonings
3
Q
You may be able to prevent death caused by the acute affects of a poison, simply by ___
A
Providing airway management and symptomatic care during transport
4
Q
The study of toxic or poisonous substances
A
Toxicology
5
Q
Any substance whose chemical action can damage body structures or impair body function
A
Poison
6
Q
A poisonous substance produced by bacteria, animals, or plants that acts by changing the normal metabolism of cells or by destroying them
A
Toxin
7
Q
The misuse of any substance to produce a desired effect
A
Substance abuse
8
Q
A common complication of substance abuse
A
Overdose
9
Q
When a patient takes a toxic or lethal dose of a substance
A
Overdose
10
Q
Primary responsibility to a patient who has been poisoned
A
Recognize that a poisoning has occurred
11
Q
Swallowing of a substance
A
Ingestion
12
Q
If you have even the slightest suspicion that an ingestion or exposure to a toxic substance has occurred, ___
A
Notify medical control and begin emergency treatment immediately
13
Q
If respiration is depressed or difficult, ___ may occur
A
Cyanosis
14
Q
The presence of burning or blistering in the mouth strongly suggest the ___
A
Ingestion of the poison
15
Q
Questions to ask a suspected poisoning
A
- What substance did you take?
- When did you take it (or become exposed to it)?
- How much did you ingest?
- Did you have anything to eat or drink before or after you took it?
- Has anyone given you an antidote or any substance orally since you ingested it?
- How much do you weigh?
16
Q
What to do with any suspicious material you find near a poisoning?
A
Place it in a plastic bag and take it with you to the hospital, along with any containers that you find
17
Q
If the patient vomits, ___
A
Examine the contents for pill fragments. Note and document anything unusual that you see
18
Q
Signs and symptoms of opiate or opioid overdose
A
- Hypoventilation or respiratory arrest
- Pinpoint pupils
- Sedation or coma
- Hypotension
19
Q
Signs and symptoms of sympathomimetics overdose
A
- Hypertension
- Tachycardia
- Dilated pupils
- Agitation or seizures
- Hyperthermia
20
Q
Signs and symptoms of sedative-hypnotics overdose
A
- Slurred speech
- Sedation or coma
- Hypoventilation
- Hypotension
21
Q
Signs and symptoms of anticholinergics overdose
A
- Tachycardia
- Hyperthermia
- Hypertension
- Dilated pupils
- Dry skin and mucous membranes
- Sedation, agitation, seizures, coma, or delirium
- Decreased bowel sounds
22
Q
Signs and symptoms of cholinergics overdose
A
- Airway compromise
- SLUDGEM
23
Q
SLUDGEM
A
- Salivation, sweating
- Lacrimation
- Urination
- Defecation, drooling, diarrhea
- Gastric upset and cramps
- Emesis
- Muscle twitching/miosis
24
Q
Lacrimation
A
Excessing tearing of the eyes
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Emesis
Vomiting
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Miosis
Pinpoint pupils
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Substance that will counteract the effects of a particular poison
Antidote
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Most common antidote available to EMTs
Naloxone (Narcan)
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Narcan is used to ___
Reverse the effects of an opioid overdose
30
In general, the most important treatment you can perform for a poisoning is to ___
Dilute and/or physically remove the poisonous agent
31
Four routes of poisoning
1. Inhalation
2. Absorption
3. Ingestion
4. Injection
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Poison control number
1-800-222-1222
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When contacting poison control, relevant information includes ___
1. When the poisoning occurred
2. Evidence found at the scene
3. Description of the suspected poison
4. Amount of poison involved
5. Patient's size, weight, and age
34
A physician who specializes in caring for patient's who have been poisoned
Medical toxicologist
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Medical toxicologists work in special facilities called ___
Medical toxicology treatment centers
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Patient's who have inhaled poison should be ___ immediately
Moved to fresh air
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Depending how long the inhaled poison patient was exposed, they may require ___
Supplemental oxygen
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If you suspect the presence of toxic gas ___
Call for specialized resources such as the HAZMAT team
39
After the patient has been removed from the toxic gas environment, ___ before you can administer emergency treatment
The patient's clothing should be removed because they may contain trapped toxic gasses
40
___ readings may be inaccurate with some inhaled poisons
Pulse oximetry
41
Anytime there is more than one patient and no evidence of the mechanism of injury or nature of illness, be suspicious of ___
Toxic fumes
42
Absorption of toxic substances through the skin in a common problem in the ___ industries
Agriculture and manufacturing
43
Signs and symptoms of absorbed poisons
1. History of exposure
2. Liquid or powder on a patient's skin
3. Burns
4. Itching
5. Irritation
6. Redness of skin
7. Typical odors of the substance
44
Emergency treatment for a typical contact poisoning (2 steps)
1. Avoid contaminating yourself or others
2. While protecting yourself from exposure, remove the irritating or corrosive substance from the patient as rapidly as possible
45
___ all clothing that has been contaminated with poisons or irritating substances
Remove
46
Skin that has a dry powder on it should be ___
Flushed with clean water for 15 to 20 minutes, and then washed with soap and water
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Skin that has a liquid material on it should be ___
Flooded with water for 15 to 20 minutes
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If the patient has a chemical agent in the eyes, ___
Irrigate them quickly and thoroughly
49
How to avoid contaminating the other eye as you irrigate the affected eye
Make sure the fluid runs from the bridge of the nose outward
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When to irrigate the eye
Initiate on the scene and continue it during transport
51
With contact poison, make sure you, the team members, and the exposed patient are ___ before transport
Thoroughly decontaminated
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Obtain the ___ from industrial sites and transport it with the patient (poison)
SDS
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This will help to ID and quickly make available specific interventions and potential antidotes
SDS
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Small children may respond by crying if the poison is ___
An acid or alkaline
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When the patient has ingested a toxin, some EMS systems allow EMTs to administer ___ by mouth
Activated charcoal
56
Injected poisons cannot be diluted or removed from the body in the field because they ___
Are usually absorbed quickly into the body or cause intense local tissue destruction
57
If you suspect that rapid absorption has occurred ___
1. Monitor the patient's airway
2. Provide high-flow oxygen for any patient with respiratory distress or signs of hypoxia
3. Be alert for nausea and vomiting
4. Remove watches, rings, and bracelets from areas around the injection site if swelling occures
58
Questions to ask yourself when arriving on the scene of a poisoning
1. Is there an unpleasant or odd odor in the room?
2. Are there medication bottles near the patient or the scene?
3. Is there medication missing that might indicate an overdose?
4. Are there alcoholic beverage containers present?
5. Are there syringes or other drug paraphernalia on the scese?
6. Is there a suspicious odor and/or drug paraphernalia present that may indicate the presence of an illegal drug laboratory?
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A primary assessment that reveals a patient with signs of ___ gives you early confirmation that the poisonous substance is causing systemic reactions
Distress and/or altered mental status
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In situations where a patient may have an inhalation injury, place the patient on high-flow oxygen regardless of the ___
Pulse oximetry reading
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If the patient is unresponsive to painful stimuli, consider ___
Inserting an airway adjunct to ensure an open airway
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Keep what available for a patient who has been poisoned?
Suction
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Medications hat promote vasodilation or bleeding can speed up the development of shock due to ___
Hypovolemia
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Questions to ask in addition to the SAMPLE history for poisoning
1. What is the substance involved?
2. When did the patient ingest or become exposed to the substance?
3. How much did the patient ingest or what was the level of exposure?
4. Over what period did the patient take or was the patient exposed to the substance?
5. Has the patient or a bystander performed any intervention on the patient? Has the intervention helped?
6. How much does the patient weigh?
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If the patient has consumed a harmful or lethal dose of the poisonous substance, reassess the vital signs at least every ___
5 minutes
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If the poison or the level of exposure is unknown, ___ is mandatory
Careful and frequent reassessment
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Activated charcoal is not indicated, nor will it be effective, for patients who have ingested ___
Alkali poisons, cyanide, ethanol, iron, lithium, methanol, mineral acids, or organic solvents
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Form of activated charcoal if carried
Plastic bottles of premixed suspension containing up to 50 g of activated charcoal
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Common trade names for the suspension of activated charcoal
InstaChar, Actidose, LiquiChar
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Usual dose of activated charcoal for an adult or child
1 g of activated charcoal per kilogram of body weight (more if food is present)
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Usual adult dose of activated charcoal
30 to 100 g
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Usual pediatric dose of activated charcoal (younger than 13)
15 to 30 g
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Before you give a patient charcoal, obtain ___
Approval from medical control
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In most cases, activated charcoal should be used within ___ of ingestion
1 hour
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Adverse effects of ingesting activated charcoal
Constipation and black stools
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If the patient vomits after taking the activated charcoal ___
The dose will have to be repeated
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How does activated charcoal work?
Binds to specific toxins, and prevents their absorption by the body, carried out of the body in the stool
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Routinely misusing a substance may need increasing amounts of it to achieve the same result
Tolerance
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An overwhelming desire or need to continue using the substance, at whatever the cost, which a tendency to increase the dose
Addiction
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Substance that decreases activity and excitment
Sedative
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Alcohol is a powerful ___ depressant
CNS
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Induces sleep
Hypnotic
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You should assume that all intoxicated patients are experiencing a ___
Drug overdose
84
Severe acute alcohol ingestion may cause ___
Hypoglycemia
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If a patient exhibits signs of serious CNS depression, ___
Provide respiratory support
86
Depression of the respiratory system can also cause ___
Emesis
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Bloody vomiting
Hematemesis
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Why can excessive alcohol cause hematemesis?
Large amounts of alcohol irritate the stomach
89
Frightening hallucinations experienced by a patient in alcohol withdrawal
Delirium tremens (DTs)
90
Approximately ___ days after a person stops drinking or when alcohol consumption levels are decreased suddenly, DTs may develop
1 to 7
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___ often precede DTs
Auditory and visual hallucinations
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Signs and symptoms of alcohol withdrawal
1. Agitation and restlessness
2. Fever
3. Sweating
4. Tremors
5. Confusion and/or disorientation
6. Delusions and/or hallucinations
7. Seizures
93
Hypovolemia may develop with DTs because of ___
Sweating, fluid loss, insufficient fluid intake, or vomiting
94
In alcohol withdrawal, if you see signs of hypovolemic shock ___
Clear the airway and turn the patient's head to one side to minimize the chance of aspiration during transport
95
A drug that produces sleep or altered mental consciousness
Narcotic
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A type of narcotic medication used to relieve pain
Opioid
97
A subset of the opioid family, refers to natural nonsynthetic opioids
Opiate
98
What opiates are derived from the opium in poppy seeds?
Codeine and morphine
99
Common synthetic opioids
Hydromorphone, oxycodone, hydrocodone, methadone
100
Common opioids and opiates
1. Butorphanol (Stadol)
2. Codeine
3. Fentanyl (Sublimaze)
4. Heroin
5. Hydrocodone (Vicodin)
6. Hydromorphone (Dilaudid)
7. Morphine
8. Methadone (Dolophine)
9. Oxycodone hydrochloride (OxyContin)
10. Oxymorphone (Opana)
101
Opioids and opiates are ___ depressants and can cause severe ___ depression
1. CNS
2. Respiratory
102
Opioids or opiates with ___ administration produce a characteristic "high" or "kick"
IV
103
Pinpoint pupils is a classic sign of ___ intoxication
Opiate
104
Patients who abuse opioids via IV injection are at a high risk for ___
Hepatitis C and HIV
105
Narcan can be administered ___
Intravenously, intramuscularly, or intranasally
106
Venous scarring is called ___
Track marks
107
Preferred route of Narcan
Intranasally
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Narcan should only be used when the patient has ___
Agonal respirations or apnea
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Place an ___ and ___ prior to administering naloxone
1. Oral or nasal airway
2. Ventilate the patient using a bag-mask device
110
Adequate ventilation while you prepare to administer naloxone decreases the risk of ___
Permanent brain damage related to hypoxia
111
Barbiturates and benzodiazepines are ___ depressants and alter the ___, with effects similar to ___
1. CNS
2. Level of consciousness
3. Alcohol
112
In general, sedative-hypnotic drugs are taken by ___
Mouth
113
Patients who have attempted suicide with sedative-hypnotic drugs will often have ___
Marked respiratory depression and may be in a coma
114
Sedative-hypnotic drugs commonly used to incapacitate people without their knowledge
1. Chloral hydrate
2. Flunitrazepam (Rohypnol or roofies)
3. Ketamine (Ketalar or Special K)
115
General treatment of patients who have overdosed with sedative-hypnotics and have respiratory depression
1. Ensure the airway is patent
2. Assist ventilations
3. Give supplemental oxygen when appropriate
4. Provide prompt transport
5. Closely monitor the patient's mental status
6. Watch for vomiting
116
Categories of sedative-hypnotic drugs
1. Barbiturates
2. Benzodiazepines
3. Others
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Common materials that are inhaled
1. Acetone
2. Toluene
3. Xylene
4. Hexane
5. Gasoline
6. Halogenated hydrocarbons (Freon or difluoroethane)
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Inhaled sedative-hypnotics can often cause ___
Seizures
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Halogenated hydrocarbon solvents can make the heart ___
Hypersensitive to the patient's own adrenaline, putting the patient at a high risk for sudden cardiac death because of ventricular fibrillation
120
Highly toxic, colorless, and flammable gas with a rotten-egg odor
Hydrogen sulfide
121
Hydrogen sulfide has the most impact on the ___
Lungs and CNS
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Hydrogen sulfide used for suicide is referred to as ___
Chemical or detergent suicide
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Chronic exposure to hydrogen sulfide can lead to ___
1. Eye, nose, and throat irritation
2. Headaches
3. Bronchitis
4. Inability to smell the gas
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Patients exposed to a high concentration of hydrogen sulfide, they will experience ___ and may experience ___
1. Nausea and vomiting
2. Confusion
3. Dyspnea
4. Loss of consciousness
5. Seizures
6. Shock
7. Coma
8. Cardiopulmonary arrest
125
CNS stimulants that mimic the effects of the sympathetic nervous system
Sympathomimetics
126
Sympathomimetics frequently cause ___
1. Hypertension
2. Tachycardia
3. Dilated pupils
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An agent that produces an excited state
Stimulant
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___ are common symptoms of sympathomimetic abuse
Paranoia and delusions
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Phentermine hydrochloride is an ___ suppressant
Appetite
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Acute cocaine overdose patients are at a high risk of ___
Seizures, cardiac dysrhythmias, and stroke
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Acute cocaine overdose patients can BPs as high as ___
250/150 mm Hg
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Synthetic Cathinones are known as ___
Bath salts
133
Bath salts are similar to ___
MDMA
134
Brand names of bath salts
Ivory Wave
Cloud Nine
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Bath salts produce ___
Euphoria, increased mental clarity, and sexual arousal
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Most bath salts are taken by ___
Snorting or insufflate the powder nasally
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The effects of bath salts last as long as ___
48 hours
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Adverse effects of bath salts
Teeth grinding, appetite loss, muscle twitching, lip-smacking, confusion, GI conditions, paranoia, headache, elevated heart rate, and hallucinations
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Some bath salt patients may require ___ to facilitate safe transport
Chemical restraint
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Alters a person's sensory perceptions
Hallucinogen
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A patient having a "bad trip" will usually have ___
Hypertension, tachycardia, anxiety, and paranoia
142
Commonly abused hallucinogens
1. Bufotenine (toad skin)
2. Datura stramonium (jimsonweed)
3. Dextromethorphan (DXM)
4. Dimethyltryptamine (DMT)
5. Ketamine
6. LSD
7. Mescaline (peyote)
8. Morning glory
9. Nutmeg
10. PCP
11. Psilocybin (mushrooms)
12. Salvia
143
Do not use restraints for a patient on hallucinogens unless ___
You or the patient is in danger of injury
144
Medications that block the parasympathetic nerves
Anticholinergic agents
145
Signs and symptoms of anticholinergic agent overdose
1. Hyperthermia
2. Dilated pupils
3. Dry skin and mucous membranes
4. Reddened skin
5. Agitation or delirium
146
Common drugs with a significant anticholinergic effect
1. Atropine
2. Antihistamines such as diphenhydramine (Benadryl)
3. Datura stramonium (jimsonweed)
4. Certain tricyclic antidepressants such as amitriptyline (Elavil)
147
It is often difficult to distinguish between an anticholinergic overdose and a ___ overdose. Both groups of patients may ___
1. Sympathomimetic
2. Be agitated and have tachycardia and dilated pupils
148
Tricyclic antidepressant overdose may cause more serious and life-threatening effects because the medication may ___
Block the electrical conduction system in the heart, leading to cardiac dysrhythmias
149
Patient's with tricyclic antidepressant overdose may appear normal, but seizure and death can occur within ___
30 minutes
150
Medications that overstimulate the normal body functions controlled by the parasympathetic nervous system
Cholinergic agents
151
Cholinergic agents are used in ___
1. Chemical warfare
2. Organophosphate insecticides
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Signs and symptoms of cholinergic agent overdose
1. Excessive salivating
2. Mucous membrane oversecretion, resulting in rhinorrhea
3. Excessive urination
4. Excessive tearing of the eyes
5. Uncontrolled diarrhea
6. Abnormal heart rate
153
Mnemonic to remember signs and symptoms of cholinergic drug poisoning
DUMBELS
154
DUMBELS
Diarrhea
Urination
Miosis, muscle weakness
Bradycardia, bronchospasm, bronchorrhea
Emesis
Lacrimation
Seizures, salivation, sweating
155
Miosis
Constriction of the pupils
156
Bronchorrhea
Discharge of mucus from the lungs
157
Emesis
Vomiting
158
Lacrimation
Excessive tearing
159
Alternative mnemonic to remember signs and symptoms of cholinergic drug poisoning
SLUDGEM
160
SLUDGEM
Salivation, sweating
Lacrimation
Urination
Defecation, drooling, diarrhea
Gastric upset and cramps
Emesis
Muscle twi
161
SLUDGEM
Salivation, sweating
Lacrimation
Urination
Defecation, drooling, diarrhea
Gastric upset and cramps
Emesis
Muscle twitching/miosis
162
The most important consideration in caring for a patient who has been exposed to a cholinergic agent is to ___
Avoid exposure to yourself
163
For a patient who has cholinergic agent poisoning, ___ will take priority of prompt transport to the ED
Decontamination
164
To care for a patient exposed to cholinergic agents ___
Can use the anticholinergic drug atropine to dry up the patient's secretions, followed by the use of pralidoxime to reverse the nerve agent's effect on the patient's nervous system. After decontamination decrease the secretions in the mouth and trachea and provide airway support
165
Most common kit to antidote cholinergic agents
DuoDote Auto-Injector
166
The military form of the DuoDote Auto-Injector
Antidote Treatment Nerve Agent Auto-Injector (ATNAA)
167
Single auto-injector containing 2 mg of atropine and 600 mg of pralidoxime
DuoDote Auto-Injector
168
If a known exposure to nerve agents or organophosphates with manifestation of signs and symptoms has occurred, us the antidote kit ___
Only on yourself
169
Aspirin poisoning may result in ___
1. Nausea and vomiting
2. Hyperventilation
3. Ringing in the ears
4. Anxiety
5. Confusion
6. Tachypnea
7. Hyperthermia
8. Seizures
170
Two main types of food poisoning
1. The organism itself causes disease
2. The organism produces toxins that cause disease
171
Salmonellosis is characterized by ___
Severe GI symptoms within 72 hours, nausea and vomiting, abdominal pain, and diarrhea. May be systemically will with fever and generalized weakness
172
Common culprit of bacteria producing toxins in old food
Staphylococcus
173
Staphylococcal food poisoning symptoms usually start within ___
2 to 3 hours or as long as 8 to 12 hours
174
Most severe form of toxin ingestion with food poisoning
Botulism
175
Bacteria that produces botulism
Clostridium
176
Symptoms of botulism
Neurologic:
-Blurring of vision
-Weakness
-Difficulty in speaking and breathing
can also cause:
-Muscle paralysis
177
Botulism is typically fatal when it ___
Reaches the muscles of respiration
178
Symptoms of botulism may develop ___
As long as 4 days or as early as the first 24 hours
179
Do not try to determine the specific cause of acute GI conditions, instead ___
Gather as much history as possible from the patient and transport them promptly to the hospital
180
When two or more people in one group have the same illness, take along some of the ___ to the hospital (food poisoning)
Suspected food
181
In advanced cases of botulism, you may have to ___
Assist ventilation and give basic life support
182
Emergency medical treatment of dieffenbachia poisoning ___
Maintaining an open airway, giving oxygen when necessary, and transporting the patient promptly to the hospital for respiratory support
