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Temple College
EMS Professions
Poisons
Suspect with:
Try to determine:
What?
How much?
How long ago?
What has already been done?
Psychiatric history?
Underlying illness?
When in doubt. . .
Assume containers were full
Entire contents were ingested
Always. . .
Bring sample of material if possible
Save for analysis, if patient vomits
Call poison center for advice on
management
Poisoning Management
Ingested Poisons
Activated Charcoal
Activated Charcoal
Names
SuperChar
InstaChar
Actidose
Liqui-Char
Activated Charcoal
Form
Premixed in water (slurry)
Usually bottle containing 12.5 gms
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
Activated Charcoal
Side Effects
Nausea, vomiting
Black stools
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
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
Dont accidentally expose yourself!
Inhaled Poisons
Remove patient from exposure
Maximize oxygenation, ventilation
CAUTION
Dont accidentally expose yourself!
Injected Poisons
Drug Abuse/Overdose
Substance Abuse
Substance Abuse
Psychological dependence
Physical dependence
Compulsive drug use
Tolerance
Addiction
Psychological Dependence
Habituation
Substance needed to support users
sense of well-being
Physical Dependence
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 Alcohol
A CNS Depressant Drug
Decreased Reaction
Time
Increased Accidental
Trauma Risk
Decreased Social
Inhibitions
Increased Intentional
Trauma Risk
Potentiation of Other
CNS Depressants
Lethal Overdoses in
Combination with Other
Drugs
Irritation, Gastritis,
Ulcer Disease, GI
Bleeds
Respiratory
Depression, Shock
Slowed GI Tract
Activity
Toxic Overdose
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
Patient is NEVER
just drunk until all
other possibilities are
excluded
Alcohol Addicts
Delirium Tremens
Life threatening condition!
Occurs 1 days to 2 weeks after
intake is decreased
5 to 15% mortality
Control airway, prevent aspiration,
monitor for hypovolemia
Narcotics
Opium
Opium derivatives
Synthetic compounds that produce
opium-like effects
Narcotics
Opium
Heroin
Morphine
Demerol
Dilaudid
Percodan
Codeine
Darvon
Talwin
Narcotics
Medical Uses
analgesics
anti-diarrheal agents
cough suppressants
Narcotics
Overdose
Coma
Respiratory depression
Constricted (pin-point) pupils
Narcotics
Withdrawal
Agitation
Anxiety
Abdominal pain
Dilated pupils
Sweating
Chills
Joint pains
Goose flesh
Barbiturates
Nembutal
Seconal
Pentobarbital
Amytal
Tuinal
Phenobarbital
Barbiturates
Induce sleepiness, state similar to
EtOH intoxication
Medical uses
Anesthetics
Sedative
Hypnotics
Barbiturates
Overdose
Coma
Respiratory depression
Shock
Barbiturates
Withdrawal
Resembles EtOH withdrawal (DTs)
Extremely dangerous
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
Tranquilizers
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
Overdose
Restlessness, paranoia
Tachycardia
Hypertension
CVA, Heart failure
Hyperthermia
Heat stroke
Withdrawal
Lethargy
Depression
lethargy
depression
Hallucinogens
LSD, psilocybin, peyote, mescaline,
DMT, MDMA
Enhance perception
Wrong setting may induce bad
trips with extreme anxiety
True toxic overdose rare
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
Solvents
Glue, paint, gas, light fluid, toluene
Inhalation produces state similar to
EtOH intoxication
Patient may asphyxiate if
consciousness lost while sniffing
Solvents
Increase risk of arrhythmias
May cause liver damage, bone
marrow depression
Chronic abuse causes CNS damage
- paranoia, violent behavior