Poisoning & Overdose | Part One

Poisoning and Overdose

Poisoning: exposure to substance that is generally harmful, with no beneficial effects
Overdose: excessive exposure to a substance that has normal treatment uses. Nearly ½ involve prescription drugs.

Types of toxicological emergencies:
Unintentional Poisonings
Dosage Errors: accidental by nurses, Drs, family members or self Idiosyncratic reactions: unpredictable side effects
Childhood poisoning: inattentive care/childhood curiosity. These are the most frequent calls to the poison control centers
Environmental exposures
Occupational exposures
Neglect and abuse: fine line between the two

Drug and Alcohol Abuse/Substance Abuse: millions of $$ of injuries and illness each year
Intentional Poisonings or Overdose
Chemical warfare: terrorism, war, WMD
Assault or homicide: using poison to commit murder
Suicide attempts: deliberate exposure to a known poison or overdose of a therapeutic drug

Scene size-up comes first.
Assure your safety and that of your team first.

Routes of absorption:
Ingestion: poison enters the body through the mouth and absorbed by the digestive tract. Mushrooms, sleeping pills. Preferred method of care is activated charcoal and/or gastric lavage
Inhalation: toxic fumes or gas inhaled into the lungs. Carbon Monoxide. Move patient to fresh air, provide hi-flow O2
Absorption: substances may pass through the skin to the blood stream. Pesticides, ag chemicals. Brush off, flush with H2O, Remove clothing, Protect yourself
Injection: toxic material injected by needles or stingers, deal with the symptoms. Epi for bee/wasp as necessary, some snakebites have antivenom, Narcan for opiates.

Geographically Specific Types:
Venomous Snakes: coral snakes
Marine animals: jelly fish, lion fish
Manufacturing industries: chemical plants, oil refineries
Transportation industries: railroad routes, interstate highways
Toxidromes: groups of drugs that present with the same patterns of toxicity

Management: protect and maintain ABCs. Antidotes may be available, but attention to the basics is most important.

Assessment: Ask:
What was taken?
How much was ingested?
When the poisoning occurred?
What has been done for the patient so far? Signs and Symptoms vary:
Burning, tearing of eyes
Respiratory distress
Nausea, vomiting, diarrhea
Diaphoresis, salivation
Weakness, dizziness, headache, seizure
Altered level of consciousness

Physical Findings:
Pulse: tachycardia – stimulants, bradycardia – heart meds, pesticides
Respiratory Rate: increased in children may mean aspirin, depressed resps from narcotics, sedatives and CO poisoning
Temperature: elevated = aspirin and stimulants, lowered = alcohol, sedatives, narcotics, pesticides
Blood Pressure: decreased by depressants or narcotics, elevated by cocaine, stimulants

Focused Physical Exam:
Respiratory System: can cause resp depression, airway obstruction, distress and wheezing
Cardiovascular System: irregular heart rhythms, chest pain, shock and cardiac arrest
Neurological System: pupil size, narcotics constrict (myosis), stimulants dilate

Care of the Poisoned Patient:
Airway, breathing, circulation
Follow vital signs, pulse Ox
Put on cardiac monitor
Position patient to prevent aspiration
High flow O2 by mask, cannula or consider intubation
PASG as per local protocols
Restrain violent/suicidal patient as per local protocols
Notify receiving hospital: bring pills, bottles, containers, samples, snakes (dead), spiders (dead)

Activated Charcoal: 1 gram per kg. 30-100g for an adult, 15-30g for a child up to 12 (Follow local guidelines)

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