EHS 202 Pharmacology Week 6

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Questions and Answers

What are some common contexts in which poisoning and overdose may occur?

Sports injuries

Suicide attempts and psychiatric illness (correct)

Routine medical check-ups

Trauma and injuries

Which type of exposure is most commonly associated with accidental overdose in children under six?

Injection of medications

Inhalation of toxic fumes

Topical absorption of substances

Ingestion due to inadequate supervision (correct)

In managing toxicological emergencies, what critical skill must paramedics possess?

Understanding of radiology

Ability to administer all medications

Knowledge of various substances and treatment plans (correct)

Expertise in surgical interventions

What is the most common method of exposure for poisoning cases?

Ingestion of substances Signup and view all the answers

Which of the following statements is true about unreported cases of overdose?

Not all cases are reported, particularly intentional incidents Signup and view all the answers

What two important pharmacological concepts should paramedics understand in overdose scenarios?

Pharmacokinetics and pharmacodynamics Signup and view all the answers

Which of the following can be a source of exposure leading to overdose?

Exposure through ingestion, inhalation, and other routes Signup and view all the answers

In which setting might toxicological emergencies present challenges unrelated to drug use?

When the primary complaint is a medical emergency Signup and view all the answers

What is the primary focus of toxicology?

The study of toxic or poisonous substances Signup and view all the answers

Which of the following describes a poison?

A substance that can damage structures or reduce normal function Signup and view all the answers

What factors influence the severity and outcome of an overdose?

The patient's age, weight, and specific substance Signup and view all the answers

What is an overdose?

Taking a drug beyond its therapeutic dose Signup and view all the answers

How can a toxin be defined?

A substance produced by a living organism that is harmful Signup and view all the answers

Which of the following substances are commonly encountered in overdoses by paramedics?

Over-the-counter medications, alcohol, and opiates Signup and view all the answers

What is the importance of scene safety during an emergency call?

To prioritize personal safety and those around you Signup and view all the answers

In an overdose scenario, which of the following symptoms might you observe?

Shallow breathing and altered consciousness Signup and view all the answers

What is the primary focus of a paramedic when managing a patient suspected of an opiate overdose?

Ensuring the patient's airway, breathing, and circulation Signup and view all the answers

Which of the following routes can naloxone be administered?

Intravenous, intramuscular, intraosseous, or subcutaneous Signup and view all the answers

What is a significant risk associated with rapid administration of naloxone?

Potential for violent withdrawal Signup and view all the answers

What is the initial dose of naloxone for adults in cases of suspected opiate overdose?

400 mcg Signup and view all the answers

What condition can cause respiratory depression and is easily treated, which should be ruled out in cases of altered consciousness?

Hypoglycemia Signup and view all the answers

Which class of drugs includes benzodiazepines, barbiturates, and alcohol?

CNS depressants Signup and view all the answers

What is the role of flumazenil in overdose management?

To reverse the effects of benzodiazepines Signup and view all the answers

Which management method can be beneficial in cases of barbiturate overdose?

Activated charcoal usage Signup and view all the answers

Which substances are contraindicated for activated charcoal administration?

Cyanide Signup and view all the answers

What are typical overdose symptoms of paracetamol?

Confusion and unconsciousness Signup and view all the answers

What is a recommended action for managing hypotension in overdose patients?

Administer IV bolus sodium chloride Signup and view all the answers

Which of the following is a common consequence of cyclic antidepressant overdose?

CNS excitability Signup and view all the answers

What may be necessary to consider alongside naloxone administration?

Activated charcoal Signup and view all the answers

Which patient group is at an increased risk of liver damage from paracetamol overdose?

Malnourished individuals Signup and view all the answers

In what scenario is activated charcoal typically recommended?

If ingestion occurred within one hour Signup and view all the answers

Which of the following is a life-threatening manifestation of cyclic antidepressant overdose?

Cardiac arrhythmias Signup and view all the answers

What is the primary indication for the use of flumazenil?

To reverse benzodiazepine overdose Signup and view all the answers

What is the maximum dose of flumazenil that can be administered to a patient under 18 years of age?

0.2 mg Signup and view all the answers

Which of the following symptoms is NOT associated with CNS stimulant intoxication?

Bradycardia Signup and view all the answers

What is the initial management step for oral overdose and poisoning?

Activated charcoal administration Signup and view all the answers

In the case of CNS stimulant intoxication with ischemic chest pain, what management should be initiated?

Oxygen and aspirin administration Signup and view all the answers

What risk is posed to patients with a reduced Glasgow Coma Scale (GCS) due to alcohol intoxication?

Aspiration risk Signup and view all the answers

What is a common effect of acute alcohol withdrawal?

Delirium Signup and view all the answers

What should be avoided when administering activated charcoal?

Inducing vomiting Signup and view all the answers

What is a common treatment for seizures caused by cyclic antidepressant overdose?

Diazepam Signup and view all the answers

Which symptoms are typical in beta-blocker overdose?

Bradycardia and heart block Signup and view all the answers

Which of the following is NOT a symptom of delirium?

Increased appetite Signup and view all the answers

What is commonly administered to improve tissue perfusion in beta-blocker overdose?

Atropine and IV fluids Signup and view all the answers

What is the maximum dose of atropine for patients aged 12 years and above in case of beta-blocker overdose?

3 mg Signup and view all the answers

Which of the following is a cause of delirium?

Chronic illness Signup and view all the answers

How soon do symptoms typically manifest in cases of beta-blocker overdose?

Within 6 hours Signup and view all the answers

What condition can result from organophosphate exposure?

Seizures and confusion Signup and view all the answers

Study Notes

EHS 202 Pharmacology for EMS - Week 6

Poisonings and overdoses are a significant portion of EMS responses
Overdoses can be associated with trauma, suicide attempts, psychiatric illness, or other medical emergencies.
Objectives of the lecture include defining overdose in paramedic practice, assessment and management of common toxins, physiological effects of overdose toxins, and clinical guidelines for overdose management.
Toxicological emergencies are a common reason for ambulance calls and can present unique challenges.
Not all overdose and poisoning cases are reported, especially intentional or illegal incidents.
Management of toxicological emergencies requires paramedics to think critically about safety, the source of the substance, differential diagnosis, and treatment plans.
Toxicological emergencies may not always be drug-related. Paramedics need a solid understanding of substances and medications, pharmacokinetics, and pharmacodynamics in pre-hospital settings.
Exposure can be via ingestion, inhalation, topical, absorption, injection, inoculation, or radiation.
Accidental overdoses are common among young children, often due to inadequate supervision.
Intentional overdoses are commonly associated with self-harm, suicide attempts, psychiatric illness, or other medical emergencies.
Toxicology is the study of toxic or poisonous substances.
A poison is a substance that damages structures or reduces normal body function, even in small amounts.
A drug has therapeutic effects (e.g., pain relief, fighting infection), but in excess, it can become poisonous.
A toxin is a harmful substance naturally produced by a living organism (e.g., bacteria, plants, animals).
Overdose occurs when a drug or substance is taken in excess, whether legal or illegal.
The severity and outcome of overdoses/poisonings depend on the patient's age, weight, the toxicity of the substance, quantity, route of exposure, and co-morbidities.
Common overdose types include over-the-counter or prescribed medications, alcohol, and opiates. Paramedics must be familiar with these various presentations and treatment strategies.

Case Study

A collapsed male patient, unconscious, was reported to EMS by police.
The patient was approximately 30 years old, lying prone, unresponsive except to pain.
Respiratory rate was 10, with shallow breathing; reduced tidal volume.
Blood pressure was 110/72, heart rate 120 bpm.
The patient showed signs of intoxication (needle marks and scars on arms).
Drug paraphernalia, needles, and an unknown brown substance (believed to be heroin) were present.

Scene Safety

Personal and environmental safety are paramount at emergency calls.
Paramedics have a duty of care to provide safe environments for patients and others involved.
Balancing patient care with safety concerns is a critical ethical consideration.

Approach to Every Scene

Paramedics need to assess danger, response, airway, breathing, and circulation.
Risk factors should be considered during the reassessment.
Additional risk factors like violence, sharps injuries, exposure to blood-borne infections like hepatitis and HIV must be considered.

Common Drugs of Abuse

Commonly abused drugs include Narcotics (opiates and opioids), Sedatives/Hypnotics/Central Nervous System depressants, Sympathomimetics/Central Nervous System stimulants, and Anticholinergics.
Prescription drugs associated with overdose include opiates (morphine, codeine, oxycodone, fentanyl, tramadol), antidepressants (amitriptyline, seroxat, citalopram, sertraline) and benzodiazepines (diazepam, tamazepam, midazolam); non-benzodiazepines (zopidem, zopiclone, zaleplon) and gabapentinoids (gabapentin & pregablin).

Narcotic, Opioid, Overdose

Overdose can result from any opiate in any setting.
Opiates depress the respiratory and circulatory systems, resulting in reduced consciousness or hypotension and respiratory depression.
Paramedics must focus on airway, breathing, and circulation management when dealing with suspected opiate overdose.
Heroin is a common causative agent in opiate-related overdoses, can be injected, snorted or inhaled.

Opiate Overdose Management

Determining the cause of altered consciousness (ruling out other metabolic conditions), and administering naloxone.
Naloxone is a competitive antagonist that binds to opiate receptors, preventing their effects.
Naloxone is administered intravenously, intramuscularly, intraosseously, or subcutaneously.
Rapid administration or excessive dosages can lead to violent withdrawal reactions, agitation, and vomiting, impacting airway compromise and increasing safety risks.
Dosage guidelines for adults (>= 12 years) and children ( <12 years) are provided separately.

Central Nervous System (CNS) Depressants

Common CNS depressants are benzodiazepines, barbiturates, anesthetic agents, inhalational solvents, and alcohol.
Overdose results in CNS depression causing drowsiness, confusion, loss of coordination, decreased blood pressure and respiration.
Benzodiazepine intoxications are less severe than barbiturate overdoses.
Flumazenil is a benzodiazepine antagonist used to reverse the sedation and respiratory depression caused by benzodiazepine overdose.
Activated charcoal is useful in barbiturate overdoses.

Alcohol Intoxication Management

Intoxication can affect body temperature, breathing, heart rate, and gag reflex.
Patients with reduced GCS risk aspiration and may not be able to consent to treatment.
Alcohol withdrawal can lead to seizures and delirium tremens.

CNS Stimulants (Methamphetamine & Cocaine Intoxication)

These drugs are chemically similar to the body's natural catecholamines (adrenaline, noradrenaline and dopamine).
Overdose leads to sympathomimetic effects (hypertension, tachycardia, cardiac arrhythmias, dilated pupils, increased activity, restlessness, seizures, and excess body temperature, mood swings, violence).

CNS Stimulant Intoxication Management

Includes tachycardia, hypertension, chest pain, and myocardial ischemia.
If ischemic chest pain is present, management needs oxygen, aspirin, GTN, and a 12-lead ECG.
Diazepam should be administered for severe chest pain (following local guidelines).
Benzodiazepines are used for seizures.

Activated Charcoal

Should be the first intervention for oral overdoses and poisonings.
Reduces poison absorption and may induce vomiting.
Follow appropriate risk assessments before administering.
It's not applicable in all ingestion cases as some ingested substances are not affected by charcoal.
Contraindicated in cyanide, petroleum distillates, lithium, iron, ethanol, and corrosive substances.

Paracetamol (Acetaminophen) Overdose

Paracetamol (Panadol, Tylenol) overdose can lead to significant liver and kidney damage.
Patients with pre-existing liver conditions or heavy alcohol use are more vulnerable.
Typical symptoms in overdose include right upper quadrant pain, nausea, vomiting, jaundice, confusion or loss of consciousness.
Clinical symptoms may not be immediately apparent.
Initial care is the same as for other ill/injured patients (maintain airway, administer oxygen, place IV line)
Treat hypotension with IV sodium chloride and consider activated charcoal (if ingestion occurred within the hour).
Consider naloxone if respiratory depression is present.

Cyclic Antidepressant Overdose

Overdoses of cyclic antidepressants are dangerously severe, especially in children.
Manifestations include CNS excitability, fever, pupil dilation, seizures and loss of consciousness, arrhythmias, tachycardia, and respiratory depression.
Initial care is supportive; activated charcoal may be administered (if allowed), and cardiac arrhythmias are a serious concern.
IV fluids may not be enough for severe hypotension. Vasopressors may be needed.
ECG monitoring and seizure management are crucial.

Beta-Blocker Overdose

Beta-blockers slow down heart rate by blocking adrenaline hormones.
Common uses include treating high blood pressure.
Overdose leads to bradycardia, heart block, and hypotension
Beta-blocker overdoses can result in severe delirium, seizures, and coma.
Symptoms typically appear within 6 hours of ingestion.

Delirium

Is an acute disturbance of the mind, marked by a sudden onset and diverse causes.
Symptoms such as euphoria, confusion, hallucinations, restlessness, agitation, lethargy, and irritability or anger are possible.
Causes include underlying illness, metabolic problems, medications, infections, alcohol or drug use/withdrawal.

Beta-Blocker Overdose Management

Focus on restoring tissue perfusion using atropine and IV fluids.
Atropine alone often insufficient; other causes need to be addressed.
Atropine dosage varies by age; consult local guidelines.
Sodium chloride (IV fluids) may be required and maximum dose should also be based on patient's age and conditions

Toxins (Organophosphates/Nerve Agents)

Organophosphates are found in insecticides and fertilizers (and can be altered for use as nerve agents).
Exposure can occur through inhalation, ingestion, or skin absorption.
These toxins inhibit the enzyme acetylcholinesterase, affecting acetylcholine breakdown, causing an overstimulation of the parasympathetic and sympathetic nervous systems.
Symptoms (muscarinic effects) include diarrhea, urination, miosis, bradycardia, bronchospasm, and vomiting; other symptoms (nicotinic effects) include mydriasis, tachycardia, weakness, hypertension, and fasciculations.
Overdoses cause symptoms within minutes and the most dangerous symptoms include excessive respiratory secretions (bronchorrhea), bronchospasm, and respiratory insufficiency.
Proper patient assessment (airway and breathing) is crucial for treatment, along with atropine given as an adjunct to oxygen. Atropine dosage varies by age; see local guidelines.
DuoDote auto-injector (atropine combined with pralidoxime) is available for rapid administration. Protective personal equipment (PPE) should be used for protection.

Paraquat Poisoning

Paraquat is a toxic herbicide, primarily found in liquid form, used in weed and grass control.
Ingesting larger amounts primarily affects the lungs, liver, and kidneys.
Symptoms include gastrointestinal issues (nausea, vomiting), dehydration, hypotension.
Management includes considering activated charcoal if ingestion is recent.
Supplemental oxygen may be unnecessary unless there are signs of hypoxia.

Medications Review (Next Week's Class)

GTN, Morphine, Clopidogrel are listed for review next week.

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Description

This quiz covers overdose and poisoning management for EMTs in the context of emergency medical services. Students will explore the definitions, assessments, and clinical guidelines concerning toxicological emergencies. Familiarity with pharmacokinetics and pharmacodynamics is emphasized for effective pre-hospital care.