Poisoning and Overdose Overview
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Questions and Answers

Which statement best defines a poison?

  • A substance that has no effect on living organisms regardless of the amount.
  • A substance that alters the normal function of organs and tissues upon contact or introduction to an organism. (correct)
  • Any substance that is used in small amounts for therapeutic purposes.
  • A substance that enhances normal metabolic processes in the body.

    • Which of the following best describes an overdose?

  • Taking multiple medications that enhance therapeutic effects safely.
  • An excessive dose that leads to acute physical or mental effects, whether deliberate or accidental. (correct)
  • Consuming a drug in smaller quantities than directed.
  • Using a drug at its prescribed dosage for an extended period.

    • Which of the following substances is NOT classified as a depressant?

  • Opiates
  • Benzodiazepines
  • Gamma-Hydroxybutyrate
  • Cocaine (correct)

    • Which route of poisoning or overdose is typically associated with household products?

    <p>Contact with petroleum products or household cleaners.</p> Signup and view all the answers

    Which route of entry is considered the most frequent for airborne substances?

    <p>Inhalation</p> Signup and view all the answers

    Which factor does NOT affect the degree of poisoning?

    <p>Time of day</p> Signup and view all the answers

    Ingestion as a route of entry typically requires which condition?

    <p>The patient must be awake</p> Signup and view all the answers

    What characteristic of skin affects the absorption of poisons?

    <p>Intactness of the skin</p> Signup and view all the answers

    Which statement about alcohol metabolism is correct?

    <p>95% of alcohol is metabolized in the liver</p> Signup and view all the answers

    Which of the following is a method of injection?

    <p>Subcutaneously</p> Signup and view all the answers

    What is the primary effect of alcohol binding to GABA receptors?

    <p>CNS depression</p> Signup and view all the answers

    Which of the following compounds is a product of ethanol metabolism?

    <p>Acetaldehyde</p> Signup and view all the answers

    What is the primary concern associated with acetaminophen ingestion beyond 12 hours?

    <p>Direct damage to the liver</p> Signup and view all the answers

    Which symptoms are associated with late-stage acetaminophen toxicity?

    <p>Seizures and coma</p> Signup and view all the answers

    What is the key treatment for acetaminophen toxicity if administered within 8 hours?

    <p>N-Acetylcysteine (NAC)</p> Signup and view all the answers

    What is the lethal dose of acetaminophen for an adult?

    <p>150 mg/kg or 10g</p> Signup and view all the answers

    What symptom can occur as a result of acetaminophen overdose that is not commonly noted in the early phase?

    <p>Rhabdomyolysis</p> Signup and view all the answers

    What is the primary benefit of treating carbon monoxide (CO) poisoning with 100% oxygen?

    <p>It reduces the duration of CO's effects from 6 hours to 2 hours.</p> Signup and view all the answers

    Which treatment is the most effective for reducing the duration of carbon monoxide effects in patients?

    <p>Hyperbaric chamber</p> Signup and view all the answers

    What condition may arise from excessive vomiting due to food poisoning?

    <p>Hypovolemia</p> Signup and view all the answers

    What is the likely outcome of chlorine gas exposure during an inhalation injury?

    <p>Inflammation and pulmonary edema</p> Signup and view all the answers

    Which mechanism contributes to the toxicity of salicylates?

    <p>Directly harming neural tissue</p> Signup and view all the answers

    What is the lethal dosage of oil of wintergreen for an average toddler?

    <p>500 mg/kg</p> Signup and view all the answers

    Why should rescuers avoid entering a potentially unsafe scene when dealing with a chlorine gas exposure?

    <p>To ensure that fire personnel have cleared the area.</p> Signup and view all the answers

    Which symptom is NOT commonly associated with cyanide poisoning?

    <p>Cyanosis</p> Signup and view all the answers

    What is the most immediate danger of organophosphate poisoning?

    <p>Respiratory paralysis and seizures</p> Signup and view all the answers

    Which of the following symptoms is associated with muscarinic effects of organophosphate poisoning?

    <p>Bradycardia</p> Signup and view all the answers

    What does the acronym SLUDGEM represent in relation to anticholinergic poisoning effects?

    <p>Salivation, Lacrimation, Urination, Defecation, Gastrointestinal distress, Emesis, Miosis</p> Signup and view all the answers

    Which treatment approach is essential for managing organophosphate poisoning?

    <p>Decontamination and airway management</p> Signup and view all the answers

    Which of the following best describes the physiological effects of nicotinic toxicity due to organophosphate poisoning?

    <p>Mydriasis, tachycardia, and fasciculations</p> Signup and view all the answers

    What does the treatment for anticholinergic poisoning involve?

    <p>Decreasing acetylcholine activity at the muscarinic junction</p> Signup and view all the answers

    In the context of decontamination procedures, which step is paramount before medical management?

    <p>Removing all clothing and irrigating exposed areas</p> Signup and view all the answers

    What symptom is NOT a part of the anticholinergic poisoning triad?

    <p>Bradycardia</p> Signup and view all the answers

    Study Notes

    Poisoning & Overdose Definitions

    • Poison: any substance that impairs normal metabolic processes upon contact or introduction into an organism, altering organ and tissue function.
      • "Everything is a poison, it is a matter of dose." (Alchemist’s Rule)
    • Overdose: excessive use of any drug causing acute adverse physical or mental effects.
      • Can be deliberate or accidental, lethal or non-lethal.

    Routes of Entry

    • Inhalation: Airborne substances breathed in, including gases, vapors, smoke, fog, dust, mists, and fumes. (rapid absorption)
    • Absorption (Skin and Mucous Membranes): Includes the eyes, generally slower than inhalation. Intact skin provides a barrier to some, but not all, poisons.
      • Affected by blood flow and temperature to the area.
      • Lipid-soluble chemicals (organophosphates) readily absorb through skin.
    • Ingestion: Patient must have been awake to take the substance.
      • Intentional: suicide or poisoning by another.
      • Unintentional: improper hand washing, smoking, eating, swallowing concentrated solids or liquids, or inhaling aerosols.
      • Most common in children.
    • Injection: Subcutaneous, intramuscular, or intravenous.
      • IV drug use, accidental high-pressure injection, lacerations, prescribed medication.

    Degree of Poisoning

    • Factors affecting the degree of poisoning include:
      • Concentration of the substance
      • Exposure time
      • The substance's affinity for tissue
      • Sensitivity of the exposed tissue
      • Route of entry
      • Age
      • Liver function.

    Alcohol

    • Isopropanol, methanol, and ethanol (ETOH) are common alcohol types.
    • Ethanol Withdrawal: Can be fatal.

    Alcohol ADME

    • Usually ingested, but can be absorbed parenterally through inhalation, rectal, or IV administrations.
    • Distributed equally through all water-carrying potential spaces.
    • Metabolized primarily through 2 enzymes:
      • Alcohol dehydrogenase: Converts ethanol to Acetaldehyde.
      • Aldehyde dehydrogenase: Converts Acetaldehyde to ketones.
    • 95% is metabolized, the remaining 5% excreted through sweat, urine, and respiration.

    Alcohol MOA

    • Binds to GABA receptors, a receptor protein causing CNS depression.
    • Continuous GABA stimulation increases the stimulus threshold.
    • More ETOH is needed to achieve the same effect as dependency increases.
    • Subclinical symptoms are caused by depression of specific areas of the brain responsible for coordination, memory, logic, consciousness, respiration, and airway protection.

    Household Poisons

    • CO and Cyanide: Failure of cells to carry out aerobic respiration, leading to lactic acidosis, cell death, MODS, and patient death.
      • Tx: 100% oxygen, hyperbaric chamber, cyanocobalamin (vitamin B12).
    • Food Poisoning: Bacteria in food causes gastroenteritis, generally self-limiting. Risk of hypovolemia from excessive vomiting may require IV fluids.
    • Blister Agents: Chemicals like Ammonia Cleaner and Chlorine Bleach cause direct trauma to the respiratory system, leading to inflammation, pulmonary edema, hypoxia, and death.
      • Tx: High-flow oxygen and rapid transport before tissue damage overwhelms basic life support (BLS) airway management.
    • Do not enter a potentially unsafe scene before the scene is cleared or the patient is brought outside.

    Rx Drugs - Salicylates

    • Used primarily to treat inflammation (ASA, Bengay, Oil of Wintergreen, Pepto Bismol).
    • Fatal dose for an average 14kg toddler:
      • 21 adult ASA tablets
      • 1 teaspoon Oil of Wintergreen
      • 1 bottle Pepto Bismol

    Rx Drugs - Salicylates

    • Salicylates cause damage through two primary mechanisms:
      • Direct neural tissue poisoning.
      • Dramatically increased metabolism and breakdown of fuel sources in the body while inhibiting aerobic respiration.
    • S/S by stage:
      • Early: 4-12 hours: Tinnitus, nausea/vomiting/diarrhea, diaphoresis, respiratory alkalosis.
      • Transitionary: ~24 hours: Worsening symptoms, agitation, delirium, hyperthermia, dehydration.
        • Pediatric: ~4 hours: metabolic acidosis, rhabdomyolysis.
      • Late: Seizures, coma.

    ASA (Acetylsalicylic Acid)

    • Tx: Supportive care, airway management during seizures, manage hyperthermia, rapid transport for gastric lavage if acute ingestion.

    Rx Drugs - Acetaminophen

    • Anti-inflammatory and antipyretic.
    • Death occurs due to direct liver damage, occurring ~12 hours post-ingestion.
    • With early treatment (< 8 hours), minimal damage occurs.
    • Lethal Dose: 150mg/kg or 10g adults
    • Toxic Dose (Acute Ingestion): Tylenol extra strength - 20 tablets

    Rx Drugs - Acetaminophen

    • Acetaminophen Toxicity: Large amounts of acetaminophen overwhelm normal metabolism and take a side pathway creating a toxic metabolite, eventually causing liver damage.
    • Tx: N-Acetylcysteine (NAC): given within 8 hours at the hospital to join with the toxic metabolite to create a safe metabolite that can be excreted by the body.

    Rx Drugs - Cholinergics-Organophosphates

    • Organophosphate poisoning causes overstimulation of cholinergic receptors, leading to problems with the muscarinic and nicotinic junctions.

    Organophosphate Poisoning

    • Muscarinic Effects (SLUDGEM):
      • Salivation
      • Lacrimation
      • Urination
      • Defecation
      • Gastrointestinal distress
      • Emesis
      • Miosis
      • Bradycardia
      • Bronchospasm
      • Emesis
      • Lacrimation
      • Salivation
    • Nicotinic Effects (MTHWF):
      • Mydriasis (pupil dilation)
      • Tachycardia
      • Weakness
      • Hypertension, hyperglycemia
      • Fasciculations

    Organophosphate Poisoning

    • Immediate danger: Respiratory paralysis and seizures due to constant stimulation by Ach at the neuromuscular junction.
    • Characteristic Sign: Muscle fasciculations at 22 seconds

    Organophosphate Poisoning

    • Tx: Standard care, airway management, oxygenation, aggressive fluid boluses to maintain blood pressure (systolic 90, or MAP 65), Atropine, Versed.

    Anticholinergic Poisoning

    • Decreases the strength of acetylcholine (Ach) at the muscarinic junction through increased acetylcholinesterase (AchE) or competitive inhibition.
    • Clinical Manifestations:
      • Dry As A Bone: dry skin, eyes, mouth, and mucous membranes.
      • Red As A Beet: flushing and fever
      • Mad As A Hatter: Confusion and delirium.
      • Hot As A Hare: Hyperthermia
      • Blind As A Bat: Mydriasis (dilated pupils)

    Treatment for Poisoning

    • Ensure scene safety.
    • Decontamination is paramount:
      • Begin before initial medical management.
      • Remove all clothing and irrigate exposed areas to remove residual material from the skin.
      • Treat the patient in a well-ventilated room or outside.
      • Maintain appropriate barrier protection and ventilation to prevent secondary casualties.
      • Decontaminate yourself AND your truck.

    Treatment for Poisoning

    • Airway management.
    • Oxygen.
    • Contact poison control.
    • IV therapy.
    • ECG.
    • ALS backup.
    • Notify receiving treatment center so a secondary decontamination area can be set up.

    Management of Overdose Patient

    • Scene safety.
    • Level of consciousness (LOC) assessment. (Must be continually reassessed.)
    • Airway management.
    • Oxygen.
    • IV therapy.
    • ECG.
    • Continual reassessment and symptom management.
    • Assess for any other injuries.

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    Description

    Explore the critical concepts of poisoning and overdose, focusing on definitions, routes of entry, and implications. Understand how different substances affect the body and the various methods they can enter the system. This quiz will enhance your knowledge of toxicology basics.

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