OD,infection,poison

Paramedic Science - Health & Human Development 2

• Topic: Poisoning/Overdose/Infection
• Course: Health & Human Development 2
• Institution: University of the West of Scotland (UWS)

Overdose

Opioid Overdose

• Opioids are compounds extracted from poppy seed, as well as semisynthetic and synthetic compounds, with similar properties that interact with opioid receptors in the brain.
• Opioids are commonly used for pain treatment, including morphine, fentanyl, and tramadol.

Opioid Overdose Signs & Symptoms

• Pupils constrict and appear small.
• Muscle tone reduced.
• Skin itching, causing scratching.
• Speech may be slurred.
• Altered levels of consciousness.
• Breathing very slow, shallow, erratic, or stopped.
• Cyanosis and pale pallor.
• Airway noises like stridor or choking.
• Vomiting.
• Fingernails and lips turn blue or purplish black.
• Pulse (heartbeat) slow, erratic, or absent.

Opioid Overdose Treatment

• Follow JRCALC Overdose and Poisoning in Adults and Children guidelines.
• Specific substance management.

Paracetamol Overdose

• Paracetamol overdose is the most common intentional overdose calls attended by pre-hospital clinicians.
• Overdose can occur after excessive ingestion of paracetamol or paracetamol-containing medication as an acute or staggered overdose, or a therapeutic excess.
• Patients are often asymptomatic or have only mild gastrointestinal symptoms at initial presentation.
• Untreated paracetamol poisoning may cause varying degrees of liver injury over 2 to 4 days after ingestion, including fulminant hepatic failure.
• In rare cases, massive overdose may initially present with coma and severe metabolic acidosis.

Paracetamol Overdose Signs & Symptoms

• Nausea.
• Vomiting.
• Pain and tenderness in the right upper abdomen.
• Confusion.
• Jaundice (yellow-tinged skin).
• Low blood sugar (hypoglycemia).
• Unexpected bleeding (normal blood clotting is impaired).
• Encephalopathy (damage to the brain).

Paracetamol Overdose Treatment

• Follow JRCALC Overdose and Poisoning in Adults and Children guidelines.
• Specific substance management.

MethyleneDioxy-MethAmphetamine (MDMA) Overdose

• Also known as ecstasy, MDMA comes in pill or powder form. Pills come in various logos and colours.
• Street names include Adam, Beans, Biscuit, Clarity, Disco Biscuit, E, Eve, Go, Hug Drug, Lover's Speed, MDMA, Molly, Peace, STP, X, and XTC.

MDMA Overdose Signs & Symptoms

• Increased motor activity, alertness, and heart rate.
• Blood pressure increase, muscle tension, tremors.
• Teeth clenching, nausea, and sweating.
• Euphoria, empathy, reduced inhibition, chills, and blurred vision.
• Confusion, anxiety, depression, paranoia, and severe dehydration.
• Sharp increase in body temperature (hyperthermia) can lead to liver, kidney, and cardiovascular failure, and death.

MDMA Overdose Treatment

• Follow JRCALC Overdose and Poisoning in Adults and Children guidelines.
• Specific substance management.

Valium Overdose

• Street Valium is a benzodiazepine-type tablet, which may be known as blues, valleys, benzos, scoobies, and diazepam.
• Often white or blue in color. Texture may vary from fuzzy to smooth, depending on quality.
• Users may confuse it with diazepam, however, it may be a more potent benzodiazepine, such as etizolam.
• Etizolam acts quickly, with side effects lasting several hours.
• It's approximately 10 times stronger than diazepam.
• Daily use of etizolam can have serious consequences for mental and physical well-being, including anxiety, depression, and sleep problems.
• High quantities or mixing with alcohol increases the risk of overdose and death.

Valium Overdose Signs & Symptoms

• Decreased energy, heart rate, appetite.
• Blurred vision, small pupils, and involuntary eye closure.
• Impaired coordination, relaxed muscles, headaches, and dry mouth.
• Nausea and vomiting, sleepiness, and yawning.
• Mental confusion, short-term memory loss, low mood, anxiety, and lowered inhibitions.
• Sedative effect.

Valium Overdose Treatment

• Follow JRCALC Overdose and Poisoning in Adults and Children guidelines.
• Specific substance management.

Tricyclic Overdose

• Tricyclic antidepressants (TCAs) were introduced in the late 1950s for depression treatment.
• With the advent of selective serotonin reuptake inhibitors (SSRIs) and other new antidepressants, the use of TCAs has decreased.
• Still used to treat depression not responding to less toxic agents.
• In adults, TCAs are used for migraine headache prophylaxis, treatment of neuralgic pain, including the pain associated with Ciguatera poisoning, and obsessive-compulsive disorder.

Tricyclic Overdose Signs & Symptoms

• Central nervous system excitability, confusion, blurred vision, dry mouth, fever.
• Pupil dilation; convulsions; decreased level of consciousness; arrhythmias, hypotension; tachycardia; respiratory depression; Rapid changes in physical condition.

Tricyclic Overdose Treatment

• Follow JRCALC Overdose and Poisoning in Adults and Children guidelines.
• Specific substance management.

Poisoning

Caustic Agent Poisoning

• Worldwide, 80% of caustic ingestions occur in young children.
• Accidental ingestions of small amounts are typically not harmful.
• Ingestions by adults are often intentional and involve larger amounts; life-threatening.
• Common caustic sources include drain and toilet bowl cleaners, battery acid, and hydrochloric acid for swimming pools.
• Industrial products are usually more concentrated and more damaging than household products.

Caustic Agent Poisoning Signs & Symptoms

• Strong acids or alkalis causing pain, blistering, penetrating necrosis, and coagulating burns.
• Cardiovascular collapse and metabolic acidosis can occur secondary to extensive corrosive injury.

Caustic Agent Overdose Treatment

• Follow JRCALC Overdose and Poisoning in Adults and Children guidelines.
• Specific substance management.

Carbon Monoxide Poisoning

• Carbon monoxide poisoning occurs when carbon monoxide builds up in the bloodstream.
• Replacing oxygen in red blood cells leads to serious tissue damage and potentially death.
• Colourless, odourless, tasteless gas produced by burning gasoline, wood, propane, charcoal, or other fuels.
• Improperly ventilated appliances and engines in tightly sealed/enclosed spaces can cause high levels of carbon monoxide to accumulate.

Carbon Monoxide Poisoning Signs & Symptoms

• Disorientation, decreased consciousness, unconsciousness, and unexplained headaches.
• Characteristic cherry-red skin coloration is rarely seen and usually precedes mortality.

Carbon Monoxide Overdose Treatment

• Follow JRCALC Overdose and Poisoning in Adults and Children guidelines.
• Specific substance management.

Rat Poisoning

• Rat poisoning is rare in humans and typically accidental in children or a suicide attempt in adults.
• Zoocoumarins (anticoagulants) disrupt vitamin K metabolism in the liver.
• Vitamin K is crucial for the synthesis of coagulation factors (VII, IX, X, prothrombin).
• Prevents blood clotting, leading to a hemorrhagic syndrome.
• Anticoagulants are rapidly absorbed almost completely after ingestion.

Rat Poisoning Signs & Symptoms

• Intense headache, pale mucous membranes and skin, epistaxis, bleeding gums, haematuria, gastrointestinal bleeding, tachycardia, hypotension, dizziness, severe weakness, and lack of appetite.
• Rat poisoning can be lethal.

Rat Poison Overdose Treatment

• Follow JRCALC Overdose and Poisoning in Adults and Children guidelines.
• Specific substance management.

Paraquat Poisoning

• Paraquat is a highly toxic chemical herbicide (weed killer).
• Ingestion or inhalation can cause fatal poisoning, with over 70% of cases resulting in death.
• Symptoms develop quickly following ingestion/inhalation.

Paraquat Poisoning Signs & Symptoms

• Swelling and pain in mouth and throat, nausea, abdominal pain, vomiting, diarrhea (possible blood), epistaxis, hypotension, dehydration, and difficulty breathing.
• Severe symptoms include confusion, muscle weakness, seizures, respiratory failure, tachycardia, and coma.
• Potentially causes acute kidney failure, liver failure, lung scarring, pulmonary edema, and respiratory failure.

Paraquat Overdose Treatment

• Follow JRCALC Overdose and Poisoning in Adults and Children guidelines.
• Specific substance management.

Infection

NEWS2 Scoring

• A system for scoring physiological measurements routinely recorded at a patient's bedside.
• Used to identify acutely ill patients (especially those with sepsis) in English hospitals.
• Measures 6 physiological parameters: respiration rate, oxygen saturation, systolic blood pressure, pulse rate, level of consciousness, and temperature.

NEWS2 Scoring (Continued)

• A score of 0, 1, 2, or 3 is assigned to each physiological parameter based on how far it deviates from the normal range.
• Higher scores indicate a higher risk of serious illness.
• Clinical responses for threshold (or trigger) levels are reviewed locally.

Chest Infection

• An infection of lungs or large airways.
• Mild infections often resolve independently; severe infections are life-threatening.
• Typically a deterioration of a cold or flu.

Chest Infection Signs & Symptoms

• Chesty cough (with green/yellow mucus).
• Wheezing and shortness of breath.
• Chest pain/discomfort.
• High temperature.
• Headache.
• Aching muscles.
• Tiredness.
• Symptoms usually resolve in 7-10 days; cough and mucus can last up to 3 weeks.

Chest Infection Treatment

• Follow the JRCALC Dyspnoea Guideline.
• If patient experiences chest pain, follow the Non-Traumatic Chest Pain guideline.

Urinary Tract Infection (UTI)

• Infection of any part of the urinary system (kidneys, ureters, bladder, urethra).
• Most often affects the lower urinary tract (bladder and urethra).
• Women are at higher risk than men.
• Bladder infections are typically painful but not life-threatening.
• Kidney infections can lead to serious health complications.

UTI Signs & Symptoms

• Pain/burning during urination, increased urinary frequency, and nocturia.
• Foul-smelling urine, cloudy/bloody urine.
• Nausea, vomiting, lethargy, irritability, poor feeding, jaundice, and fever.
• Kidney infection symptoms include increased temperature (>38°C), fatigue, and rigors.

UTI Treatment

• Follow the JRCALC Abdominal Pain Guideline.

Sepsis

• Immune system's overreaction to an infection or injury.
• Body's own organs and tissues may be attacked, potentially leading to organ failure and death.
• Timely treatment with antibiotics is essential.
• 5 UK deaths per hour from sepsis.

Sepsis Signs & Symptoms (in children/adults)

See page 40 for details; specifics vary.

Sepsis Signs & Red Flags (specific indicators)

See page 41 for details; specifics vary.

Sepsis Treatment

• Follow the JRCALC Sepsis Guideline.

Neutropenic Sepsis

• Occurs when a patient's neutrophils (white blood cells) are diminished.
• Neutrophils fight infection.
• Low neutrophil levels increase susceptibility to infection, potentially leading to life-threatening neutropenic sepsis.
• Commonly associated with anti-cancer treatments like chemotherapy, especially those affecting the bone marrow (e.g., leukemia, lymphoma, myeloma).
• Diagnosis can often be challenging due to the side effects of chemotherapy.

Neutropenic Sepsis Treatment

• Follow the JRCALC Sepsis Guideline.

Peritonitis

• Inflammation of the peritoneum, a thin membrane lining the abdominal cavity.
• Tissues become inflamed when exposed to irritating or infected body fluids (often through leaks or breaks).
• Infection is the most common cause; it can be extremely dangerous.

Peritonitis Signs & Symptoms

• See details on page 46.

Peritonitis Treatment

• Follow the JRCALC Abdominal Pain Guideline.

Diverticulitis

• Infection of small bulges or pockets (diverticula) in the lining of the large intestine (colon).
• Bacteria trapped inside these diverticula can trigger more severe symptoms.
• Can lead to complications, like abscesses near the intestine.

Diverticulitis Signs & Symptoms

• More severe abdominal pain, especially on the left side.
• High temperature (fever) of 38°C or higher.
• Diarrhea or frequent bowel movements.

Diverticulitis Treatment

• Follow the JRCALC Abdominal Pain Guideline.

Crohn's Disease

• Inflammatory bowel disease (IBD) involving inflammation in various areas of the digestive tract.
• Frequently affects the small intestine; inflammation can spread to deeper layers of the bowel.
• Characterized by inflammation and swelling, leading to significant abdominal pain, severe diarrhea, fatigue, weight loss, and malnutrition.

Crohn's Disease Signs & Symptoms

• See details on page 53 .

Crohn's Disease Treatment

• Follow the JRCALC Abdominal Pain Guideline.

Irritable Bowel Syndrome (IBS)

• Common digestive disorder that affects the stomach and intestines.
• Symptoms can include cramping, abdominal pain, bloating, gas, diarrhea, or constipation, or a combination of these conditions.
• Generally a long-term chronic condition that can be managed with dietary changes, lifestyle modifications, and stress reduction.

IBS Signs & Symptoms

• Abdominal pain/cramping eased by bowel movement.
• Changes in bowel habits (diarrhea or constipation).
• Swelling of the abdomen.
• Excessive flatulence.
• Urgency to evacuate the bowels

IBS Treatment

• Follow the JRCALC Abdominal Pain Guideline.

Kidney Stones

• Hard object formed from minerals and chemicals in the urine, including calcium oxalate, uric acid, struvite, and cystine.
• Symptoms include severe lower back pain, blood in the urine, nausea, vomiting, fever, and chills, or foul-smelling / cloudy urine.
• Stones may lodge in the kidney, ureter, bladder, or urethra, causing blockage.
• Treatment can vary from passing the stone through the urine stream to surgical procedures.

Kidney Stones Signs & Symptoms

• Severe pain in the lower back.
• Vague pain or stomach ache that doesn't subside.
• Blood in the urine.
• Nausea or vomiting episodes.
• Fever or chills.
• Urine that smells bad or looks cloudy.

Kidney Stones Treatment

• Follow the JRCALC Abdominal Pain Guideline.

Appendicitis

• Inflammation of the appendix, a finger-like pouch that extends from the colon.
• Usually located on the lower right side of the abdomen.
• Infection is the primary cause of appendicitis.
• Left untreated, appendicitis can cause complications; often requiring surgery.

Appendicitis Signs & Symptoms

• Sudden abdominal pain on the right side, potentially migrating towards the navel and worsening with movement or jarring activities .
• Nausea and vomiting, loss of appetite.
• Low-grade fever.
• Constipation or diarrhea.
• Abdominal bloating and flatulence.

Appendicitis Treatment

• Follow the JRCALC Abdominal Pain Guideline.

Liver Conditions

• Liver conditions range from scarring (cirrhosis) to inflammation (hepatitis) to liver failure.

Liver Conditions - Signs & Symptoms

• Details on page 67.

Liver Conditions Treatment

• Follow the JRCALC Abdominal Pain Guideline.

Scarlet Fever

• Bacterial illness, usually developing from strep throat.
• Symptoms including a bright red rash, sore throat, and high fever.

Scarlet Fever Signs & Symptoms

• Red rash (often on the face, neck, trunk, limbs).
• Red lines in body folds (groin, armpits, elbows, knees).
• Flushed face, pale area around the mouth.
• Strawberry tongue.

Scarlet Fever Treatment

• Antibiotic treatment is often effective.

Scabies

• Contagious skin condition caused by burrowing mites.
• Intense itching, usually worse at night.
• Skin rash where mites burrow.

Scabies Signs & Symptoms

• Itching, often severe, usually worse at night.
• Thin, wavy tunnels of tiny blisters or bumps on the skin.
• Often found in skin folds, including between fingers/toes, armpits, waist, inside wrists, inner elbows, soles of feet, chest, around nipples, belly button, genitals, groin, and buttocks.

Scabies Treatment

• Cream or lotion application over the whole body, often recommended by a pharmacist; treat all individuals in the household.

Chicken Pox (Varicella)

• Highly contagious viral disease.
• Characterized by small, itchy blisters which eventually scab over.
• Starting on the chest, back, and face, spreading throughout the body.

Chicken Pox Signs & Symptoms

• Rash with small, itchy blisters.
• Blisters typically scab over.
• Fever.
• Tiredness
• Headaches.
• Complications include bacterial infections, pneumonia, and an inflammation of the brain.

Shingles (Herpes Zoster)

• Viral infection affecting a specific nerve and its associated skin area (dermatome).
• Reactivation of the varicella-zoster virus which also causes chicken pox.

Shingles Signs & Symptoms

• Prodromal phase with skin sensations pain and abnormalities.
• headache, photophobia; malaise.
• maculopapular rash, progressing to clustered vesicles, which burst and scab over, typically within 7-10 days..

Guillain-Barré Syndrome

• Rare and serious nerve condition.
• Characterised by the immune system mistakenly attacking and damaging nerves.
• It can develop after a respiratory or gastrointestinal infection.
• Symptoms include numbness, pins and needles, muscle weakness, pain, and coordination/balance problems; worsening over time, often in limbs.

Guillain-Barré Syndrome Treatment

• Treatment often requires hospitalization and supportive therapy to maintain essential body functions as well as pain and symptom relief.
• Intravenous immunoglobulin (IVIG), plasma exchange (PLEX), and pain relief.

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