Chapter 22 Poisoning and Overdose PDF

Slid e1 CHAPTER 22 POISONING AND OVERDOSE Slid OVERVIEW e2 History of Poisoning Types of Toxins Ingested Toxins Inhaled Toxins Injected Toxins Absorbed Toxins Airway Management...

Slid e1 CHAPTER 22 POISONING AND OVERDOSE Slid OVERVIEW e2 History of Poisoning Types of Toxins Ingested Toxins Inhaled Toxins Injected Toxins Absorbed Toxins Airway Management Use of Activated Charcoal Slid HISTORY OF POISONING e3 Toxin Any substance, including medications, that produces adverse effects when it enters the body Slid HISTORY OF POISONING e4 Focused history and physical exam SAMPLE and OPQRST Important questions to consider asking patient What substance? When did you ingest/become exposed? If an ingestion, how much did you ingest? Over what time period? Interventions? How much do you weigh? Slid TYPES OF TOXINS e5 Ingested Signs and symptoms History of ingestion spy almond Nausea Vomiting Diarrhoea Altered mental status Abdominal pain Chemical burns around the mouth Different breath odours Slid TYPES OF TOXINS e6 Ingested Emergency medical care Remove pills, tablets, or fragments with gloves from patient’s mouth, as needed, without injuring oneself Consult medical direction for administration of activated charcoal Bring all containers, bottles, labels, etc. of poison agents to receiving facility Slid TYPES OF TOXIN e7 Inhaled Signs and symptoms It is of the utmost History of inhalation of toxic substance Difficulty breathing importance to protect the Chest pain Cough Hoarseness providers. If the scene is Dizziness Headache not safe, do not enter. Confusion Seizures Altered mental status Slid TYPES OF TOXINS e8 Slid TYPES OF TOXINS e9 Inhaled Emergency medical care Have trained rescuers remove patient from poisonous environment Give oxygen, if not already done in the initial assessment Bring all containers, bottles, labels, etc. of poison agents to receiving facility  Slid TYPES OF TOXINS e 10 Injected Poison enters body through a puncture Insect bites Spider bites Snake bites Stings and bites of marine animals Injected into vein with a syringe and needle TYPES OF TOXINS Black widow spider  Slid TYPES OF TOXINS e 12 Brown recluse spider  Slid TYPES OF TOXINS e 13 Jellyfish  Slid TYPES OF TOXINS e 14 Sea urchin  Slid TYPES OF TOXINS e 15 Injected Signs and symptoms Weakness Dizziness Chills Fever Nausea Vomiting  Slid TYPES OF TOXINS e 16 Injected toxins Emergency medical care Airway and oxygen Be alert for vomiting Bring all containers, bottles, labels, etc. of poison agents to receiving facility  Slid TYPES OF TOXINS e 17 Absorbed toxins Signs and symptoms History of exposure Liquid or powder on patient’s skin Burns Itching Irritation Redness  Slid e 18 IT MAY BE NECESSARY TO HAVE OTHER RESCUERS WITH APPROPRIATE GEAR DECONTAMINATE THE PATIENT PRIOR TO TREATMENT AND TRANSPORT.  Slid TYPES OF TOXINS e 19 Absorbed Emergency medical care Skin—remove contaminated clothing while protecting oneself from contamination Powder—brush powder off patient, then continue as for other absorbed poisons Liquid—irrigate with clean water for at least 20 minutes (and continue en route to facility if possible) Eye—irrigate with clean water away from affected eye for at least 20 minutes (and continue en route to facility if possible)  Slid e 20 FOR SOME SUBSTANCES, IT IS BEST TO FLUSH FOR 20 MINUTES PRIOR TO TRANSPORT. CONTACT MEDICAL DIRECTION TO DETERMINE IF THE PATIENT SHOULD HAVE THE AREA OF CONTACT FLUSHED WITH WATER FOR THE FULL 20 MINUTES PRIOR TO TRANSPORT.  Slid e 21 AIRWAY MANAGEMENT  Slid AIRWAY MANAGEMENT e 22 A patient’s condition may deteriorate Continue to assess patient for airway difficulties and manage as learned previously  Slid USE OF ACTIVATED CHARCOAL e 23  Slid USE OF ACTIVATED CHARCOAL e 24 Medication name adsorption absorption Generic Activated charcoal Trade SuperChar™ InstaChar™ Actidose™ Liqui-Char™  Slid USE OF ACTIVATED CHARCOAL e 25 Indications Poisoning by mouth  Slid USE OF ACTIVATED CHARCOAL e 26 Contraindications Altered mental status Ingestion of acids or alkalis Unable to swallow  Slid USE OF ACTIVATED CHARCOAL e 27 Dosage Adults and children: 1 gram activated charcoal/kg of body weight Usual adult dose: 25-50 grams Usual infant/child dose: 12.5-25 grams  USE OF ACTIVATED CHARCOAL Administration technique Shake the container thoroughly to suspend the medication in the container  USE OF ACTIVATED CHARCOAL Administration technique Pour the liquid into a container Because the medication looks like mud, covering the container with a lid and using a straw may make it easier for the patient to drink it  USE OF ACTIVATED CHARCOAL Administration technique Persuade the patient to drink the full dose. If the patient takes a long time to drink the medication, the charcoal will settle; shake or stir the liquid again  Slid USE OF ACTIVATED CHARCOAL e 31 Mechanism of action Binds to certain poisons and prevents them from being absorbed into the body Not all brands of activated charcoal are the same Some bind much more poison than others; so consult medical direction about the brand to use  Slid USE OF ACTIVATED CHARCOAL e 32 Side effects Black stools Some patients, particularly those who have ingested poisons that cause nausea, may vomit If the patient vomits, the dose should be repeated once  Slid USE OF ACTIVATED CHARCOAL e 33 Reassessment strategies Be prepared for the patient to vomit or further deteriorate  Slid SUMMARY e 34 History of Poisoning Types of Toxins Ingested Toxins Inhaled Toxins Injected Toxins Absorbed Toxins Airway Management Use of Activated Charcoal