Toxicologic Emergencies Study Guide.docx

1. Definitions a. Poisoning i. Any substance that impairs health or causes death by its chemical action when it enters the body or comes in contact with skin b. Toxicology ii. The study of toxins, antidotes, and the effects of toxins on...

1. Definitions a. Poisoning i. Any substance that impairs health or causes death by its chemical action when it enters the body or comes in contact with skin b. Toxicology ii. The study of toxins, antidotes, and the effects of toxins on the body c. Antidotes iii. A substance that will counteract or neutralize the effects of a poison iv. Common antidotes 1. Carbon monoxide poisoning -- Oxygen 2. Opiate OD -- Naloxone (Narcan) 3. Ingestions -- Activated charcoal 2. Routes of exposure d. Ingestion v. Most common type of poisoning vi. Drug or substance is swallowed 4. Absorbed in the GI tract 5. Slower onset vii. Important questions 6. What/how much did you take? 7. When did you take it? 8. Important to find this info early, in case the medications start to take effect and the patient has a decrease in LOC viii. Signs/Symptoms 9. Swelling or burns around mouth 10. Nausea/vomiting/diarrhea 11. Altered mental status (ALOC) 12. Abdominal pain 13. Others, depending on what they took ix. Activated charcoal -- antidote 14. Trade names -- Actidose, Actidose-aqua 15. Indications a. Ingestions b. Within one hour of ingestion 16. Contraindications c. Inability to swallow d. Altered mental status e. Acids or alkalis f. Cyanide 17. Dosage g. 1gm/kg h. Adults i. Generally 30-100g i. Children ii. Generally 12.5-25g 18. Actions j. Binds to poisons in the stomach, not allowing them to get absorbed in the bloodstream 19. Side effects k. Vomiting iii. If patient vomits, have them repeat the dose! l. Black stools e. Inhalation x. Breathing in a poison xi. Most rapid onset of signs/symptoms xii. Signs/Symptoms 20. Difficulty breathing / chest pain 21. Airway or breathing sounds 22. Neurological issues f. Injection xiii. Common injected poisons 23. Bites and stings 24. Drugs xiv. Signs/Symptoms 25. Injection site swelling 26. Euphoria 27. Nausea / vomiting g. Absorption xv. Poison enters through skin or mucous membranes xvi. Skin related signs/symptoms 28. Burns 29. Rashes 30. Blisters 3. Carbon Monoxide Poisoning h. Colorless, tasteless, odorless gas i. Look for sources of incomplete combustion xvii. Furnaces xviii. Water heaters xix. Gas stoves xx. Fire places xxi. Car exhaust j. Carbon monoxide binds to red blood cells at a much higher affinity than hemoglobin, therefore hemoglobin cannot bind to red blood cells. Leads to the signs/symptoms of hypoxia, but the skin will continue to be pink due to the RBC's being fully saturated. k. Signs/symptoms xxii. Headache xxiii. Nausea xxiv. Confusion xxv. Cherry red lips/skin. This is a late sign. 4. Pesticide exposure / SLUDGEM l. Also includes insecticides and nerve agents m. Salivation n. Lacrimation o. Urination p. Defecation q. GI upset r. Emesis s. Miosis 5. Drugs and Alcohol t. Definitions xxvi. Drug abuse -- Self admin of drugs or medications in a manner not approved by medical or social norms xxvii. Overdose -- poisoning with drugs or alcohol xxviii. Withdrawal -- period of abstinence from a drug to which the body has become accustomed xxix. Tolerance -- Larger doses required to get the same effect u. Drug and alcohol withdrawals xxx. Stage one 31. 8 hours from last drink 32. Nausea, Insomnia, sweating, tremors xxxi. Stage two 33. 8-72 hours from last drink 34. Worsening symptoms 35. Hallucinations start xxxii. Stage three 36. 48 hours plus from last drink 37. Same S/S 38. Seizures can happen in stage three only xxxiii. Stage four 39. Delirium Tremens / DT's 40. True medical emergency, life threatening 41. Loss of memory, hallucinations, fevers, sweating, insomnia, confusion, psychosis v. Opioids xxxiv. Drugs derived from opium, or synthetics xxxv. Heroin, Fentanyl, Morphine, Vicoden/Hydrocodone, Percocet/Oxycontin/Oxycodone, Dilaudid xxxvi. Signs/Symptoms 42. Respiratory depression or arrest, pinpoint pupils, hypotension xxxvii. Treatment -- May administer Naloxone xxxviii. Naloxone / Narcan 43. Indications m. Suspected opioid OD [with respiratory depression of less than 12, or respiratory arrest] 44. Actions n. Opioid antagonist o. Binds to opioid receptor sites to [reverse respiratory depression] 45. Side effects p. Possible acute withdrawal 46. Dosage q. Intranasal -- 2mgs. 1mg in each nostril. w. CNS Stimulants xxxix. Cocaine, crack, meth, PCP, diet pills, MDMA/ecstasy xl. Stimulate the central nervous system xli. Signs/Symptoms 47. Excitable, nervous, hypertension, dilated pupils, tachycardia x. CNS Depressants xlii. Alcohol, Benzodiazipines (Xanax/Alprozolam, Ativan, Valium) xliii. Depress the CNS xliv. Signs/Symptoms 48. Euphoria, drowsy, dilated pupils, sluggish, bradypnea y. Hallucinogens xlv. LSD, PCP, Bath Salts, MDMA xlvi. Signs/Symptoms 49. Anxiety, paranoia, violent behavior, hallucinations, dilated pupils