POISONING & OVERDOSE

Thousands of Children Are Poisoned Every Year as They Explore Their Environment. Adults Overdose on Medication, Either Deliberately or Accidentally. With Early Prehospital Management, the Vast Majority Have Better Outcomes.

OVERVIEW

• Different Types of Poisons & How They Enter the Body
• Identify & Treat Patients Who Have Overdosed or Had Contact With Poisons
• Who Should Receive Activated Charcoal
• Role of Medical Control (Medical Command)
• How to Document Findings & Care of a Patient With a Poisoning / OD. Emergency

POISONING & OVERDOSE

• Know Why to Administer Activated Charcoal
• Know Why its Important to Contact Medical Command Early with These Types of Calls

POISON

Any substance that can harm the body

POISONING & OVERDOSE

4 Ways Poison Can Enter Into the Body

• Ingestion
• Injection
• Inhalation
• Absorption

POISONING & OVERDOSE

• Important Questions to Ask
• What Substance is Involved

• Get Exact Name
• Bring Container

• When Was it Taken or Exposure Occur
• How Much Was Ingested or Involved

POISONING & OVERDOSE

• Important Questions to Ask
• Over What Time Period
• Have Any Interventions Taken Place
• What is the Patient’s Weight
• What Effects On the Patient

POISONING & OVERDOSE

• Airway Management
• Be Prepared for Deterioration, Vomiting, and the Need to Secure Airway.

POISONING & OVERDOSE

• Altered Mental Status
• Nausea and/or Vomiting
• Abdominal Pain
• Chemical Burns Around Mouth

POISONING & OVERDOSE

• Different Breath Odors
• Diarrhea
• Patient Has a History of Ingesting

POISONING & OVERDOSE

• Emergency Care
• Do the Basics – Is It SAFE, BSI, ABC, O2
• Remove Pills From Mouth w/o Injury 2 U
• Consult Medical Command Early

• Activated Charcoal ?
• E.D. Can Contact Poison Control
• Info is Faxed – Game Plan Developed

• All Containers, Bottles, Labels to the Hospital

ACTIVATED CHARCOAL

• Trade Names
• Actidose
• SuperChar
• InstaChar
• LiquiChar

• Indications
• Poisoning By Mouth

• Contraindications
• Decreased Mental Status
• Unable to Swallow
• Ingestion of Acid or Alkali

• Medication Form
• Pre-mixed With Water & Sorbitol
• Powder – Avoid for Field Use

• Dosage
• Adults & Children - 1 gm/kg
• Usual Adult Dose – 25-50 Grams
• Usual Infant/Child Dose – 12.5-25 Grams

• Actions
• Binds & Prevents Absorption of Some Poisons

• Side Effects
• Black Stools
• Vomiting, Repeat Once if Pt Vomits
• Will Turn Clothing Black & Ruined
• Administration
• Obtain Medical Command Order
• Shake Container Well & Often
• Persuade Patient to Drink
• Covered Container & Straw May Help
• Record Activity & Time

EVERYDAY POISONS ???

• Acetaminophen
• Nausea / Vomiting, Liver Damage
• Antihistamines / Cough & Cold Meds
• Hyperactivity or Drowsiness
• Rapid Pulse, Flushed Skin, Dilated Pupils
• Aspirin
• Ringing in Ears
• Bruising / Bleeding
• Deep Rapid Breathing
• Liver Damage

POISONING & OVERDOSE

• History of Inhalation Abuse
• Difficulty Breathing
• Chest Pain
• Cough

POISONING & OVERDOSE

• Hoarseness
• Dizzy, Headache
• Altered Mental Status
• Seizure

POISONING & OVERDOSE

• Inhaled Emergency Care
• Is It SAFE
• Trained Personnel Should Remove From Contaminated Environment
• Do the Basics - ABC’s, O2 asap
• All Containers, Bottles, Labels to the Hospital

Carbon Monoxide

• Very common inhaled poison
• Colorless, odorless, tasteless gas
• Results from incomplete combustion
• Causes hypoxia by taking the place of oxygen in red blood cells

• Headache, dizziness, nausea
• Difficulty breathing
• Cyanosis
• Altered mental status

POISONING & OVERDOSE

• History of IV Drug Abuse
• "Track Marks"
• Suspected Insect Bite / Sting
• Usually Swollen Red Area
• Scrape, Don’t Pinch, Stinger

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• Respiratory Compromise
• Weakness
• Dizziness
• Chills
• Fever
• Nausea
• Vomiting

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• Injection Emergency Care
• You Know the Routine
• Safety, ABC’s, O2, ALS
• Be Prepared to Ventilate
• Be Prepared for Vomiting
• All Containers, Bottles, Labels to the Hospital

POISONING & OVERDOSE

• History of Exposure
• Powder or Liquid On Skin
• Burns
• Itching
• Irritation
• Redness

POISONING & OVERDOSE

• Absorbed Emergency Care
• I’m Not Going to Repeat Myself
• Protect Yourself
• Skin – Remove Clothing

• Powder – Brush Off, ** Soap & Water
• Liquid – ** Irrigate H2O for 20 Minutes

POISONING & OVERDOSE

• Absorbed Emergency Care (cont.)
• Eyes

• Flush for 20 Minutes
• Continue Enroute
• Flush Away from Good Side

Alcohol Overdose

• Often not thought of as a "serious problem."
• Providers may be callous towards it.
• High potential for traumatic AND medical emergencies.
• Key is providing a thorough assessment.

Signs & Symptoms of Alcohol Abuse

• Odor of alcohol on person
• Swaying/Unsteadiness
• Slurred speech/Incoherent words
• Nausea and vomiting
• Altered mental status

Problems with Alcohol Withdrawal

• Symptoms may be the same as if intoxicated.
• Patients may suffer from delirium tremens (DT’s).
• Patient may experience sweating,
  seizures, trembling, anxiety, and
  hallucinations.
• Can be fatal.

Emergency Care of Alcohol Overdose

• Assess for respiratory compromise.
• Monitor level of consciousness.
• Monitor vital signs.
• Treat for shock.
• Protect from injury and transport.

Substance Overdose

• A chemical substance that is being taken for other than therapeutic (medical) reasons
• Most common substances are:
• Uppers & Downers
• Narcotics
• Hallucinogens
• Volatile Chemicals

Uppers & Downers

• Uppers – Stimulate the nervous system
• Include caffeine, cocaine, & amphetamines
• Downers – Depress the nervous system
• Include Rohypnol ("Roofies") & GHB

Narcotics

• Cause stupor, pain relief, sleep, and

cough control

• Include heroin, codeine, & oxycodone

Hallucinogens

• Alter perception of reality & cause

intense excitement

• Include PCP, LSD, & ecstasy

Volatile Chemicals

• Cause an intense rush and then depress the nervous system
• Include glue, cleaning fluid, & propane

Emergency Care of Substance Overdose

• Ensure scene safety; restrain patient if needed.
• Assess for respiratory compromise.
• Monitor level of consciousness.

Emergency Care of Substance Overdose

• Monitor vital signs.
• Treat for shock.
• Assess for injuries.
• Transport.

POISONING & OVERDOSE

• Re-Assessment Strategy
• Be Prepared For Vomiting
• Be Prepared for Patient to Deteriorate
• Be Prepared for Patient to Become Violent