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Chap 22 Toxicology
Toxicology
| Term | Definition |
|---|---|
| DUMBELS | Signs and symptoms of cholinergic drugs -defecation -urination -muscle twitching/miosis (constriction of pupils) -bradycardia, bronchospasm, bronchorrhea (discharge of mucus from the lungs) -emesis/eye constriction -lacrimation -salivation |
| SLUDGE-M | Signs and symptoms of cholinergic drugs -salivation -lacrimation -urination -defecation -GI irritation -eye constriction/emesis -muscle twitching/miosis |
| What is the most commonly abused drug in the US? | alcohol |
| What is the most frequently seen long term effect of alcohol abuse? | liver damage |
| Severe acute alcohol ingestion may cause | decreased blood glucose level - hypoglycemia |
| What are the contraindications to the administration of activated charcoal? | ingestion of an acid, alkali poisons, cyanide, ethanol, iron, lithium, menthanol, mineral acids, organic solvents or petroleum product. is in the form of a suspension decreased LOC, inability to swallow |
| What is the usual dose of activated charcoal? | 1 g per kilogram of body weight usual adult dosage is 30-100 grams usual pediatric dose is 15-30 gram (under 13 years old) should be used within 1 hour of ingestion |
| What medical problem related to opioids is a concern for responders? | respiratory distress |
| What organ does acetaminophen overdose damage? | liver |
| What is an Opioid? | CNS depressant a synthetically-produced narcotic medication drug or agent similar to the opiate morphine, but not derived from opium; used to relieve pain (i.e. heroin, meperidine, hydromorphone, oxycodone, hydrocodone and methadone) |
| Sympathomimetics signs and symptoms | CNS stimulants, hypertension, Tachycardia, Dilated pupils, Agitation/seizures, paranoia, delusions, Hyperthermia, (i.e. epinephrine, cocaine, meth) fight-or-fight |
| Sedative-hypnotics signs and symptoms | CNS depressant, Slurred speech, Sedation/coma Hypoventilation, Hypotension chloral hydrate (knock-out) benzodiazepines, barbiturates, flunitrazepam (rohypnol) ketamine (special K) |
| Anticholinergics Agents | Block parasympathetic nerves. Tachycardia, Hyperthermia Examples: Atropine, Jimson weed (hyperthermia), Dilated pupils, Dry skin & mucous membranes, Reddened skin, Agitation or delirium |
| Anticholinergics Agents overdose | "hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a hatter" |
| Cholinergics | these are medication that overstimulate the normal body functions controlled by the parasympathetic nervous system. (Examples: Pilocarpine, nerve gas) |
| Alcohol | Powerful CNS depressant Decreases activity and excitement Also induces sleep Dulls the sense of awareness, slows reflexes, and reduces reaction time May cause aggressive and inappropriate behavior and lack of coordination |
| Drugs that depress CNS and can cause respiratory depression | Opioids, sedative-hypnotic drugs, and abused inhalants |
| Opiates signs and symptoms | hypoventilation or respiratory arrest pinpoint pupils sedation or coma hypotension (morphine, codeine) |
| Opioids treatment | Supporting the airway and breathing |
| Sedative-Hypnotic Drugs | Depress CNS In general, these agents are taken by mouth. Occasionally, the capsules are suspended or dissolved in water and injected |
| Sedative-Hypnotic Drug treatment | Provide airway clearance, ventilatory assistance, and prompt transport. The antidote (flumazenil) may be administered in the hospital. |
| Symptoms of alcohol withdrawal | Agitation, Fever, Seizures, Tremors, Confusion, Delusions |
| Ways in which cocaine may be taken? | Inhalation, injection, absorption |
| Absorbed poisoning signs and symptoms | Burns, irritation of the skin |
| Absorbed poison treatment | Avoid contaminating others while protecting yourself, remove substance from patient as rapidly as possible Remove all contaminated clothing. Flush and wash the skin |
| Injected poison | Absorbed quickly into the body so they are impossible to dilute/remove. Causes local tissue destruction. Usually the result of drug abuse, such as heroin or cocaine |
| Injected poison signs and symptoms | Weakness, Dizziness, Fever/chills, Unresponsiveness or the patient may be easily excitability |
| Injected poison treatment | activated charcoal, monitor the airway, provide high-flow oxygen, be alert for nausea and vomiting prompt transport is essential remove watches, rings and bracelets in areas of swelling |
| Poison ingestion indications | Burning or blistering of mucous membranes |
| Medical problems that cause the patient to present as intoxicated | Head trauma, Uncontrolled diabetes (hyper or hypoglycemia), and toxic reactions |
| Carbon monoxide | Odorless, produces severe hypoxia but no damage to the lungs |
| Chlorine: exposure signs and symptoms | Wheezing, chest pain, cough, causes pulmonary edema |
| Inhaled poison examples | Chlorine, Carbon monoxide, Natural gas, Sewer gas, and Certain pesticides |
| Opiate, sedative or barbiturate effects | Cause depression of the CNS and slow breathing |
| Standard treatment of poisonings | Administer specific antidote, Provide high flow O2 Diluting the agent |
| Side effects of ingesting activated charcoal | vomiting, nausea, and black stool (major side effect) |
| 2 types of food poisoning | In one, bacteria in the food directly causes disease, such as salmonellosis In the other, bacteria such as Staphylococcus produce powerful toxins that cause disease |
| Addiction | A state of overwhelming obsession or physical need to continue the use of a substance |
| Antidote | A substance that is used to neutralize or counteract a poison (most poisons do not have one) |
| Delirium Tremens (DT's) | A severe withdrawal syndrome seen in alcoholics who are deprived of ethyl alcohol Characterized by agitation/restlessness, fever, sweating, tremors, confusion/disorientation, delusions/hallucinations and seizures Can be fatal if untreated |
| Emesis | Vomiting |
| Hallucinogen | An agent that produce false perceptions in any one of the five senses (LSD, PCP) |
| Hematemesis | Vomiting blood Hema - blood, emesis - vomit |
| Hypnotic | A sleep-inducing effect or agent |
| Ingestion | Swallowing: taking a substance by mouth |
| Material Safety Data Sheet (MSDS) | a form provided by manufacturers and compounders (blenders) of chemicals, containing information about chemical composition, physical and chemical properties, health and safety hazards, emergency response and waste disposal of a specific material. aka SDS |
| Narcotic | A drug that produces sleep or altered mental consciousness |
| Opiate | A subset of the opioid family referring to natural non-synthetic opioids Ex: heroin, fentanyl, pain relievers (Oxycontin, Vicodin) |
| Overdose | An excessive quantity of a drug that when taken or administered can have toxic or lethal consequences |
| Poison | A substance whose chemical action could damage structures or impair function when introduced into the body |
| Sedative | A substance that decreases activity and excitement |
| Stimulant | An agent that produces an excited state |
| Substance Abuse | The misuse of any substance to produce a desired effect For example heroin intoxication |
| Tolerance | The need for increasing amounts of a drug to obtain the same effect |
| Toxicology | The study of toxic or poisonous substances |
| Toxin | A poison or harmful substance produced by bacteria, animals or plants that acts by changing the normal metabolism of cells or by destroying them |
| Chronic Poisoning | Often caused by the long-term abuse of medications, tobacco and alcohol |
| What is your primary responsibility to the patient who has been poisoned? | Recognize that a poisoning has occurred Then the "where, what and how" the exposure occurred |
| Opioids signs and symptoms | hypoventilation or respiratory arrest (depression) pinpoint pupils sedation or coma hypotension (heroin, methadone, oxycodone) |
| Anticholinergic signs and symptoms | Tachycardia Hyperthermia Hypertension Dilated pupils Dry skin and mucous membranes Sedation, agitation, seizures, coma or delirium Decreased bowel sounds (Atropine, Diphenhydramine, Chlorpheniraminek Doxylamine, Datura Stramonium Jimsonweed) |
| Cholinergics signs and symptoms | Airway compromise Salivations, Sweating Lacrimation (excessive tearing of the eye) Urination Defecation, drooling, diarrhea Gastric upset and cramps Emesis Muscle twitching/ miosis (pinpoint pupils) (Organophosphates, Pilocarpine, Nerve gas) |
| What questions should be asked to a patient who has ingested a poison? | What substance did you take? When did you take it? How much did you ingest? Did you have anything to eat or drink before or after you took it has anyone given you an antidote or any substance orally since you ingested it? How much do you weigh? |
| Determine the nature of poison (NOP) by | Looking around the immediate area for objects that may provide clues An overturned bottle A needle / syringe Scattered pills, Chemicals Remains of food / drink items Overturned / damaged plant |
| In addition to the name and concentration of the drug, a pill bottle label may list? | Specific ingredients The number of pills that were originally in the bottle The name of the manufacturer The dose that was prescribed |
| If the patient vomits what should you do? | Examine the contents for pill fragments. note and document anything unusual that you see |
| Naloxone (Narcan) | Most commonly available antidote to EMT's in the field Used to reverse the effects of an opioid overdose. (heroine, methadone, oxycodone) intranasal route (IN) Its atomized through the nares into the nasal mucosa (repeat dose after 4 minutes) |
| What are the four routes of poison administration? | Inhalation Absorption (surface contact. skin/membranes) Ingestion Injection |
| Inhaled poisons signs and symptoms | Burning eyes Sore throat Cough Chest pain Hoarseness Wheezing Respiratory distress Dizziness Confusion Headache or stridor in sever cases Altered mental status Possible seizures |
| Treatment of inhaled poisons | Remove the patient from the exposure Prompt transport to the ER Supplemental oxygen via non-rebreathing mask and or ventilator Support with a Bag-valve mask (BVM) Suction unit if the patient vomits |
| Absorbed poisons signs and symptoms | History of exposure Liquid or powder on a patients skin Burns, itching, irritation Redness of skin (in light-skinned people) Typical orders of the substance |
| If a dry powder has been spilled you should? | Thoroughly brush off the chemical (avoid creating a dust cloud) Flush the skin with clean water for 15-20 minutes Then wash with skin with soap and water |
| If a liquid material has been spilled on a patient you should? | Flood the affected part for 15 - 20 minutes |
| If the patient has a chemical agent in there eyes you should? | Irrigate them quickly and thoroughly. to avoid contaminating the other eye as you irrigate the affected eye Make sure the fluid runs from the bridge of the nose outward (initiate this action on scene and continue during transport) |
| Ingested poisons include | Liquids Household cleaners Contaminated food Plants Most cases drugs |
| Abused inhalants (aka huffing) | These substances briefly displace oxygen in the brain and cause a rush of euphoria. Acetone, Toluene, Xylen, and Hexane which are found in glues, cleaning compounds, paint thinners and lacquers, Freon |
| Halogenated Hydrocarbon Solvents | These can make the heart hypersensitive to the patients own adrenalin Putting the patient at high risk for sudden cardiac death because of ventricular fibrillation Even the action of walking may release enough adrenaline to cause a fatal V-fib |
| Hydrogen Sulfide | Highly toxic, colorless and flammable gas with a distinctive rotten-egg odor Affects all organs but has the most impact on the lungs and CNS |
| Hydrogen Sulfide signs and symptoms | Inability to smell the gas Nausea and vomiting Confusion and dyspnea Loss of consciousness Seizures, shock, coma and cardiopulmonary arrest |
| Acute Cocaine overdose | High risk for seizures, cardiac dysrhythmias and stroke blood pressure measurements as high as 250/150 mm hg Hallucinations and Cocaine bugs (patients thinks bugs are crawling out of their skin) |
| Bath Salts | Produces euphoria, increased mental clarity, and sexual arousal It is either snorted or insufflate the powder nasally The effects last as long as 48 hours |
| Signs and symptoms of Bath Salts | Effects include teeth grinding, appetite loss, muscle twitching, lip smacking, confusion, gastrointestinal conditions, paranoia, headache, elevated heart rate and hallucinations |
| Tetrahydrocannabinol (THC) | This is the chemical in the marijuana plant that produces its high. inhaling this smoke from a cigarette or pipe produces euphoria, relaxation and drowsiness. |
| Cannabinoid Hyperemesis Syndrome | Characterized by chronic marijuana use and extreme nausea and vomiting that is relieved only by a hot shower or bath |
| Synthetic Marijuana (spice) | Refers to a variety of herbal incense or smoking blends that resemble THC, and produce a similar high. (K2 and Skunk) |
| Tricyclic Antidepressant Overdose | May cause more serious and life threatening effects because the medication may block the electrical conduction system in the heart leading to lethal cardiac dysrhythmia Seizer and death can occur with 30 minutes ALS as backup |
| Treatment for exposure to a Cholinergic Agent (parasympathetic) | Anticholinergic drug (atropine) to dry up the patients secretions followed by pralidoxime to reverse the nerve agents effect on the patients nervous system Decrease secretions in the mouth/trachea that may suffocate the patient Provide airway support |
| DuoDote Auto Injector (AKA ATNAA - the antidote treatment nerve agent auto-injector) | This is a single autoinjector containing: 2 mg of Atropine 600 mg of Pralidoxime |
| Signs and symptoms of Cardiac Medication Overdose | Bleeding Cardiac Dysrhythmias Unconsciousness and even Cardiac Arrest |
| Aspirin poisoning | Potentially lethal condition Ingesting too much acutely or chronically is an emergency that may result in Nausea Vomiting Hyperventilation Ringing in the ears Anxiety Confusion Tachypnea Hyperthermia and are in danger of having seizures |
| Methyl Alcohol | Found in dry gas products and stove kits (like Sterno Co) Causes feeling of intoxication, severe tachypnea, blindness, and death (often taken by someone trying to commit suicide) |
| Ethylene Glycol | Found in some antifreeze products Causes a feeling of intoxication, severe tachypnea, renal failure and eventually death. (often taken by someone trying to commit suicide) |
| Salmonella Bacterium (salmonellosis) | A condition characterized by severe gastrointestinal symptoms within 72 hours of ingestion Includes nausea, vomiting, abdominal pain and diarrhea May be systemically ill with fever and generalized weakness. |
| Staphylococcus Bacterium | A common bacteria Is quick to grow and produce toxins in foods that have been prepared in advance and kept too long even in the refrigerator. |
| Botulism | The most severe form of toxin ingestion Often fatal Usually results from eating improperly canned food in which the spores of clostridium bacteria have grown and produced a toxin |
| Signs and Symptoms of Botulism | Neurologic Blurring of vision, weakness and difficulty in speaking and breathing, muscle paralysis and is typically fatal when it reaches the muscles of respiration |
| Dieffenbachia | Common with a houseplant that resembles elephant ears Causes irritation of the skin and or mucous membranes |
| Activated Charcoal is in the form of a? | Suspension |
| The MOST important consideration in caring for a patient who has been exposed to an organophosphate insecticide or some other cholinergic agent is to? | Avoid exposure/exposing yourself |
| ________ Crack produces the most rapid means of absorption and the most potent effect | Smoked |
| Inhalant effects range from mild drowsiness to coma, but unlike most other sedative-hypnotics these agents may often cause? | Seizures |
| Naloxone (Narcan) should only be used in a patient with a suspected opiate / opioid overdose who has? | Agonal respirations or Apnea (gasping, snoring/obstructed breathing) |
| Which of the following is NOT commonly associated with an overdose from a Cardiac Medication? | Bleeding |
| This may develop from sweating, fluid loss, insufficient fluid intake, or vomiting associated with Delirium Tremens | Hypervolemia (shock) (excessive fluid) |
| How does Activated Charcoal work to counteract ingested poison? | It adsorbs (binds to) the toxin and keeps it from being absorbed in the gastrointestinal tract |
| Acetaminophen poisoning (Tylenol) | Does not appear until the damage is irreversible up to a week later Finding evidence at the scene can save a patients life |
| Shigella, Campylobacter and Enterococcus are associated with what type of poisoning? (bacterias) | Food |
| Ice, Crank, Speed, Uppers and Meth are all street names for which type of poison? | Sympathomimetics (mimic stim of the sympathetic nervous system) |
| What can stop a drug from reacting as expected? | Drugs, food, alcohol, vitamins, over-the-counter meds, etc can prevent a drug from interacting as expected or decrease/increase the effectiveness |
| In addition to providing immediate life-saving treatment, what else should you do when arriving on scene? (overdose) | Never make assumptions. Obtain info from family/bystanders. Provide a full secondary assessment to reveal injuries or symptoms. Are others having the same symptoms? Obtain a full SAMPLE |
| How can knowledge of signs/symptoms of meds help improve the care you provide? | When assessing an overdose (med or substance), a careful assessment may help identify the type of toxin. Some toxins only need oxygen, while others need antidote or insulin, activated charcoal, etc. |
| Poison Help Hotline (American Association of Poison Control Centers: AAPCC) | 1-800-222-1222 (24/7) |
| If there's no evidence of MOI or NOI what should you be? | Be suspicious. Especially if the patient has changes in LOC or at an industrial site. Look for containers or leaks. There may be evidence of meds/drugs/fumes |
| What's the most common way for poison to enter the body for someone who works in Agraculture? | Absorption: Solvents, insecticides, herbicides, pesticides |
| What is the most appropriate treatment for a patient who is: Slouched Sleepy, constricted pupils, tactile response Oral secretions, snoring resp Slow, shallow, diminished breaths Rapid, weak radial + cool, pale, wet skin | Patient should be laid down supine and given a rapid exam to check for injuries. Patient should then be given an NPA+Bag mask. Assess blood glucose. |
| Based on Slouched, sleepy, constricted pupils, oral secretions, snoring, slow/shallow/diminished breaths, rapid/weak radial, cool/pale/wet skin What do you think the patient overdosed on? | Opioids are depressants, limiting the parasympathetic nervous systems (mostly autonomic). Slouched, sleepy, oral secretions, slow/shallow breaths, rapid/weak pulse are all signs of opioid overdose |
| Patient has stopped breathing from an opioid overdose and is given an OPA+BVM. Would Activated Charcoal benefit this patient? | No. First the patient is unconscious and cannot swallow. This would cause aspiration. Patient also recently vomited up most of their contents. Charcoal only works on contents in the stomach, not those absorbed into the system. |
| Patient has stopped breathing from an opioid overdose, is given an OPA+BVM respirations and now Naloxone. Why was Naloxone given? | Naloxone blocks opioid receptors and reverses the effects of the overdose. The patient's presentation indicates they ingested a narcotic based on pupils, level of sedations, and decreased ventilation |
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