The Grand Unifying Theory of Poisoning/Overdose Surveillance A Collaborative Effort June 9, 2013.
20)Poisoning And Overdose
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Transcript of 20)Poisoning And Overdose
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Poisoning and Overdose
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Poisoning and Overdose
• Poison/Toxin• Any substance that usually kills, inures, or impairs an organism
through its chemical actions. • Toxicology
• Study of poisons• Toxic
• Poisonous • Overdose
• Self administration of a drug in excess OR in combination with other agents to the point where poisoning occurs.
• DTs• “Delirium Tremens”• A severe form of alcohol withdrawal that involves sudden and
severe mental or neurological changes
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Introduction
Regional Poison Center– 1-800-222-1222
Second leading COD 2004– Exposure every 14 seconds– 2,482,041 exposures in 2007– 51.2% in childrem < 6 yo– 73.3% fatalities bt 20-59 yo– 32,691 poisoning deaths in 2005
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Types of Exposure
• Ingestion• Swallowing
• Suicidal pt with pills, Alcoholic with methanol, toddler/animal with antifreeze
• Injection• Opioids – Insulin – Envenomation
• Inhalation• CO is most common• Glue sniffing• Freebasing cocaine
• Absorption • Organophosphate poisoning• Corrosives (acids/alkali)
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Poisoning and OverdoseS/S per Route
• Ingested• Hx of ingestions• Nausea • Vomiting• Diarrhea• AMS• Abd pain• Chemical burns around the mouth• Different breath odors
• Emergent care• Remove pills, tablets, fragments from pt mouth with gloved hands as
needed, without injuring yourself• Consult medical direction – Activated Charcoal• Bring ALL containers, bottles, labels, etc of poison agent to hospital
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S/S per Route: Inhalation
• S/S• Hx of inhalation of toxic substance• SOB• Chest pain• Cough• Hoarseness • Dizziness• Headache• Confusion• Seizures• AMS• Singed nasal hairs
• Emergent care• Have trained rescuers remove pt from scene• Supplemental O2• Bring ALL containers, bottles, labels, etc of poison agent to hospital
Smoke inhalation
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S/S per Route: Absorbed
• S/S• Hx of exposure• Liquid or powder on pt skin• Burns• Itching• Irritation• Redness
• Emergent Care• Remove contaminated clothing while protecting yourself• Brush powders off pt• Irrigate for at least 20 minutes of liquid exposure• If in eyes, irrigate for at least 20 minutes and while en route away
from unaffected eye
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S/S per Route: Injection
• S/S• Weakness• Dizziness• Chills• Fever• Nausea• Vomiting• Tack marks
• Emergent Care• Airway patency and ventilation• Be alert for vomiting• Bring ALL containers, bottles, labels, etc of poison agent to
hospital
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Sedatives, Hypnotics, Anti-Anxieties
• Sedatives/Hypnotics/Anti anxiety• Sedatives
• Calming, decrease activity• Hypnotics
• Induce Sleep• Examples:
• Barbiturates • Benzodiazepines
• Ativan, Valium, Xanax, Sleeping Pills
• GHB• Rohypnol
• S/S• Resp depression• Depressed LOC• Coma• Death
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Opiods
• Opioids• Narcotics• CNS depressants• Made from the Opium Poppy (Papaver somniferum)
• Examples• -Morphine – Codeine – Heroin – Oxycodone (Oxycontin)–
Methadone – Meperidine (Demerol) – Fentanyl - Opium • S/S
• CNS depression• Depressed LOC• Depressed Resp • PINPOPINT PUPILS
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Meperidine Meperidine (Demerol)(Demerol)
Methadone
Morphine
Morphine
OpiumHeroin
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Stimulants
• Stimulants• Stimulates CNS• Increase alertness and physical activity
• Examples• Amphetamines/Speed, Methamphetamine, Ritalin, Ecstasy, Cocaine, PCP,
Nicotine• S/S
• Excitability• Seizures• Increased heart rate• Increased BP• Chest pain• Dysrhythmia • Death• Ischemia• CVA• MI• Hyperthermia
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Amphetamines-Amphetamines-Adderall
Cocaine
MethamphetamineMethamphetamine- Crystal Meth.- Crystal Meth.
Ritalin
Ecstasy
Nicotine
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Ecstacy
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Alcohol
• Alcohol• Intoxicating agent in fermented and distilled liquors
• S/S• AMS• Motor deficit • Coma• Resp failure• Vomiting• Aspiration• Death
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Analgesics
• Analgesic• Pain killers
• Examples• Aspirin• Acetaminophen• Motrin• Advil
• S/S• Few early on• Liver damage within 48 hrs
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Organophosphates
• Organophosphates – Inhibit acetylcholinesterase
activity – Initial overstimulation
followed by disruption of nerve transmission
• Examples• Insecticides• Fertilizer• Nerve gases
• S/S• Over stimulation of
secretions• Bronchocontrsiction• Weakness• SLUDGE
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Food
• Food• Botulism
• Suspect• When 2 of more people are
ill after eating same food• S/S
• Flu like S/S• Double vision• Trouble moving
eyes/swallowing• Head-to-toe weakness• Paralysis• Resp arrest
Clostridium botulinum
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Assessment
• HIGH level of suspicion • Not always obvious• Suspect when large number
of people become ill at once• i.e. Multiple people in a
building with c/o headache, nausea, ALOC = CO poisoning
• Bring containers and labels with you
• Report noticeable odors• Consider trauma • ABC’s
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General Approach
Pt Hx– ESSENTIAL– High suspicion
Date of prescription vs medication left– ID/Quantity/Time of exposure/How/
Where exposed/Any treatments tried– Transport pills/bottles
Approach– Vitals, Oxygen, Monitor, IV, Transport (VOMIT)– Supportive care
Aspiration?– Consider AEIOU-TIPS– Traditional approach
Syrup of Ipecac (Airway compromise) Gastic lavage (Manpower, esophageal rupture) Activated charcoal (Relatively safe option)
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Scene Size Up/Initial Assessment
• Scene Size-Up• Scene safety/BSI• Decontaminate pt
• Remove contaminated clothing• Irrigate 20 minutes• Brush off powders
• Initial Assessment• General impression• ABC’s• LOC/AVPU• Trauma? • Most deaths are due to Respiratory Compromise
• Aggressively manage airway
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Focused Hx/Px
• Hx• What substance?• When did pt ingest/become exposed?• How much did the pt ingest?• Over what time period? • Interventions?• How much does the pt weigh?
• Px• Baseline Vitals• Track marks?• Some poisons present with a classical patter
• Opiods – PINPOINT pupil, AMS, Decreased/Shallow Resps• Organophosphates – SLUDGE
• -Salivation – Lacrimation – Urination – Defecation – GI complaints – Emesis
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Toxidromes
Set of clinical S/S that are diagnostic of certain toxins/class of toxins
Narcotics– Decreased LOC, Res Depression, Constricted pupils
Morphine, Codeine, Demerol (no pupil change), etc
Anticholinergics– “Hot as Hades, blind as a bat, dry as a bone, red as a beet, mad
as a hatter” Cholinergics
– Organophosphate poisoning– SLUDGE
Salivation, Lacrimation, Urination, Defecation, GI complaints, Emesis
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Opioid Overdose
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Salivation Lacrimation Urination
Defecation
GI Complaints Emesis
Organophosphate Poisoning
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Management
• Ensure Open Airway• Ensure proper ventilation• Prevent further absorption
• Activated Charcoal
• Treat S/S• O2• Supportive Care• ALS
• Naloxone• Opioids
• Atropine • Organophosphate
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Re Assessment
• Re assessment• Be alert for vomiting• Be alert for further deterioration due to poisoning• ABC’s• Vitals• LOC
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Activated Charcoal Pharmacology
• Generic• Activated Charcoal
• Trade• SuperChar – InstaChar – Actidose – LiquiChar
• Indications• Poisoning by toxic ingestion
• Contraindications• AMS• Inability to swallow• Ingestions of alkali/acids
• Form• Pre mixed in water with various amounts of charcoal. (12.5 g normal)
• Dose• Adults/Children = 1g/kg of body weight • Usual Adult dose = 25-50 g• Usual child/infant dose= 12.5-25 g
• Route• PO
• Actions• Binds to certain poisons and blocks absorption
• Side Effects• Black Stools• Vomiting• If pt vomits, repeat dose once
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Activated Charcoal Administration
• Obtain order from medical control• Shake container thoroughly• Pt may need to be persuaded to drink medication since it
looks like mud• Cover container and supply a straw to aid in
administration • If pt takes a long time to drink the charcoal shake again
as it will settle out of solution• DOCUMENT activity and time• Transport• Re assess pt
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Refusals
• Encourage pt to go to hospital• Call police if needed• Pt cannot be assumed to be acting in best
intent if OD/Suicidal/AMS.
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