Chapter - Marquette General Hospitalww4.mgh.org/emt/EMTLib/Mistovich_ch22_PEC09.pdf · Chapter 22...
Transcript of Chapter - Marquette General Hospitalww4.mgh.org/emt/EMTLib/Mistovich_ch22_PEC09.pdf · Chapter 22...
01/09/2013
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Chapter 22
Toxicologic Emergencies
Copyright ©2010 by Pearson Education, Inc.
All rights reserved.
Prehospital Emergency Care, Ninth Edition
Joseph J. Mistovich • Keith J. Karren
Objectives
1. Define key terms introduced in this chapter (slides 16-
20).
2. List the primary concerns of the EMT in managing drug
and alcohol emergencies (slide 15).
3. Describe each of the four routes by which a poison can
enter the body (slides 17-20): a. Ingestion
b. Inhalation
c. Injection
d. Absorption
4. Describe the important steps in managing a poisoning
patient, regardless of the specific poison or route of
exposure (slides 21-22).
Objectives
5. Explain the limited role of specific antidotes in
toxicologic emergencies (slides 23-24).
6. Given a scenario involving a patient who has ingested a
poison, describe the steps of assessment-based
management (slides 26-36).
7. Describe the indications, contraindications, mechanism
of action, side effects, dosage, and administration of
activated charcoal (slides 37-38).
8. Given a scenario involving a patient who has inhaled a
poison, describe the steps of assessment-based
management (slides 39-50).
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Objectives
9. Given a scenario involving a patient who has been
exposed to an injected poison, describe the steps of
assessment-based management (slides 51-60).
10. Given a scenario involving a patient who has absorbed
a poison, describe the steps of assessment-based
management (slides 61-72).
Objectives
11.Describe special considerations in assessing and
managing patients with each of the following (slides 73-
91): a. Food poisoning
b. Carbon monoxide poisoning
c. Cyanide poisoning
d. Exposure to acid or alkali substances
e. Exposure to hydrocarbons
f. Methanol ingestion
g. Isopropanol ingestion
h. Ethylene glycol ingestion
i. Exposure to poisonous plants
Objectives
12. Explain the importance of contacting the poison control
center with as complete a patient history as possible,
and list specific types of information you should include
(slides 92-93).
13. Given a scenario involving a patient experiencing a
drug or alcohol emergency, describe the steps of
assessment-based management (slides 94-105).
14. Describe special considerations in managing violent
drug or alcohol abuse patients (slides 106-107).
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Objectives
15. Describe special considerations in assessing and
managing patients experiencing emergencies
associated with each of the following (slides 108-127): a. Drug withdrawal
b. Alcoholic syndrome
c. Withdrawal syndrome, including delirium tremens
d. PCP use
e. Cocaine use
f. Amphetamines and methamphetamines
g. Medication overdose
h. Huffing
Multimedia Directory
Slide 121 Cocaine Dependence Animation
Topics
Poisons and Poisonings
Ingested Poisons
Inhaled Poisons
Injected Poisons
Absorbed Poisons
Specific Types of Poisoning
Poison Control Centers
Drug and Alcohol Emergencies
Specific Substance Abuse Considerations
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CASE STUDY
Dispatch
Respond to 1445 Cohasset Drive for a
three-year-old with abdominal pain.
EMS Unit 101
Time out 1236
• Frantic woman rushes out holding a child
• Identifies herself as Mrs. Horowitz; she is
carrying her daughter Sophie
• She thinks Sophie ate leaves of a house plant
• Sophie now has bad stomach pains
•
Upon Arrival
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How would you proceed to assess and care for this patient?
Back to Topics
Poisons
and Poisonings
Poisons and Routes of
Exposure
Back to Objectives
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• Poison
• Toxicology
• Toxins
• Antidotes
• Overdose
Back to Objectives
Ingestion
• Definition
• Location
• Effect
Back to Objectives
Inhalation
• Definition
• Location
• Effect
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Injection
• Definition
• Types
• Location
• Effect
Absorption
• Definition
• Location
• Effect
Managing the Poisoning
Patient
Back to Objectives
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• Supportive care
• Reassessment
• Preventing aspiration
Antidotes
Back to Objectives
• Availability
• ALS unit medications
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Ingested Poisons
Back to Topics
• Length of time
• Amount ingested
• Common types
Back to Objectives
Assessment-Based Approach:
Ingested Poisons
Scene Size-Up
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Scene
Size-Up
Look for clues.
Assessment-Based Approach:
Ingested Poisons
Primary Assessment
Primary
Assessment
• Mental status
• ABCs
• Skin temperature,
color, condition
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Assessment-Based Approach:
Ingested Poisons
Secondary Assessment
Secondary
Assessment
• History
• Signs and symptoms
• Vital signs
Assessment-Based Approach:
Ingested Poisons
Emergency Medical Care
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Emergency
Medical Care • Maintain airway
• Provide O2
• Assist ventilation
• Prevent further
injury
• Consult medical
direction
• Bring possible
poison
Assessment-Based Approach:
Ingested Poisons
Reassessment
Reassessment
• Monitor ABCs
• Monitor vital signs
• Monitor mental status
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Activated Charcoal
Back to Objectives
• Use
• Action
• Dose
• Brands
Inhaled Poisons
Back to Topics
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• Common poisons
• “Huffers”
• Effect
Back to Objectives
Assessment-Based Approach:
Inhaled Poisons
Scene Size-Up
Scene
Size-Up
• SAFETY for all
• May need
assistance – Fire
– More ambulances
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Assessment-Based Approach:
Inhaled Poisons
Primary Assessment
• ABCs
• Ventilation
• O2
• Skin color,
temperature
, condition
Primary
Assessment
Assessment-Based Approach:
Inhaled Poisons
Secondary Assessment
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Secondary
Assessment
• History
• Vital signs
• Signs and
symptoms
Assessment-Based Approach:
Inhaled Poisons
Emergency Medical Care
Emergency
Medical Care
• Remove patient
from environment
• Position patient
• Open airway
• Provide O2
supplement
• Bring containers
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Assessment-Based Approach:
Inhaled Poisons
Reassessment
Reassessment
• Reassess ABCs
• Reassess vital
signs
Injected Poisons
Back to Topics
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• Points of entry
• Most common
types
• Anaphylactic
shock
Back to Objectives
Scene Size-Up
Assessment-Based Approach:
Injected Poisons
Scene
Size-Up
• Look for
possible
paraphernalia
• Consider
possible bite or
sting
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Primary Assessment
Assessment-Based Approach:
Injected Poisons
Primary
Assessment
• ABCs
• Ventilation
• O2
• Signs and
symptoms
• Mental status
Secondary Assessment
Assessment-Based Approach:
Injected Poisons
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Secondary
Assessment
• History
• Vital signs
• Signs and
symptoms
Reassessment
Assessment-Based Approach:
Injected Poisons
Reassessment
• Reassess
ABCs
• Reassess vital
signs
• Monitor for
anaphylactic
reaction
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Absorbed Poisons
Back to Topics
• Causes
• Reactions
Back to Objectives
Assessment-Based Approach:
Absorbed Poison
Scene Size-Up
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Scene
Size-Up
• Note any open containers
• Wear gloves
• Consider additional help
• Remove patients from scene
Assessment-Based Approach:
Absorbed Poison
Primary Assessment
Primary
Assessment
• ABCs
• Ventilation
• Look for
poison on
clothes
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Assessment-Based Approach:
Absorbed Poison
Secondary Assessment
Secondary
Assessment
• History
• Vital signs
• Signs and symptoms
Assessment-Based Approach:
Absorbed Poison
Emergency Medical Care
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Emergency
Medical Care
• Remove the patient from source
• Remove contaminated clothing
• Provide O2
• Brush dry chemical from skin
• If liquid, flush skin
• If in eye, flush eye
Assessment-Based Approach:
Absorbed Poison
Reassessment
Reassessment
Reassess the patient’s airway and breathing.
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Specific Types of
Poisonings
Back to Topics
Food Poisoning
Back to Objectives
• Types
• Signs and symptoms
• Emergency medical care
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Carbon Monoxide Poisoning
• How it is formed
• Signs and symptoms
• Emergency medical care
Cyanide
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• Where it is found
• Signs and symptoms
• Emergency medical care
Acids and Alkalis
• Where they are
found
• Effect on body
• Signs and
symptoms
• Emergency
medical care
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Hydrocarbons
• Where they are found
• Route
• Signs and symptoms
• Emergency medical care
Methanol (Wood Alcohol)
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• A poisonous form of alcohol found in
many common products – Gasoline, antifreeze, paints, canned fuels
• Route: ingestion, inhalation, absorption
• Signs and symptoms
• Emergency medical care
Methanol (Wood Alcohol)
Isopropanol
(Isopropyl Alcohol)
Isopropyl Alcohol
• Most common form is rubbing alcohol
• Also found in cosmetics, disinfectants,
and other cleaning agents
• Route: most commonly by ingestion
• Signs and symptoms
• Emergency medical care
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Ethylene Glycol
Ethylene Glycol
• Found in detergents, antifreeze,
windshield deicers, and coolants
• Route: most commonly by ingestion
• Signs and symptoms
• Emergency medical care
Poisonous Plants
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• Route
• Where they are found
• Emergency medical care
Poison Control
Centers
Back to Topics
• Available across the U.S.
• Toll-free calls
• Utilize in poisonings
Back to Objectives
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Drug and Alcohol
Emergencies
Back to Topics
• Drug abuse
• Overdose
• Withdrawal
Back to Objectives
Assessment-Based Approach: Drug
and Alcohol Emergencies
Scene Size-Up
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• Safety
• Watch for weapons
• Rule out medical
causes – Stroke
– Hypoglycemia
Scene
Size-Up
Assessment-Based Approach: Drug
and Alcohol Emergencies
Primary Assessment
Primary
Assessment
• General
impression
• Mental status
• ABCs
• Priority
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Assessment-Based Approach: Drug
and Alcohol Emergencies
Secondary Assessment
Secondary
Assessment
• Check for
trauma
• “Huffers”
• History
• Vital signs
• “Pharming”
• Signs and
symptoms of
different drugs
Assessment-Based Approach: Drug
and Alcohol Emergencies
Emergency Medical Care
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Emergency
Medical Care
• ABCs
• O2
• Positioning
• Keep patient
warm
• Blood glucose
level
• Restrain only if
necessary
Assessment-Based Approach: Drug
and Alcohol Emergencies
Reassessment
Reassessment
• ABCs
• Vital signs
• Reassess – Every five
minutes for
unstable
– Every 15 for
stable
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Managing a Violent Drug or
Alcohol Abuse Patient
Back to Objectives
The Talk-Down Technique
• Make the patient feel welcome
• Identify yourself clearly
• Reassure the patient
• Help the patient verbalize
• Reiterate simple and concrete
statements
• Forewarn the patient about the
effect of the drug wearing off
• Once patient is calm, transport
Specific Substance
Abuse Considerations
Back to Topics
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Drug Withdrawal
Back to Objectives
• Tolerance
• Dependence
• Preoccupation
• Signs and
symptoms of
withdrawal (© Craig Jackson/In the Dark Photography)
The Alcoholic Syndrome
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• Signs and
symptoms
unrelated to
alcohol
• Wernicke-
Korsakoff
syndrome
• Illnesses to which
alcoholics are
prone
The Withdrawal Syndrome
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The Withdrawal Syndrome
Delirium Tremens
Delirium
Tremens
• Life-threatening
• Occurs one to
14 days after
last drink
• Can last days
• Signs and
symptoms
PCP, Cocaine,
Amphetamines, and
Methamphetamines
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• PCP
• Cocaine
• Amphetamines
• Methamphetamines
PCP, Cocaine, Amphetamines,
and Methamphetamines
Signs and Symptoms of PCP,
Cocaine, Amphetamines, or
Methamphetamines
Signs and
Symptoms
• Agitation or excitation
• Unresponsiveness to pain
• Seizures
• Myocardial infarction
• Aortic dissection
• Severe headache
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Cocaine Dependence
Return to Directory
Click here to view an animation about cocaine dependence.
PCP, Cocaine, Amphetamines,
and Methamphetamines
Emergency Medical Care
Emergency Medical Care
• Safety
• Restrain if
needed
• Check for injuries
• ABCs
• Vital signs
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Medication Overdose
• Types of medications
• Signs and symptoms
• Emergency medical care
Huffing
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• Where poison
is found
• Effect
• Emergency
medical care
CASE STUDY
Follow-Up
Primary Assessment
• Patient’s name is Sophie; she is sitting
on mom’s lap holding her stomach
• Able to remove tiny plant fragments from
patient’s mouth
• Noticeable irritation in her throat
• Able to place a nonrebreather mask on
patient at 15 lpm
CASE STUDY
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Secondary Assessment
• Has been a half hour since mom initially
noted an overturned philodendron and
patient with several leaves in her hand
• BP: 102/66mmHg; P: 96; RR: 32; skin
warm and dry; SpO2: 98 percent
• Contact poison control center
CASE STUDY
Treatment and Reassessment
• ABCs adequate • Swelling in mouth not worsening • Reassess mental status every five
minutes • Says belly pain is still “same” • Arrive at ED; transfer care to staff • Finish report and prepare for
another call
CASE STUDY
• Dispatched to a local housing project for
an unknown medical emergency; it’s a
cold winter evening
• Upon arrival, Fire and PD are on scene;
you’re greeted by the son of the elderly
gentleman inside the apartment
• He has not been able to reach his father
since yesterday and is afraid something
happened to him
Critical Thinking Scenario
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• After finding the doors and windows locked,
the son gives permission for Fire to force
entry into the residence
• Fire reports there is a kerosene heater in
the living room and all the burners on the
gas stove top and oven were ignited
• The son tells you his father’s furnace failed,
and he had to wait to call a repairman until
his Social Security check arrives next week
Critical Thinking Scenario
• Once inside the apartment, you make
contact with the patient
• You conclude that the patient may have
succumbed to the noxious fumes of the
burning gas and kerosene as well as
carbon monoxide that may be present
• The patient responds to painful stimuli with
nonpurposeful motion
Critical Thinking Scenario
Vital signs:
• BP: 102/88
• Peripheral pulses are weak
• Breathing is shallow at 38 times per
minute; lungs are clear
• Skin is ashen
• SpO2: 94 percent
• Pupils are dilated
Critical Thinking Scenario
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1. Why was it a good idea to allow the fire
department to access the home first?
2. What is the underlying mechanism for
poisoning in this patient?
3. What is the single greatest intervention
you could provide for this patient?
4. Given this type of poisoning, why is the
pulse oximeter of little use?
5. What basic tenets of care should you
provide the patient?
Critical Thinking Questions
Reinforce and Review
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