chapter - marquette general hospitalww4.mgh.org/emt/emtlib/mistovich_ch22_pec09.pdf · chapter 22...

01/09/2013

1

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


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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


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.


Ingested Poisons

Primary Assessment

Primary

Assessment

• Mental status

• ABCs

• Skin temperature,

color, condition

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Ingested Poisons

Secondary Assessment

Secondary

Assessment

• History

• Signs and symptoms

• Vital signs


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


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


Inhaled Poisons

Scene Size-Up

Scene

Size-Up

• SAFETY for all

• May need

assistance – Fire

– More ambulances

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Inhaled Poisons

Primary Assessment

• ABCs

• Ventilation

• O2

• Skin color,

temperature

, condition

Primary

Assessment


Inhaled Poisons


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Secondary

Assessment

• History

• Vital signs

• Signs and

symptoms


Inhaled Poisons


Emergency

Medical Care

• Remove patient

from environment

• Position patient

• Open airway

• Provide O2

supplement

• Bring containers

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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


Injected Poisons

Scene

Size-Up

• Look for

possible

paraphernalia

• Consider

possible bite or

sting

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Primary Assessment


Injected Poisons

Primary

Assessment

• ABCs

• Ventilation

• O2

• Signs and

symptoms

• Mental status



Injected Poisons

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Secondary

Assessment

• History

• Vital signs

• Signs and

symptoms

Reassessment


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


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


Absorbed Poison

Primary Assessment

Primary

Assessment

• ABCs

• Ventilation

• Look for

poison on

clothes

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Absorbed Poison


Secondary

Assessment

• History

• Vital signs



Absorbed Poison


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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


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


• Emergency medical care

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Carbon Monoxide Poisoning

• How it is formed



Cyanide

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• Where it is found



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



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



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



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Ethylene Glycol

Ethylene Glycol

• Found in detergents, antifreeze,

windshield deicers, and coolants

• Route: most commonly by ingestion



Poisonous Plants

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• Route

• Where they are found


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



Primary Assessment

Primary

Assessment

• General

impression

• Mental status

• ABCs

• Priority

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Secondary

Assessment

• Check for

trauma

• “Huffers”

• History

• Vital signs

• “Pharming”

• Signs and

symptoms of

different drugs




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Emergency

Medical Care

• ABCs

• O2

• Positioning

• Keep patient

warm

• Blood glucose

level

• Restrain only if

necessary



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



• Safety

• Restrain if

needed

• Check for injuries

• ABCs

• Vital signs

media/cocaine2.htm

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Medication Overdose

• Types of medications



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

01/09/2013

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• 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


• 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


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


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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

Please visit

www.bradybooks.com

and follow the myBradykit links

to access content for the text.

http://www.bradybooks.com/

chapter - marquette general hospitalww4.mgh.org/emt/emtlib/mistovich_ch22_pec09.pdf · chapter 22...

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