Substance Abuse and Poisoning

Goals for the Chapter• Physiology: How a substance moves through the

body• 4 Routes of Absorption• Terms:

o Substance Abuseo Withdrawalo Poisono Toxin

• Commonly Encountered Substances• Signs and Symptoms• Proper Care and Protocol

DefinitionsSubstance Abuse:

Intentional misuse of a substance that results in significant impairment.

Withdrawal:Physical impairment that occurs when the substance is absent

Poison:Substance that causes harmful effects when introduced in to the body

Toxin:Poison that comes from an organism

Physiology• Absorption

o absorption, distribution, metabolism, elimination• Distribution

o Single Organ system or entire bodyo Once a substance is in the blood stream it will circulate rapidly.

• Metabolismo Break-down substanceso Liver is primary site of metabolism

• Eliminationo Purging of substanceo Urine, GI tract, lungs, skin

Methods of Absorption1. Ingestion

o Intake of a substance through the moutho Absorption through the GI tract

2. Inhalationo Absorption through the Lungso Rich vascular networko Easily damaged

3. Transdermalo Absorption through the Skino Largest body system

4. Injectiono Needles or other sharp objectso Rapid absorptiono Stinger from bee or scorpion

Distribution• Distribution: transportation to site where substance

has effecto Isolated effect ORo Systemic: entire body

• Body Systems commonly effectedo Nervous system

• Central Nervous System: brain and spinal cord• Peripheral Nervous System: nerves

o Hearto Eyeso Blood

• Body systems may have extra barrier to distributiono Blood-brain barrier: separates circulating blood from brain extracellular

fluid (BECF)

Metabolism and Elimination

• Metabolism:o Body breaks down substanceo liver damage metabolism takes longer

• Elimination:o Urine, GI tract, lungs, and/or skin (sweat)o Anything that impairs proper function of these organ systems means

substance is in the body longer

Commonly Encountered Substances

Recreational Drugs:Alcohol

o Slows brain function, sensory input, and motor coordination

o Lowers inhibitiono Diuretic (may cause dehydration)

Marijuanao Most commonly used (illegalish) drugo Distorts perceptiono Affects thinking, memory, and learning

Designer Drugs (club drugs)o Drug constructed by a chemist to produce

unique and specific effectsHallucinogens

o Distort sensory perceptions, loss of judgment

o LSD, PCP

Commonly Encountered Substances

Medicine:OTCs

o OTCs are accessible o Acetaminophen= Tylenol, Aspirin=acetylsalicylic acid, Benadryl=diphenhydramine

Prescription Drugso Antianxiety, antidepressants, antipsychoticso Overdose is often accidental– effective dose close to toxic dose

“Polypharmacy” or “cocktails” can be very dangerous___________________________________________________Not meant for consumption:Acids & Bases

o Commonly used in household productso Can cause direct tissue damage

Inhalantso Chemical vapors from household products

Carbon Monoxide “The Silent Killer”o Odorless, colorless, tastelesso Impairs oxygenation of tissueso By product of combustiono Consider Ventilation

AssessmentAssess the scene

o Pay Attention to potential Hazardso If necessary, request assistance

• Fire department• HazMat team• Law Enforcement

o Evidence of substance or poison?

• Special attention to ABCDs• LOR based on AVPU scale• SAMPLE with paying attention to misuse of substances:

what/dosageo WebMD pill identification tool

• Collect all items (as long as your not endangering yourself)• Nausea and vomiting likely

Managemento Personal Safety is Paramounto High Flow Oxygen

In General,1. Reduce further exposure

• Dilute ingested poisons with water• Do NOT provide water if:

o Nausea/vomiting (NEVER induce vomiting)o Low LOR/ potential for low LOR

• Remove transdermal irritants (remember PPE)• Inhaled poisons – remove from source

2. Reduce absorption• Activated Charcoal • Ingestion if effective in decreasing absorption

o must be authorized3. Rapidly transport to a definitive-care facility

• At the bowl: MVAA (ambulance)• National Capital Poison Center: 1-800-222-1222