A poison is any substance whose chemical action can damage body structures or impair body function.
Substance abuse is the misuse of any substance to produce a desired effect.
An overdose is a toxic dose of a drug.
Very small amounts of some poisons can cause considerable damage or death.
If you suspect poisoning, notify medical control and begin emergency treatment.
Presence of such injuries at the patient’s mouth suggests the ingestion of a poison.
If possible, ask the patient:
What substance did you take?
When did you take it (or become exposed to it)?
How much did you ingest?
What actions have been taken?
How much do you weigh?
Place any suspicious material in a plastic bag and take it with you.
Containers at the scene can provide critical information.
If the patient vomits, examine the contents for pill fragments.
Wear proper personal protective equipment.
Collect the vomitus in a plastic bag
Most often, you will not be administering an antidote.
How you provide treatment depends on how the poison got into the body
The patient may require supplemental oxygen.
Use self-contained breathing apparatus to protect yourself from poisonous fumes
Some patients may need decontamination after removal from the toxic environment.
All patients who have inhaled poison require immediate transport.
Take containers, bottles, labels when transporting the patient to the hospital
Exhaust fumes contain high levels of carbon monoxide
When you open the door, you may be overcome as well.
Contact hazardous materials responders and have them remove the victim
It is important to distinguish between contact burns and contact absorption
Liquid or powder on a patient’s skin
Typical odors of the substance
While protecting yourself, remove substance from patient as rapidly as possible.
Remove all contaminated clothing.
Flush and wash the skin.
If the patient has a chemical agent in the eyes, irrigate them quickly and thoroughly. (be sure water runs from bridge outward)
5 to 10 minutes for acid substances
15 to 20 minutes for alkalis
Many chemical burns occur in an industrial setting.
Wash the substance off immediately.
Obtain material safety data sheets
Brush the chemical off.
Remove contaminated clothing.
Apply a dry dressing to the burn area
Usually accidental in children and deliberate in adults
Age of the patient
Time that has passed since ingestion
Further care will be provided at the emergency department.
Generally not used today
Many EMS systems use activated charcoal.
Comes as a suspension that binds to the poison in the stomach and carries it out of the system
Signs and symptoms may include:
Usually absorbed quickly into the body
Can cause intense local tissue destruction
Monitor the airway, provide high-flow oxygen, be alert for nausea and vomiting, and transport promptly
Number of patients involved
Need for additional resources
Whether spine stabilization is required
Use the appropriate PPE
Dispatcher may specify
If not, look for clues and ask yourself the following questions:
Are there medication bottles lying around?
Are there alcoholic beverage containers?
Are there syringes or drug paraphernalia?
Is there an unpleasant or odd odor?
Do I see anything suggesting a drug lab
Assess the patient’s LOC.
Determine any life threats.
Do not be fooled into thinking that a conscious, alert, and orientated patient is in stable condition
Do not hesitate to begin oxygen therapy.
Consider decontamination of the patient before transport depending on the poison that the patient was exposed to.
Decontamination is especially important when transporting in a helicopter
If your patient is responsive, begin with an evaluation of the exposure and the SAMPLE history.
If your patient is not responsive, obtain this history from friends, family members, medical jewelry, or cards in his or her wallet
Guides you in what to focus on as you continue to assess the patient’s complaints
Also, ask the following questions:
What is the substance involved?
When did the patient become exposed to it?
What was the level of exposure?
Over what period did the patient take the substance?
Has the patient or a bystander performed any intervention?
How much does the patient weigh?
Many poisons produce no outward indications of the exposure’s seriousness.
Look for alterations in the LOC, pulse, respirations, blood pressure, and skin
Evaluate your interventions.
Repeat the assessment of vital signs:
Every 15 minutes for a stable patient
Every 5 minutes, or constantly, for a patient who has consumed a harmful or lethal dose
Dilute airborne exposures with oxygen.
Remove contact exposures with water.
Consider activated charcoal for ingestions.
Contact medical control or a poison center to discuss treatment options
Bring, or have the company fax, the material data sheet to the hospital if the poisoning occurred in a work setting
Follow standard precautions.
Perform external decontamination.
Remove tablets or fragments from the patient’s mouth.
Wash or brush the poison from the patient’s skin.
Assess and maintain the patient’s ABCs.
Provide oxygen and perform assisted ventilations if necessary.
If approved by medical control, give activated charcoal
You will likely carry plastic bottles of premixed suspension, each containing up to 50 g of activated charcoal.
Insta-Char, Actidose, Liqui-Char
The usual dose for an adult or child is 1 g per kilogram of body weight.
Before you give a patient charcoal, obtain approval from medical control
Who have ingested an acid, an alkali, or a petroleum product
Who have a decreased LOC and cannot protect their airway
Who are unable to swallow
This is called developing a tolerance.
Almost any substance can be abused
Known drug abusers have a fairly high incidence of serious and undiagnosed infections, including HIV and hepatitis.
Always wear the appropriate PPE.
Expect the unexpected
drug user not drug poses greatest threat.
Kills more than 200,000 people each year
One of the greatest national health problems
Alcohol abuse can result in many long-term effects.
Most common effect is liver damage
90% of heavy drinkers will develop some level of hepatitis.
10% to 20% of alcoholics will develop cirrhosis
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
Alcohol is commonly not the only drug taken
If a patient exhibits signs of serious CNS depression, you must provide respiratory support.
May cause vomiting
Patients may experience frightening hallucinations, or delirium tremens (DTs).
Confusion and/or disorientation
Delusions and/or hallucinations
Many addicts may have started using opioids with an appropriate medical prescription.
Tolerance develops quickly.
Some users may require massive doses to experience the same high.
Often cause nausea and vomiting
May lead to hypotension
Treatment includes supporting the airway and breathing.
Open the airway, give supplemental oxygen, and be prepared for vomiting.
Narcotic antagonists are the only antidote
Patient may appear drowsy, peaceful, or intoxicated.
In general, these agents are taken by mouth.
Occasionally, the capsules are suspended or dissolved in water and injected.
Your treatment is to provide airway clearance, ventilatory assistance, and prompt transport.
The antidote (flumazenil) may be administered in the hospital.
Acetone, toluene, xylene, hexane
Found in glues, cleaning compounds, paint thinners, and lacquers
Gasoline and halogenated hydrocarbons are also abused.
Commonly abused by teenagers
Halogenated hydrocarbon solvents can make the heart hypersensitive to the patient’s own adrenaline.
Even the action of walking may cause a fatal ventricular arrhythmia.
Use a stretcher to move the patient, give oxygen, and transport to the hospital
A stimulant is an agent that produces an excited state.
Frequently cause hypertension, tachycardia, and dilated pupils
Designer drugs are frequently abused in certain areas of the United States.
Can be absorbed through all mucous membranes and even across the skin
Effects last less than an hour
Smoked crack is the most potent
Cocaine is one of the most addicting substances known.
Acute overdose is a genuine emergency.
Severe agitation can lead to tachycardia and hypertension.
Patients may be paranoid.
Do not leave the patient unattended.
Provide prompt transport.
Produces euphoria, relaxation, and drowsiness
Impairs short-term memory and the capacity to do complex thinking
Could progress to depression and confusion
Marijuana use rarely necessitates transport to the hospital.
Except for a patient who is hallucinating, very anxious, or paranoid
Reassure the patient and transport with a minimum amount of excitement.
Marijuana is often used as a vehicle to get other drugs into the body.
Cause visual hallucinations
Intensify vision and hearing
Generally separate the user from reality
Patients experiencing a “bad trip” will be hypertensive, tachycardic, anxious, and paranoid.
Provide emotional support.
Do not use restraints unless you or the patient is in danger of injury.
Watch the patient carefully throughout transport.
These medications have properties that block the parasympathetic nerve.
Common drugs include atropine, Benadryl, and Jimson weed
The patient can go from appearing “normal” to seizure and death within 30 minutes.
Seizures and arrhythmias are best treated in the hospital
Overstimulate normal body functions that are controlled by the parasympathetic nerves
An abnormal heart rate
Decontamination may take priority over immediate transport.
Decrease the secretions in the mouth and trachea.
Provide airway support.
Antidote kits may be available.
Mark I kit, DuoDote kit
Indications include a known exposure to nerve agents or organophosphates with manifestation of signs and symptoms.
The kit consists of an auto-injector of atropine and one of 2-PAM chloride
Children may ingest them thinking they are candy.
Signs and symptoms depend on the medication ingested.
You will likely be given an order to administer activated charcoal
Ingesting too many may result in:
Ringing in the ears
Patients with this problem are frequently:
In danger of having seizures
Be extremely careful in dealing with a child who has ingested a poison.
Some alcohols, including methyl alcohol and ethylene glycol, are even more toxic than ethyl alcohol (drinking alcohol).
Organism itself may cause disease
Organism may produce toxins that cause disease
One organism that produces direct effects of food poisoning is the Salmonella bacterium
Characterized by severe GI symptoms within 72 hours of ingestion, including nausea, vomiting, abdominal pain, and diarrhea
Proper cooking kills bacteria, and proper cleanliness in the kitchen prevents the contamination of uncooked foods.
The bacterium Staphylococcus is quick to grow and produce toxins in food.
Foods prepared with mayonnaise, when left unrefrigerated, are a common vehicle
Can result from eating improperly canned food
Symptoms are neurologic:
Blurring of vision
Difficulty in speaking and breathing
Notify the regional poison center.
Take the plant to the emergency department.
Provide prompt transport.
Maintain an open airway.
Transport the patient promptly to the hospital for respiratory support.