red blood cells from carrying oxygen, or interfere with the normal biochemical processes in the body at the level of the cell. The actual effect and extent of damage is dependent on the nature of the poison, on its concentration, and sometimes on how it enters the body. These factors vary in importance depending on the patient’s age, weight, and general health.
1. Stay alert for airway and respiratory problems. Be prepared to perform airway maintenance, suctioning, and positioning of the patient should the patient lose consciousness, seize, or vomit. Help the patient so that vomitus will not be aspirated. Have a rigid-tip suction device ready. Provide oxygen and assist respirations as needed.
2. Assess for trauma the patient may be unaware of because of his intoxication. 3. Be alert for changes in mental status as alcohol is absorbed into the bloodstream. Talk
to the patient in an effort to keep him as alert as possible.
4. Monitor vital signs.
5. Treat for shock.
6. Protect the patient from self-injury. Use restraint as authorized by your EMS system.
Request assistance from law enforcement if needed. Protect yourself and your crew.
7. Stay alert for seizures.
8. Transport the patient to a medical facility.
body. (pp. 547-548)
others at scenes where poisoning, alcohol abuse,
or substance abuse is involved. (pp. 546-567)
who has been poisoned. (pp. 549, 554, 558)
management of ingested poisons. (pp. 550-553)
ingested a poison. (p. 553)
inhaled poisons. (pp. 554-558)
have absorbed poisons through the skin.
(pp. 558-559, 560)
abuse. (p. 561)
abuse and alcohol withdrawal. (pp. 561-562)
associated with abuse of substances, including
stimulants, depressants, narcotics, volatile
chemicals, and hallucinogens. (pp. 563-566)
plan for patients with emergencies related to
alcohol and substance abuse. (pp. 562-563, 566-567)
Evaluate the need for prompt transport of critical patients.
2. Perform a secondary assessment; obtain vital signs. This includes removing contami-
nated clothing while protecting oneself from contamination.
3. Remove the poison by doing one of the following:
• Powders. Brush powder off the patient, then continue as for other absorbed poisons.
• Liquids. Irrigate with clean water for at least 20 minutes and continue en route if
• Eyes. Irrigate with clean water for at least 20 minutes and continue en route if possible.
4. Transport the patient with all containers, bottles, MSDS sheets, and labels from the
5. Perform reassessment en route.
poison or its effects.
3. Insert an oropharyngeal or nasopharyngeal airway and administer high-concentration oxygen by 4. Gather the patient’s history, take baseline vital signs, and expose the chest for auscultation.
5. Contact medical direction. 6. Transport the patient.
by altering cell structure or functions.
bacteria, plants, or animals.
2. Call medical direction on the scene or en route to the
3. If directed, administer activated charcoal. You may
wish to administer the medication in an opaque cup
that has a lid with a hole for a straw.
4. Position the patient for vomiting and save all vomitus.
Have suction equipment ready.
When a patient has ingested a poison, it provides another reason to avoid mouth-to-mouth contact. Provide ventilations through a pocket face mask or other barrier devic
The harm it can cause can result in a medical emergency
“All things are poison and nothing is without poison, only the dose permits something not to be poisonous.” Paracelsus
Dependent on: 1. Nature of poison 2. Concentration 3. How poison enters the body 4. Patient’s age, weight, and general health
Adult: often an accidental or deliberate medication overdose
Look for container; check labels
Transport with patient to hospital
When did exposure occur?
Quick-acting poison requires faster treatment
ER personnel need to know for appropriate testing and treatment
How much was ingested?
Estimate missing pills by looking at prescription label
Over how long a time?
Treatments may vary
Was medication taken for very first time?
Was medication being taken chronically?
What interventions have been taken?
Treatments indicated on label,
Other home remedies (syrup of ipecac)
What is patient’s weight?
Rate of onset of toxic effects is related to weight
What effects has patient experienced?
Nausea, vomiting, altered mental status, abdominal pain, diarrhea, chemical burns around mouth, unusual breath odors
Symptoms: nausea, vomiting, abdominal cramps, diarrhea, fever
May occur within hours of ingestion, or a day or two later
Not an antidote: prevents or reduces amount of poison absorbed by body
Altered mental status
Agricultural chemicals and pesticides
When did exposure occur?
Over how long did exposure occur?
What interventions has anyone taken?
What effects is patient experiencing?
Move patient from unsafe environment using trained and equipped personnel
Detect/treat life threatening injuries
Open airway; provide high flow oxygen
History, physical exam, vital signs
Transport with all containers, bottles, and labels
Reassessment en route
If the CO poisoning is the result of a malfunctioning heater or poorly vented fireplace, everyone in the home or building may be affected. Commonly accepted idea that patients exposed to CO have cherry-red lips is not true.
Can take several hours or days to “wash” CO from bloodstream
Substances can irritate skin and eyes, damage lungs, and progress to respiratory or cardiac arrest
“Smoky” or chemical smell on breath
Black (carbon) residue in mouth, nose or sputum
Singed nasal or facial hair
Maintain airway; provide high flow oxygen
Monitor patient closely—airway burns may lead to swelling of airway
The body’s reaction to toxic gases and foreign matter in the airway can often be delayed. Convince all smoke inhalation patients that they must be seen by a physician, even if they are not yet feeling serious effects.
Mix two easily-obtained chemicals to release hydrogen sulfide gas
Commonly released inside enclosed space such as a car
A source of acid, such as a strong household cleaner, and a source of sulfur, often a pesticide, when mixed together will quickly release significant amounts of toxic hydrogen sulfide gas. Often the victim will leave notes warning others of the hazardous gas.
May or may not cause damage to skin
Patient may require decontamination prior to treatment
History, physical exam, vital signs
Brush off powder, then irrigate
Irrigate skin and eyes for at least 20 minutes and during transport
Transport with all containers
Reassessment en route
Contact poison control
Information on poisons, signs and symptoms, and treatments
Follow local protocol for contact procedures
Alcohol might disrupt the assessment of a patient with altered mental status. See many patients whose conditions are caused either directly or indirectly by alcohol or substance abuse
Abuse of alcohol and other drugs crosses all geographic and economic boundaries
Can be addictive
Emergencies may result from recent consumption or years of abuse
Treat patients as any others
Abuse can lead to or worsen other medical conditions
Alcohol often consumed with other drugs, which can result in a serious medical emergency
Impaired patients can be uncooperative or combative
Contact law enforcement if safety concern
Intoxicated patients may also have medical problems
All patients receive full assessment regardless of suspicion of intoxication Remember that diabetes, epilepsy, head injuries, high fevers, hypoxia, and other medical problems may make the patient appear to be intoxicated. This can also include many traumatic injuries such as blood loss and head injury.
Unsteady on feet
Slurred, rambling speech
Flushed, complaining of being warm
Confusion/altered mental status
Can be serious, resulting in tremors, hallucinations, and seizures
Unusual behavior, demonstrating “insane” behavior
Hallucinations, gross tremor of hands, profuse sweating, anxiety
Alcohol can be a respiratory depressant. The patient may not be a reliable source of information. Try to seek other sources such as bystanders, family, medical bracelets, or law enforcement. Be on the alert for signals—such as depressed vital signs—that the patient has mixed alcohol and drugs.
Keep suction ready
Stay alert for airway and respiratory problems
Monitor vital signs
Gather history from patient, bystanders
Stay alert for seizures
Includes illicit drugs, prescription medications, industrial chemicals
May be snorted, smoked, or injected
Heroin, codeine, morphine
OD characterized by coma, pinpoint pupils, and respiratory depression
LSD, PCP, some mushrooms, XTC
Initial “rush,” then can act as central nervous system depressant
Patient’s level of consciousness
Patient may have taken more than one type of drug
Patient may be uncooperative or combative
Be aware of a possibility of contaminated needles and the presence of chemicals
Seeing or hearing things (Hallucinations)
Swollen membranes in nose or mouth
Numbness or tingling sensation inside head
Changes in heart rhythm
May be residue of chemical on face or in bag
Provide oxygen and assist respirations as needed
Treat for shock
Talk to patient to keep them calm and cooperative
Perform physical exam
Look for evidence of injection sites (“track marks”)
Transport as soon as possible
Consult with medical control on further treatment
Follow local protocol concerning consideration for restraint
mediately treat life-threatening problems. Ensure an open
airway. Administer high-concentration oxygen if the poison
was inhaled or injected.
Next, perform a secondary assessment, including baseline vi-
tal signs. Find out if the poison was ingested, inhaled, ab-
sorbed, or injected; what substance was involved; how much
poison was taken in; when and over how long a period expo-
sure took place; what interventions others have already
done; and what effects the patient experienced.
• What substance was involved?
• When did the exposure occur?
• How much was ingested?
• Over how long a period did the ingestion occur?
• What interventions have the patient, family, or well-meaning bystanders taken?
• What is the patient’s estimated weight?
• What effects is the patient experiencing from the ingestion?
For absorbed poisoning?
powders from the patient, being careful not to abrade the patient’s skin. Remove contaminated clothing. Irrigate with clear water for at least 20 minutes while catching contaminated water and disposing of it safely. Contact medical direction and transport.
The most commonly injected poisons include snake and insect venom and:
Ordinary charcoal adsorbs some substances, but activated charcoal is different because it has been manufactured to have many cracks and crevices. As a result, activated charcoal has an increased amount of surface area available to which poisons can bind.
Ingested poisons pose a significant danger to patients due to the potential for regurgitation and aspiration. Caustic chemicals, for example, will cause much more damage to the delicate tissues of the lungs than to the lining of the stomach.
to treat erectile dysfunction, such as sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis), or similar medication. If so, he should not take
bility of a serious negative interaction with these drugs.
sure is always a potential side effect of administration. If this should occur, you may also need to lay the patient flat as you contact medical direction again for advice.