Identifying the Patient and the Poison Chapter 22 Notes

Identifying the Patient and the Poison ● Toxicology - the study of toxic or poisonous substances. ● Poison is any substance whose chemical action can damage the body structures or impair body function. ● A toxin is a poisonous substance produced by bacteria, animals, or plants that acts by changing the normal metabolism of cells or by destroying the,. ○ Toxins can have: ■ Acute effects (e.g. an injection of heroin may cause respiratory arrest) ■ Chronic effects (e.g. years of substance abuse may lead to a weakened immune system) ● Substance abuse is the misuse of any substance to produce a desired effect. ○ Common complication of substance abuse is overdose. ● If you have any suspicion that an ingestion or exposure to a toxic substance has occurred, notify medical control and begin emergency treatment immediately. ● In the SAMPLE history, ask: ○ What substance did you take? ○ How much did you ingest? ○ When did you take it? ○ Did you have anything to eat or drink before or after you took it? ○ Has anyone given you an antidote or any substance orally since you ingested it? ○ How much do you weigh? ● Try to determine the nature of the poison. ● Place any suspicious material in a plastic bag and take it with you to the hospital, along with any containers you find. ● Drug containers at the scene can provide critical information: ○ Name and concentration of the drug ○ Specific ingredients ○ Number of pills originally in the bottle ○ Name of the manufacturer ○ Dose that was prescribed. How Poison Enters the Body ● Most poisons do not have an antidote. ● Treatment for the patient depends on whether the poison entered the body via: ○ Inhalation ○ Absorption ○ Ingestion ○ Injestion ● If you are uncertain on how to treat a patient who has been poisoned or exposed to a specific substance, find the container if possible, and contact medical control and/or the poison control center before you proceed. Inhaled Poisons ● If you suspect the presence of a toxic gas, call for specialized resources such as the hazardous material team. ● Never approach a contaminated patient unless you have specialized hazmat training and are using the appropriate PPE. ● Patients may need to be decontaminated by the hazmat team after they are removed from the toxic environment. ○ The patient’s clothing should be removed because it may contain trapped gasses that can be released. ● The patient may have: ○ Burning eyes ○ Sore throat ○ Cough ○ Chest pain ○ Hoarseness ○ Weakness ○ Wheezing ○ Respiratory Distress ○ Dizziness ○ Confusion ○ Headache ○ Stridor in severe cases ○ Seizures ○ Alertered mental status ● Most inhaled toxins can be treated by removing the patient from the exposure and applying oxygen. ● Some inhaled agents cause progressive lung damage, even after the patient has been removed from direct exposure. ● May take 2 or 3 days or more of intensive care to restore normal lung function. ● Pulse ox readings may be inaccurate with inhaled poisons. Absorbed and Surface Contact Poisons ● Signs and symptoms: ○ History of exposure ○ Liquid or powder on patients skin ○ Burns ○ Itching, irritation, and redness of the skin in light-skinned people. ● Emergency treatment for contact poisoning includes: ○ Avoid contaminated yourself or others ○ Remove the irritating or corrosive substance rapidly ■ If the dry powder has been spilled: ● Thoroughly brush off the chemical ● Flush the skin with clean water for 15 to 20 minutes ● Wash the skin with soap and water ■ If liquid material has been spilled, flood the affected part for 15 to 20 minutes. ● If the chemical is in the patients eyes, irrigate them quickly and thoroughly. ○ Make sure the fluid runs from the bridge of the nose outward. ● After effective decontamination has occurred, promptly transport the patient to the emergency department for definitive care. ● Obtain a material safety data sheet (MSDS) from the industrial sites and transport it with the patient. ○ If it is not immediately available, ask the company to fax this information to the receiving hospital while you are en route. ○ The MSDS will help to identify and quickly make available specific interventions and potential antidotes. Ingested Poisons ● Ingested poisons include: ○ Liquids ○ Household cleaners ○ Contaminated food ○ Plants ○ Drugs ● Ingested poisons are usually accidental in children, except for contaminated food, deliberate in adults. ○ Plant poisoning is common among children ○ Poisons that are acid or alkaline often cause burns around the mouth. ○ Other signs and symptoms depend on the substance involved. ● Treat signs and symptoms, and notify the poison center and medical control of the patient’s condition. ● If the patient has an altered mental status, protect the patient from aspirating. Injected Poisons ● Signs and symptoms include: ○ Weakness ○ Dizziness ○ Fever ○ Chills ○ Unresponsiveness ● If you suspect that rapid absorption has occured: ○ Monitor airway ○ High Flow oxygen ○ Be alert for nausea and vomiting ● Remove rings, watches, and bracelets around the injection site. ● Take all containers, bottles, and labels with the patient to the hospital. Primary Assessment ● With substance abuse and poisonings, don't expect an oriented patient. ● Ensure airway ● Begin oxygen therapy if necessary ● In situations of inhaled poisons, place the patient on oxygen regardless of pulse ox reading. ● Have suction available. ● Assess circulatory status ● Everyone who is exposed to the hazardous material must be thoroughly decontaminated by the hazmat team before leaving the scene. ● In addition to SAMPLE history, ask the following: ○ What is the substance? ○ When? ○ How much? ○ Over what period? ○ Has any intervention been performed? ○ How much does the patient weigh? Secondary Assessment ● Do a general review of all body systems. ● Get a complete set of baseline vital signs. ● Many poisons give no outward indications of the seriousness of exposure. ● Alterations in the level of consciousness, pulse, respirations, blood pressure, and skin are more sensitive indicators that something serious is wrong. Reassessment ● Repeat vital signs ● Evaluate effectiveness of interventions you have provided. ● If a material safety fata sheet is available in a work setting, take it with you to the hospital. Specific Poisons ● Long term misuse of a substance can lead to developing a tolerance to a substance. ● A person with an addiction has an overwhelming desire or need to continue using the substance, at whatever cost, with a tendency to increase dose. Alcohol ● Alcohol is a: ○ Powerful CNS depressant ○ Sedative ○ Hypnotic ● Alcohol: ○ Does the sense of awareness ○ Slows reflexes ○ Reduces reaction rate ○ Causes aggressive and inappropriate behavior and lack of coordination ● Look for signs of head trauma, mental illness, toxic reactions, or uncontrolled diabetes. ● Can cause hypoglycemia ● If a patient exhibits signs of serious CNS depression, provide respiratory support. ○ This may be complicated by emesis or hematemesis. ● About 1 to 7 days after a person stops chronic drinking or when alcohol consumption levels are decreased suddenly, delirium tremens may develop. ● Auditory and visual hallucinations often precede DTs, which are a complication. Opiates and Opioids ● A narcotic is a drug that produces sleep or altered mental consciousness. ● An opioid is a type of medication to relieve pain. ● Opiates are a subset of the opioid family, that is, natural, nonsynthetic opioids. ● Pinpoint pupils are the most commonly accepted sign of opiate abuse. ● Common opioids and opiates: ○ Butrophanol ○ Codeine ○ Fentanyl ○ Heroin ○ Hydrocodone ○ Dilaudid ○ Morphine ○ Methadone ○ Oxycodone ○ Oxymorphone Naloxone ● Reverses the effects of overdose. ● Only use when patient has agonal respirations or apnea ● Provide ventilations Sedative-Hypnotic Drugs ● CNS depressants and alter the level of consciousness ● May appear drowsy, peaceful, or intoxicated. ● Sedative-hyponic drugs such as chloral hydrate may also be given to people as a