the Patient and the Poison
- a poison is any substance
that when introduced into the body in substantial amounts causes harm.
- a poison can be something as simple as water if consumed in excess or it can
be something like inhaled cyanide which takes very minute amounts to kill.
- poisons work by altering cell metabolism in such a way that is causes harm.
- poisons may act acutely, such as a heroin overdose, or over years such as
with alcohol abuse.
- signs and symptoms are an important clue to identifying a patient that has
been poisoned. Ingested poisons, for example, may result in injury to the mouth.
- if a patient vomits, collect the vomitus and bring it to the hospital so that
it can be examined. In addition, if you suspect overdose of pills or medicines,
brings those to the hospital as well.
How Poisons Get Into the Body
are introduced into the body in one of four ways:
80% of all poisoning is by mouth; ingested products include household
products, food, plants and in the majority of cases... drugs.
- children are poisoned most frequently and the most common products they
are poisoned with are household products.
- if an ingested poison is suspected the EMT's job is to first assess
Airway, Breathing, Circulation and Disability (ABCD). If this appears
stable, you should attempt to remove as much poison as possible. This
can be accomplished in several ways but a common method used in many EMS
agencies is activated charcoal.
- activated charcoal is a suspension of charcoal that binds (adsorbs)
to the ingested poison and carries it through the body minimizing and
limiting absorption through the GI tract.
- inhaled poisons
include several substances including natural gas -- the most common accidental
inhaled poison -- pesticides, chlorine, smoke and others.
- all patients should be moved into an environment where there is fresh
air. Supplemental oxygen should also be provided for those suspected of
inhaling a poison. .
- signs and symptoms may include burning or watery eyes, sore throat,
cough, hoarseness, respiratory distress, stridor, pulmonary edema, seizures
and altered mental status. Remember, signs and symptoms need not be immediate...
therefore, if an inhaled poison is suspected, ALL
patients require transport to the hospital.
- EMT's should be prepared to use Basic Life Support (BLS) skills.
- injected poisonings
are almost always the result of substance abuse. Heroin and cocaine top
the list... but injected poisons can also be the result of bites and stings.
- signs and symptoms (s/s) vary in every patient but common s/s include
weakness, dizziness, altered mental status, excitability, or unresponsiveness.
- injected poisons are difficult for EMT's to treat since dilution is
difficult. Some medications can be given in certain circumstances that
counteract the effects of some drug-induced poisoning but quick transport
to the hospital is the key to effective treatment.
- EMT's should be prepared to use Basic Life Support (BLS) skills.
- chemicals that contact the skin, mucus membranes or eyes have the potential
to cause severe damage. Alkalis, acids and hydrocarbons are some of the
- signs and symptoms (s/s) of such poisonings include a history suggestive
of this, irritated skin, erythema of the skin or bullae (blisters) present
on the skin. .
- emergency treatment involves removing the offending chemical by first,
preventing self-contamination and secondly diluting with copious amounts
of water. If the patient is wearing clothing -- REMOVE IT.
Flush with water for 10 minutes if contact is on the skin.
- if the patient has chemical exposure in the eyes irrigation should be
at least 10 minutes
for acid substances
and 20 minutes for alkali
substances. If you are unsure, irrigate for 20 minutes.
- the only time irrigation is contraindicated is if a potential harmful
reaction may occur from contact with water. Examples include phosphorous
and elemental sodium.
- provide prompt transport to the emergency department. Irrigate while
in route if necessary.
Emergency Medical Care
solution to pollution is dilution.
- the key to emergency medical
care is diluting the poisoned substance so much that it lacks the ability to
- treatment then focuses on support i.e. assessing and maintaining ABCD.
- in circumstances where charcoal is indicated, the usual adult dosage is 25
- 50g, and the usual pediatric dose is 12.5 - 25g. If a small child is involved,
the dose is 1g of charcoal per kg of body weight.
- charcoal is CONTRAINDICATED in patients that have ingested acids, alkalis
or petroleum products, or those patients who have a decreased level of consciousness
- side effects of charcoal ingestion include abdominal pain, diarrhea, constipation
and black stools. Vomiting is a serious side effect that can occur due to the
risk of aspiration into the lungs.
most commonly abused drug in the United States contributing to more than
200,000 deaths each year.
- EtOH is a powerful CNS depressant that sedates (to decrease the activity
of) and is a hypnotic (induces sleep).
- EtOH dulls the senses, slows reflexes, reduces reaction time, and reduces
- signs and symptoms include any of the above and CNS depression. Periods
of CNS depression may result in a patient vomiting without even knowing
s/he has vomited... so ALWAYS PROTECT THE AIRWAY in these patients.
- a patient with EtOH withdrawl may experience delirium tremors (DT's)
-- syndrome characterized by restlessness, fevers, sweating, chills, delusions,
hallucinations, agitation and seizure activity.
- overall treatment for patients suspected of EtOH abuse is to dilute
with oral or IV fluid and to provide BLS support. Protect the airway by
having suction devices ready and turing patients to their side.
named so due to its origin from the poppy seed. Include such drugs and
medicines as heroin, codeine, and morphine, demerol, dilaudid, percocet,
vicodin and methodone.
- these substances are CNS depressants and result in severe CNS depression.
- s/s include "sedated" patients, occasionally they are cyanotic
and have pinpoint pupils.
- treatment includes supporting ABC, administering supplemental oxygen,
being prepared for vomiting and dilution with IV fluids.
- an antidote for narcotics include a powerful narcotic-antagonist called
Narcan -- usually administered by paramedics
-- that will reverse the "high" in as little as two-minutes.
includes a category of drugs and medicines categorically known as barbiturates
- these substances are CNS depressants and alter level of conscious.
- s/s are similar to EtOH intoxication.
- these substances are lethal when used in combination with alcohol (EtOH).
- these drugs are also touted to be given to people as "knock-out"
drugs or "date rape drugs." Rohypnol is one such example.
- general treatment for such individuals is airway support, ventilatory
assistance, and transport to the emergency department for continued ventilatory
support. Always administer supplemental oxygen.
- an antidote -- romazicon -- can be administered by paramedics.
s/s are similar to the CNS effects seen with sedative-hypnotic but the
route is via inhalation vs. ingestion or infection.
- common inhalants include acetone, hexane (found in glues), paint thinner,
hydrocarbons (found in gasoline or other petroleum products), propellants
found in aerosol sprays.
- drowsiness is a common finding, but seizures can also occur with the
use of this substance.
- patients that inhale hydrocarbons can make the heart sensitive to the
patients own adrenaline putting them a risk for sudden cardiac death;
try to keep such patients from struggling or exerting themselves.
- treatment should always include supplemental high-flow oxygen and use
stretches to move these patients.
- transport to a hospital is always recommended.
these are CNS stimulants (substances that produce an excited state) causing
hypertension (HTN), tachycardia and dilate the pupils. |
- examples include amphetamines, methamphetamines, phentermine, caffeine,
phenylpropanolamine (nasal decongestants), and pseudoephedrine (nasal
- cocaine and crack are the classic sympathomimetics though recently ecstasy
-- a so-called "designer drug" -- has become increasingly abused
in certain areas of the United States.
- designer drugs can be ingested, inhaled and injected.
- s/s include disorganized behavior, restlessness, delusions, paranoia.
Effects of the medication last less than one hour usually.
- the risk of cardiac arrhythmia and stroke is also high -- particularly
with cocaine or crack. EMT's may see extremes of HTN and seizures.
- treatment includes oxygen, IV establishment if possible and be prepared
to suction and protect the airway.
it is estimated that as many as 20 million people use marijuana daily
in the United States.
- s/s normally include euphoria, drowsiness, hallucinations and relaxation.
- marijuana normally impairs short-term memory and complex thinking, but
usually doesn't result in a hospital admission or an ambulance transport.
- exceptions include the patient who is hallucinating and is paranoid
- marijuana is a "gateway drug" -- a drugs that is used as vehicle
for additional and oftentimes more harmful drugs.
hallucinogens alter one's sense of perception.
- two common hallucinogens include LSD and PCP.
- s/s include visual hallucinations and intensify auditory and visual
- many of the hallucinogens have sympathomimetic properties therefore
treatment usually invokes a calm manner and providing emotional support.
these drugs block the parasympathetic nervous system.
- common medications include benadryl and tricyclic antidepressants.
- s/s include tachycardia, agitation and pupil dilation. Serious side
effects include cardiac arrhythmia's and seizures.
- treatment for such serious side effects include sodium bicarbonate intravenously
otherwise monitoring is necessary in a hospital environment.
cholinergic agents are the "nerve gases" used in chemical warfare.
- the mechanism by which they act upregulate the parasympathetic nervous
- normally found in insecticides or some wild mushrooms.
- s/s are easily remembered by the acronym SLUDGE
- GI irritation
- eye constriction
- patients exposed to cholinergic actions frequently require decontamination
by HAZMAT units.
- treatment include IV atropine and aggressive airway support.
two of the more common medications that can lead to lethal conditions include
aspirin (ASA) and tylenol (acetaminophen - APAP).
- over-ingestion of ASA can result in nausea and vomiting and tinitus (ringing
in the ears). Serious side effects include lowering the pH of the body to
lethal levels resulting in tachyarrhthymias or kidney failure.
- over-ingestion of APAP leads to liver failure... the problem is, it may
not be apparent for over a week and the patient may be symptom free until
that time. If information about the overdose is obtained early enough, a
antidote may minimize and in some cases prevent liver failure.
- there are two main types. In one type,
the organism is responsible for the disease process; in the other type, the
organism produces a toxin which then causes the disease.
- Salmonella is one example in which the organism
causes the disease process.
- s/s of salmonellosis is characterized by nausea, vomiting, abdominal pain,
diarrhea, fever and generalized weakness. It occurs within 72 hours of eating
and is common when eating improperly cooked poultry.
- Staphylococcus is an example where the organism produces a toxin
that causes the disease process.
- s/s include nausea, vomiting, and diarrhea starting within 2-3 hours after
ingestion of the offending organism.
- this type of poisoning commonly occurs when eating food that are prepared
in advance and kept unrefrigerated.
- treatment includes supportive care until IV fluids and medications can be
- thousands of cases each year due to contact
- though it is impossible to memorize all plants that can cause harm, two common
offending organisms are listed below -- poison ivy and poison oak.
poison ivy |
- treatment include maintaining an open airway and monitor vital signs, notifying
the regional Poison Control Center (PCC) below to identify the plant, taking
the patient and the plant to the Emergency Department and transporting the patient
to the hospital.
Poison Control Center
- the PCC is the best resource for any poisoning.
- all PCC can be found at the following link: http://www.aapcc.org/findyour.htm
- the 800# is: 1-800-222-1222
- 2006 Center for Emergency Programs
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