so our next chapter is chapter 22 we're going to talk about toxicology again toxicology it's the recognition and management of carbon monoxide poisoning and nerve agent poisonings a couple of things that we're going to talk about because our national education standards really want us to address those too for sure and then how and when to contact poison control we need to look at the anatomy physiology pathophysiology assessment and management of the different types of poisonings that we have inhaled poisoning ingested poisoning injected poisons absorbed poison and then alcohol intoxication and withdrawal okay so truly everything we come into contact could possibly or potentially be a poisonous thing and acute poisoning affects over 2 million people every year and chronic poisoning is even more common deaths caused by poisoning are fairly rare though but poisoning in children that's one of the biggest areas but it's been decreasing since the 60s due to child resistant calves like under medicine bottles and such and then deaths caused by chronic poisoning in adults has been rising because of our drug abuse so in kids it's going down and adults is going up so toxicology is the study of toxic or poisonous substances a poison is any substance whose chemical reaction can damage body structures or impair body function a toxin is a poisonous substance produced by bacteria animals or plants and then substance abuse is a misuse of any substance that to produce a desired effect and then overdoses is too much of that toxic drug your primary responsibility to patients is to recognize that a poisoning has occurred so that's what we really need to do we need to pay attention to our surroundings we need when you're doing bsi scene safe yes the scene is safe and now we have to look at our surroundings very small amounts of some poisons can be considerable damage or death for example what if a toddler eats too many cigarette butts so now we have a nicotine nicotine poisoning signs and symptoms of poisoning can vary really due to the specific agent so this is a listing uh that you'll find that's table 22-1 so if you start on the left we talk about opioids uh opioids sorry opiates and in opioids so the difference being you know the fentanyl the the heroin is the biggest thing that we think about with opioids uh again the signs and symptoms they have hypo ventilation or respiratory arrest they have pinpoint pupils they might be in sedation or a coma and have hypotension that's the opioids or the opiates the the methadone the cocaine the methamphetamine that's the other big one where everything's sped up it's the hypertension the tachycardia the dilated pupils agitation hyperthermia they're really hot dry and red uh some other sedatives that you might see like diazepam the barbitols that kind of stuff slurred speech almost like drunk and then you have the anticholinergics like the atropine uh the diphenhydramine yeah and everything's sped up again so with cholinergics like orgo orco i can't even say it now organophosphate sorry it's been a long day organophosphates or nerve gas the thing the mnemonic that we always think about is called sluggin and sludgeon stands for your with your patient you're gonna see excess of salivation and sweating l is lacrimation excessive tearing of the eyes u is urination d is defecation drooling or diarrhea g is gastric upset or cramps e is emesis or vomiting and m is muscle twitching or meiosis which is pinpoint pupil so if you think of sludgeon basically everything is in your body is trying to escape by one route or another anything that's fluid anything that's food is trying to escape out of your body if you have an organophosphate poisoning such as nerve gas so you ask your patient what'd you take when did you take it or when did you get exposed to it if they know how much did you ingest did you have anything to eat or drink before or after has anyone given you an antidote or a substance orally since you ingested it and how much do you weigh these are truly very important patient questions when it comes to some type of poisoning try to determine the nature of the poison look for the clues take any suspicious material with you but handle it safely so that you do not become poisoned also and even the containers at the scene can provide critical information so anything that they've taken um maybe they drank bleach let's take the bleach bottle with us uh maybe they ate mushrooms let's if they have any of those left over let's take those but again be very careful in how you take that with you so that you don't become poisoned at the same time if they vomit we want to look to see if there's any pill fragments in there doesn't that sound nice note and document anything anything unusual that you see hear smell anything and it's all very relative when it comes to poisonings so how do poisons enter your body so it really depends on how the poison gets into your body is how we're going to treat it so the four routes are inhalation so they inhale poison they absorb it through their skin they ingest it or eat it or it's injected into their body again it doesn't matter which way it gets into your body they can all be lethal and life-threatening so you can inhale something out of the jar you have the powder put on your skin you absorb it you ingest a tablet or you inject the poison through a needle that's i mean these are just fairly common rounds so if you've inhaled a poison we need to get them to fresh air right away think about giving them oxygen again they've inhaled it's gone into their lungs let's get them out of that environment that hat might have more of that poison let's give them oxygen and then if you need them you might need to call a hazmat team if it's a toxic gas like a semi truck rollover a train derailment an industrial accident farming accidents as well so they might need to be decontaminated by the hazmat team once they get out of that toxic environment what the hazmat team is going to do is they're going to rinse them off scrub them get them out of their clothes because those that their clothing could have that poison or that gas on them so we got to get rid of all that stuff before we put them in that little box called your ambulance if they've inhaled it they need immediate transport give them oxygen and maybe again with everything in ems nausea vomiting could be happening so we have to have our suction ready so they might have tried to inhale this poison to commit suicide one of the things to think about are exhaust fumes maybe somebody uh turned on their car parked it in the garage shut the garage door rolled all their windows down and now they're gonna get carbon monoxide poisoning maybe it's an intentional suicide attempt it could be carbon monoxide when they fire up their furnaces for the first time in the winter maybe they uh the gas dryer in the basement of their house could create a carbon monoxide poisoning event so you have to be really kind of either a suspicious or b remember when you were doing your patient assessment you always say bsi scenes say blah blah blah number of patients this is where it really comes into play because instead of having just one person that's nauseous vomiting has a headache maybe the whole house has those same signs and symptoms so number of patients comes into play here absorbed or surface contact poisons again you can get it into your body through your eyes your mucosal membranes your chemical burns rashes lesions and it causes sometimes systemic effects or widespread effects it's important to distinguish between contact burns and contact absorption so the absorbed chemical could create a burn or is the burn from something else signs and symptoms here we go history of exposure liquid or powder on their skin burns itching irritation redness of the skin typical odors of the substance so anything could really truly be a poison if there was enough of it so you have to look for these signs and symptoms think about treatment number one we don't want to become infected so we want to make sure it's seen as safe for us it's safe for us to care for our patient get the substance off the patient as quickly as possible if they have it on their clothing we want to get rid of their clothing and we want to flush and wash the skin and then the term we always use is we want to use copious amounts of water tons of water water water water water rinse rinse rinse if it's a liquid chemical now the difference being dry chemicals and we're going to treat those differently if it's dry uh we want to brush it off and then rinse so we don't want to mix the water with the substance because that could cause the burning process so we want to brush off as much as we can as and then we're going to do the copious amounts of water so if it's been spilled we're talking 15 to 20 minutes of rinsing and so hopefully they've started the rinsing process before you get there on your ambulance chemical agents in the eyes we want to make sure that we're not washing the chemical into the good eye if they only have it in one eye if they have it in both eyes we want to rinse both eyes at the same time one of the really kind of cool tricks and they show it here is you can hook up an iv fluid bag to a nasal cannula and run the fluid through the nasal cannula and it's going to rinse both eyes at the same time i do it with my students on skills days and it's such a cool little trick works great perfect so if it's occurred in industrial setting they have like safety showers they have eye wash stations in the industrial settings even in schools you'll see that around the the science labs if you will uh you might have hazmat there to assist you that would be a great thing because really they're trained in how to decontaminate a patient to get them prepared for transport to the hospital the other thing that you might think about getting it from the industrial setting is the msds or the material safety data sheet if you're not familiar with that an msds sheet is basically a sheet that lists the chemical lists what will happen to if you get it in your anya or you inhale it how to treat that everything that you need to know about that chemical is on that msds sheet and it's typically a one sheet piece of paper really good organizations will have that copied often you'll pick it up when you pick up your patient so msds sheet don't forget it there's even msds sheets for soap hand soap isn't that crazy you know what an msds sheet says for hand soap if you get gets you on you then you use water and you rinse it off okay duh about 80 percent of poisonings are by mouth liquids cleaners contaminated food plants drugs you can see kind of how this really does affect children more so than anybody because kids always put stuff in their mouth so accidental in children and it's deliberate in adults signs and symptoms of an ingested poison you might have burns around the mouth gastrointestinal pain vomiting cardiac dysrhythmias and it could be even seizures if it's the right kind of poison so it's going to get absorbed into your gi tract after you eat it or ingest it treat science symptoms notify the poison control center medical control of the patient's condition and again consider whether it's an absorbed uh unabsorbed poison remaining in the gi tract whether you can safely and effectively prevent its absorption so that's kind of what we're talking about when we talk about you know how much did you take when did you take it did you try to get rid of it blah blah blah all that stuff when we're getting our patient assessment it says notify poison control and medical control you know what most medical controls are going to tell you if you have a poisoning is they're going to tell you contact poison control and tell us what they said because not the medical controls don't know what happens with every poisoning there is available that's what they're going to reference as well as the poison control center that's the experts so the one thing that we can administer an ems is called activated charcoal and it comes in a pre-mixed suspension and so some systems and i really emphasize some will allow emts to administer this activated charcoal so basically with activated charcoal is you're they're going to drink this and that's going to go in and combine itself or glob on to that poisoning if it's a anything other than a liquid if they're going to glom onto that and then you're going to eliminate that out of your body safely because this is going to kind of stick to that poisoning and help get it out of your system it's going to help it not be absorbed into your body exposure see how much time we really spend on activated charcoal i really truly believe that's because uh i come from indiana in indiana we took that off our ambulances 15 or 20 years ago i can't even tell you how long ago there's a lot of steps involved in using activated charcoal it's it's more of a hospital based medication versus an ems thing you'll get into it when you get into your ambulance because your protocols or your bible if you will is going to tell you what you can't and can't do and when and when you can't do it so injected poisonings that's when you think about insects arachnids reptiles it's going to get absorbed into the body quickly or it's going to absorb into the tissue surrounding that injection site and create local tissue destruction or damage cannot be diluted or removed from the body in the field there's nothing we can do for that signs and symptoms this is going along with any injected poisoning that fever and chills uh unresponsiveness excitability you think about if that person is excited and they have a poison in them we're just going to transport that poison faster around their body so we really want to calm them when we do that our treatment for them is really going to involve calming them monitor your abcs remove rings watches bracelets from injecting sites because that they might have swelling so you get bit by a snake let's say in your hand and when you get bit by that snake it's going to cause your your tissue to have swelling and if you have the ring or watch on there that's gonna restrict blood flow so let's get those off as quickly as possible bsi scene safe we're looking for clues is there an odor in the room sometimes by the time you smell that that's dangerous to you as well are the medication bottles laying around medication missing that might have said that they overdosed maybe a child got into grandma's medicine alcoholic beverage containers present especially if they're like young children who got into alcohol i i know it sounds crazy syringes drug paraphernalia suspicious odor that might indicate the presence of a drug lab like methamphetamine production real real strong chemical smell do a general impression assess our level of consciousness life threats do not assume a conscious alert and or oriented patient is in stable condition that the underlying condition with that poisoning could tell you otherwise airway and breathing again we're assessing abc's right make sure they have an adequate airway they're breathing properly they're getting oxygen suction ready because a lot with a lot of things in ems there's puking in nausea circulation it says the skin and the pulse not just the pulse the skin condition are they pale cool sweaty are they warm and dry again it really depends on what's going on with them i know like if we talked about earlier like opioids you're going to be slowing things down with amphetamines or methamphetamine you're going to be speeding things up so you can do kind of an assessment just by checking their circulation you've taken a guess at what's going on consider prop transports yes indeed and again we're assessing the x abcs the x for examination and then airway breathing circulation examination again is for bleeding out anyone exposed to hazmat materials must be thoroughly decontaminated before leaving the scene you cannot put that person who's been partially decontaminated in the back of your ambulance because now you're exposed to that substance take a history sample history yep if they're unresponsive look for other clues for their history from other sources so you can ask bystanders you can ask family look in their refrigerator for medications look in the cabinet next to the bathroom or backs of the sink in the kitchen where they keep their medicines look for medical alert bracelets necklaces tattoos that even say that they're have a medical history sample history what was involved when were they exposed to it how much did you ingest or what is your level of your exposure so somebody says well i i took tylenol because i want to kill myself how many tablets did you take i don't know it was a brand new bottle i took a handful if you grab that bottle and then you count how many tablets are still in there that's a rough guess at how much they took then take that bottle with you and say this was new this is what's left they took the rest questions that you should ask over what period did they take or were exposed to that substance so let's go back to the tylenol how many did you take i took a handful how often well i took five then a couple hours later i took another 10 and that didn't do it i'm still alive so i took a couple hours later i took another 10 so you can see how that does make a difference again has anybody done anything or performed any intervention is typically what with poisoning people try to make you throw up so that you get rid of that poisoning so there's a little jar a little bottle that a lot of first aid kits called syrup of impact and syrup of epic hack makes you vomit google it on youtube you see stupid people drinking it and puking all over the place uh kind of reminds me of that simpsons or not simpsons it was the family guy episode where everybody's puking all over the place uh so did anybody give you that to throw up because syrup of ipac when you vomit and you throw up the contents it's not always everything that's in your stomach that you will you throw up how much do you weigh because that comes into factors with poison control because they can calculate how poisonous that substance is to you because of your weight look at the the affected body area review all body systems really and get a complete set of baseline vitals this is going to be again important when we get our patient to the hospital assess the abc's with your are excuse me your ex abc's is part of your reassessment bible signs there and again it depends are they stable 15 minutes if they're unstable five minutes or i love this or constantly for a patient who has consumed a harmful or lethal dose sometimes five minutes is not quick enough to reassess vital signs on those people treatment support your ex abc's contact medical control poison control 1-800-222-1222 that's the number for poison control every one of you that's a parent out there or grandparent you should have that in your phones manage airborne exposures uh remove contact exposures with water remember if it's dry though we're going to brush it off first and then consider activated charcoal for ingestions with activated charcoal we really want that person to we're going to put that activated charcoal in a cup we typically mix it with seven upper sprite to make it more drinkable you put a lid on the cup and you put a straw in the cup and you have them drink through the straw because typically if they saw what they were drinking they probably wouldn't drink it in the first place so we kind of disguise it if you will and have them drink through a straw and then we're going to either a suction it out of their stomach through their nose or we're going to wait for it to pass out their rectum communication documentation holy smokes this is really important now for poison control or the hospital when it comes to those chemicals that are ingested we need to write it document it properly bring that msds sheet to the hospital if you can really in a factories that because of osha they will have msdes sheets on every chemical or every product in their plant so their safety person or their hr person should have an msds sheet available for you or they'll save you i'll fax it to the hospital they'll have it before you get there big thing make sure it's safe for you scene safety is the first thing remove tablets or fragments from the patient's mouth if you can get in there they're unconscious and they still have tablets in their mouth sweep it out suction it out wash or brush the poison from the patient's skin again if it's powder brush it if it's liquid wash it assess the abx abcs oxygen if they inhaled it or they uh the our assist with ventilations treat for shock we're gonna put them on a uh wrap them in a blanket we're gonna put them on high flow oxygen we're gonna transport to the nearest hospital and again it says some ems systems allow them to give activated charcoal very rare it's very rare activated charcoal binds to the pot and the specific toxins and then carried out the body in the stool or it's actually suctioned out also it's contraindicated in patients who have ingested alkalized poisons cyanide ethanol iron lithium methanol acids or solvents a lot of your liquids is where it's really counter indicated if local protocols permit carry a pre-mixed suspension of 50 grams of activated charcoal the dose for an adult or child is one gram per kilogram so we need to know the weight and then we need to know how to calculate pounds to kilograms so you take your weight and you divide it by 2.2 and that comes with how many kilograms you have before you give a patient charcoal you want to get approval from medical control you want to shake the bottle you may need to convince the person to drink it but you don't force them to because it's really horrible looking stuff record the time you administer the activated charcoal and if they refuse the charcoal document the refusal and transport uh the patient for further evaluation side effects of activated charcoal constipation in black stools well duh if it's charcoal it's going to make your stool black if they've ingested a poison that makes them nauseous they might vomit after they took the charcoal so it's going to look black so don't be scared by that have a bag ready for them to puke in and then over a time a person who routinely misuses a substance may need increased amounts of it to achieve the same result so if they use a little bit of heroin to begin with later on they're going to be using more and more of that heroin because they want to get the same effect but they have to use more of that drug a person with an addiction has an overwhelming need to continue using no matter what cost that's the horrible part about addictions and almost any substance anything can be abused the importance of seeing safety and seeing awareness again with drugs holy smokes you have to be highly suspicious uh and and then think about infections maybe the person might have hiv or hepatitis if they're a drug user tuberculosis something uh many calls for service and involve alcohol you're going to be called out to motor vehicle accidents uh maybe welfare checks the cops are already there and again alcohol is another form of a poison or a substance that you could could misuse you could damage the liver uh through binge drinking you can use more and more to get that same effect that's why drinkers drink more and more and more and more because they want to get that initial high or that initial feeling that they had but they have to drink more to get that feeling now alcohol is a depressant okay i don't care what you think it's a depressant it decreases activity and excitement it induces sleep it dulls your awareness slows your reflexes reduces reaction time you might be aggressive you might be the loving drunk you might be the fighter drunk i don't know and alcohol increases the effects of other drugs that you might take i spent years in law enforcement and the one thing that always killed me was when somebody would say to me i drive better with a few beers under my belt there's no way you do don't be so ignorant i drive with a few beer i've drive better with a few more beers under my belt that's crazy if a patient exhibits signs of central nervous system depression we're going to do respiratory support that'd be your your opioids your opiates or we need to bag them because their respiratory system has been depressed and if we don't help them eventually they're going to stop breathing uh they might have frightening hallucinations or the derivative i can't even say the word delirium tremens the dts so they have these hallucinations and pink elephants and that kind of stuff the dts that's the really bad stuff sweating tremors confusion hallucinations even the seizures that's really bad withdrawal from alcohol you might be seeing these in the jails if your ambulance services your local jail or prison opioids and opioids anything that we really use to alleviate pain um coding morphine that's the kind of stuff that we're thinking about and it's really sad that we really do know more about morphine now than we have in years past because it has become one of those drugs that we're seeing a lot more of some common opioids or opiates that's fentanyl heroin hydrocodone hydromorphone morphine methadone all these kind of things codeine is even one so you have to be kind of familiar with the types of opioids that are out there prescription opioid drugs are the most commonly abused drugs in the united states florida is huge it used to be one of the it was the number one state for opioid prescription abuse they become physically dependent on opioids after they've taken they take it for a real true medical emergency and they hurt their back they took some uh coding and then after a while that didn't do it they had to take more and more and more even though their back didn't hurt they were kind of hooked to that then types of depressants that's what they are your tolerance develops quickly that's why people overdose on heroin because they want to they got to use more than they did the last time um often nausea vomiting hypotension yeah yep sure seizures are uncommon but you can see them maybe and they usually appear to be sedated or unconscious or cyanotic with pinpoint pupils they usually have that snoring respiration that's the ones i've encountered naloxone or narcan that reverses the effects of the opioid or the opioid overdose you can give it iv intermuscular muscularly or internasally which is the preferred route ems that's the way we like to administer it because it's quick and easy again if they have agonal respirations or their ethnic we're going to use narcan or naloxone in some areas lay people people that can get this prescription at cvs uh you find out from bystanders if they've given them naloxone this uh the addiction clinic in south bend indiana uh used to give out free doses of narcan and that was they were always out of it [Music] the sedative hypnotic drugs those would be the barbitus the benzodiazepines they may alter your level of consciousness they might be drowsy peaceful appearing or intoxicated usually these are pills or tablets uh they dissolved in water or injected um they get again this tolerance built up um these are things sometimes that creeps are going to drop in a woman's drink and then again they'll have these different types of effects and then treatment is abcs abused inhalants acetone xylene all these different things that i'm not even familiar with found in glues cleaning compounds paint thinners lacquers gasoline uh halo generated hydrocarbons okay things that people huff or they inhale uh i've only seen it a couple times where i had a kid in the basement of a house he poured five gallons of gasoline on the floor of his basement house in the basement of his house and he put a chair down there and just sat there was inhaling fumes oh my god think what could have happened if he started smoking special care with abused these halo generated hydrocarbon solvents they make your heart sensitive uh to their own adrenaline so they're struggling or exerting themselves again don't let them walk on their own because that exerts them even more so use your stretcher to move your patient give them oxygen transport hydrogen sulfide it's a highly toxic colorless flammable gas with a distinctive rotten egg odor that's the odorant that they actually put into this hydrogen sulfide it affects all organs and especially your lungs and central nervous system because you inhale it it's used to commit suicides a lot of times and if you suspect this gas wait for the hazmat team to tell you it's safe because they're going to go into the scene with their self-contained breathing apparatus or scba and they're not going to breathe this material so we want to make sure that we're safe for us not to breathe it as well nausea vomiting loss of consciousness seizure shock coma cardiopulmonary arrest we need to do cpr sometimes once they've been decontaminated now we just basically support their abcs sympathomimetics these are the stimulants that mimic the effects of this sympathetic nervous system cocaine uh crack cocaine um ecstasy i just look at the list methamphetamine is the other big one i always think of speeders and uppers those are the pills that the people like to use but if you think about it even there's another one on here that's not even listed caffeine caffeine does the same effects it's an excited state you have hypertension tachycardia dilated pupils amphetamines methamphetamines that's probably the ones we think of the most or mdma like a date rape drug or a club drug cocaine it's still out there still used all the time crack cocaine is probably the most potent form of cocaine where the the the cut or the uh the contaminants that are mixed with that cocaine are actually cooked out of it so it becomes really more potent and it's the cocaine in its purest form we think about poisonings and overdoses with these things so they have seizures cardiac dysrhythmia stroke hallucinations we don't want to leave them by themselves because we're not sure if they're going to hurt themselves or take off and then provide prompt transport bath salts oh lord you know i sometimes wonder why people do the things they do and again bath salts is another thing that's becoming uh abused a lot uh they produce a euphoria increased mental clarity and sexual arousal so it uses they they snort it or in sulfate the powder nasally so they inject it into their nose nasally and these drugs can last up for 48 hours adverse effects teeth grinding appetite loss muscle twitching lip smacking gastrointestinal paranoia headache elevated heart rate hallucinations so these are the patients that we want to speak calmly to our patient we might think about turning the lights down a little bit lower in the back of the ambulance so it's there's less stimulant not using the the siren or flashing lights kind of stuff and then think about maybe even doing an als intersect with them because of that elevated heart rate marijuana yeah we still talk about that thc is the chemical marijuana that produces the high that's why you don't have it in um the other forms that we get like the the creams and all that kind of stuff anyway producing euphoria relaxation drowsiness impairs short-term memory uh the capacity to do complex thinking and could progress to depression and confusion this is the one drug that most people think is not a big deal but in very high doses they might have hallucinations or become very anxious and paranoid so that's the reason for your ems call reassure them transport them speak calmly to them uh you know the big thing about ems and stuff we try to tell the patient hey we're not the cops we're not here to arrest you for that stuff um so just what did you take and how much that's the things that we think about several states have legalized recreational marijuana um and others are allowing for edibles uh again you think about uh could lead to hyper emesis syndrome or in other words uh lots of vomiting uh that's the biggest thing and especially if in people who um weren't prescribed this legal medicine uh in a kid overdoses or takes grandmas whatever the synthetic marijuana or spice it's the herbal essence or smoking blends that resemble thc and produce a similar high and again it's powerful it ranges from simple euphoria to complete loss of consciousness i mean that's kind of what we're thinking about with this this spice you get them at a lot of times at gas stations hallucinogens some of the stuff on the left commonly abused or lsd peyote or the mushrooms pcp the ketamine is the other one that's coming out a lot now even in ems we use ketamine as a way to intubate you or kill pain so even if paramedics with ambulances will use ketamine they cause hallucinations intensified vision and hearing people say i can hear colors or whatever we generally separate the user from reality and they're not really sure they're having this bad trip when they have hypertension tachycardia anxiety paranoia everything is increased that's what makes them the bad thing [Music] calm unprofessional or excuse me hundreds use a calm professional manner sorry about that be supportive and don't use restraints unless there's really a danger to you or uh or a danger of injury watch them carefully don't leave them unattended i don't know why we would even think that and use als when appropriate have anticholinergic agents have properties that block the parasympathetic nerve so the person is they're described as hot as a hair blind as a bat dry as a bone red is a beat and that is a hatter those are common uh drugs that would do this would be like benadryl uh they've overdosed on ben and drill i've had to even google some of these things like gyms and weed and ammo tryptolene i'm not sure who how they use those how they find them but again anything that would do that some tricyclic antidepressants have that anticholinergic effect and death can be rapid they go from normal to seizure within 30 minutes there's so many things that the the internet is bad for and one of them is how to kill yourself cholinergic agents like nerve gas that's the stuff that i think of all the time with this or the organophosphate insecticides really nerve gas is a an insecticide for people if you will and then the organophosphates are what farmers use to kill bugs in their fields so again remember that dumbles uh the diarrhea urination meiosis bradycardia bronchospasm bronchoria the emesis the lacrimation the seizures salivation sweating um so that's one way to remember the mnemonic of what's there just a fluid and everything in your body is trying to escape sludge is the other one they're sludging the salvation lacrimation urination defecation gastric upset emphasis and muscle twitching excuse me i don't care how will you remember going back either dumbbells or sludging most people know that sludging make sure your patient has been decontaminated so you don't get exposed to it so if they have that the farmers spray on their body we want to make sure that they're decontaminated before they get in the ambulance there's something called an antidote kit the duo don't auto injector it's a auto injector that contains the two medicines one is atropine the other is plaxodrome if i can say right or i always excuse me i was always told atropine and two pam chloride those are the same thing but even if you were in the military you remember these these kits that were first issued during uh iraq and afghanistan so this this antidote or this medication atropine is going to block the response and speed up your heart but really truly one dose of atropine is probably not going to be enough examples of fatally ingested poisons there's a whole list over there why is that important well it's because maybe a child got into grandma's beta blockers for her high blood pressure um aspirin taking too much can be a poison uh there's all kinds of different things maybe the elderly person forgot that they took their medicine and they took two or three doses of it so again it's not always meant for suicide but it could be an accidental overdose contact poison control they're the ones that are going to tell you everything to do aspirin poisoning again it's a lethal condition leads to too too much aspirin could lead to nausea vomiting hyperventilation and ringing in the ears or tinnitus that's interesting isn't it too much aspirin patients with this problem have anxiety confusion tachycardia hyperthermia and again they could have seizures the body is really just shutting down when it gets to the point of having seizures it's been trying to fight this poison but it just gives up overdoses in acetaminophen are common uh some alcohols uh more so than drinking alcohol even you know kids will try things inmates in jail will make their own or tries things um all kinds of things if you're an alcoholic and you can't get real booze what you you drink whatever you can food poisoning is another form of poison we didn't think about there's two main types where the organism itself causes the disease or it produces a toxin that causes the disease common food poisoning let's see which ones are the the listeria the notavirus salmonella shigella the staph uh there's all kinds of different things but you know we always think of like that salmonella bacteria where that produces the effects that's the salmonella cause gi bleeds or excuse me gi symptoms within three days of ingesting that bad food if you will nausea vomiting diarrhea again proper cooking kills bacteria proper cleaning in the kitchen kitchen prevents the contamination a lot of people think oh i ate last night and i got all these symptoms well usually salmonella takes about three days the more common uh would be the staph it's really growing quick to grow and produces toxins in food especially foods that aren't refrigerated and again those start within two to three hours after ingestion so that might be one of the things again improperly cooked or improperly stored food if you eat improperly canned food it could lead to botulism it's one of those really rare ones but it's canned food is where you get botulism blurred vision weakness difficulty speaking and breathing botulism i want to say that that's you'll see that again on exams for sure try not to determine the cause of the acute gi problems but get a history when was the last time you had anything to eat or drink what was it um if a couple of you if you get a number of patients have two patients with the same signs and symptoms what did they eat can we take some of that food with us that they didn't eat some plant poisonings oh my gosh uh mistletoe i didn't know about that one rhubarb uh the castor bean i've heard of that nightshade um there's that jimson wheat or stinkweed um hemlock wild carrots there's all kinds of different things that they're listing there so yeah how do you memorize every plant or poison you don't that's what poison control is there for uh take the plant to the emergency department with you what's emergency department gonna do they're gonna contact poison control so just just know that so uh i'm just looking at those there's all kinds of different things that the nightshade and fox glove and uh the rhododendron and castor bean and mistletoe all these things are common poisons to be absorbed they say i'm thinking well who would eat them or ingest those i'm not sure there's the jimson weed in the upper left death cameras poison ivy we've probably heard of that poison oak you've probably heard of that poke weed rosemary pea or poison sumac some of those are going to be contact poisonings so first question which of the following questions is of least pertinence for the emt to ask for someone who intentionally overdosed on a medicine how much do you weigh how much did you ingest what did you take and why did you take the medicine hopefully you all answered d why we don't care why i mean really truly does that affect how we treat our patient nope it has no effect whatsoever 30 year old male who ingested an unknown substance begins to vomit you should collect the vomitus and bring it to the apply hospital bbm analyze the vomitus and try to identify the poison or suction as oral pharynx for no longer than 30 seconds mmm this is a good one what do you do he he just begins to vomit did you guess a we're gonna remember that we're gonna look at the to see if there's any pill fragments in there and analyze it what a great job that is think about yummy when caring for a patient with a surface contact poisoning it's apparent it's important to remember to a prevent contamination b avoid contaminating yourselves c let the patient remove the poison or d immediately flush dry chemicals with water so they have a surface contact poisoning it's important to remember what [Music] yeah b make sure it's safe for you we want to make sure that i mean they've already been contaminated so we don't do that dry chemicals we want to brush off before we flush and then we're not going to let the hospital remove that we're going to do it ourselves or call the hazmat team most poisonings occur via what route injection ingestion inhalation or absorption most poisonings yep it's b about 80 percent of all poisonings are ingestions they talk about less than 20 for everything else how much activated charcoal should be administered to a 55 pound child who swallowed a bottle of aspirin 12.5 25 2 grams per kilogram or 50 grams oh we need to know how to convert his weight to kilograms so if you take 55 divided by 2.2 he weighs 25 kilograms if that helps you so 25 kilograms how much does he get b one gram per kilogram so we really do have to know how much they weigh and we then need to convert that again it shows you how to convert that you take 55 pounds divided by point two equals twenty five kilos after taking vicodin for two years for chronic pain a fortier woman finds that her usual dose is no longer effective and goes to the doctor for a higher dose this is an example of addiction dependence tolerance or drug abuse tolerance they've built up a time launch for that drug and now they need to take more of that drug to get the same desired effect which of the following effects does drinking alcohol not produce induction of sleep slows responses inappropriate behavior increased sense of awareness yep increased sense of awareness it does not promote and everything else is slowing down everything else is getting sluggish [Music] yeah hypnotic or sleep that's why we always you know crash when they're drinking and that kind of stuff not we not me no not you 21 year old male found unconscious in an alley your initial assessment reveals that his respirations are slow and shallow his pulse is slow and weak further assessment reveals that his pupils are bilaterally constricted which presence presentation sorry is most consistent with an overdose sorry his presentation is most consistent with an overdose of what cocaine opioid stimulant methamphetamine there's only one drug that of those three that we're making things slow down and that's the opioid whether it's some type of heroin or whatever coding morphine fentanyl whatever the pneumonic dumbbells can be used to recall the signs and symptoms of cholinergic drug poisoning the e in dumbbells stands for emesis urethemia echimosis or elevated blood pressure yep emesis vomiting not urethria that's red skin echimosis is bruising and then elevated blood pressure nope and the last one food poisoning is almost always caused by eating food that contains fungi viruses bacteria or protozoa i hope you all said bacteria remember salmonella poisoning and botulism those are probably the two most common and i know for a fact you will see those again in the future fungi that's the molds the the the mushrooms and that stuff viruses are are not considered to be independent living so they're not found in food and protozoa were our single cell organisms we didn't even talk about that but bacteria is correct okay so that was chapter 22.