Chapter 22: Toxicology

Introduction to Toxicology

• Everyday exposure to potential poisons.
• Any substance can be a poison in certain doses (e.g., aspirin can be safe or lethal).
• Acute vs. chronic poisoning:
  • Acute poisoning affects over two million people annually.
  • Chronic poisoning from long-term substance abuse (medications, tobacco, alcohol) is more common.
  • Deaths from acute poisoning are rare due to safety measures (e.g., child-resistant caps) but chronic poisoning deaths are rising.
• Emergency care can prevent death from acute poisoning through airway management and symptomatic care.

Identifying Poisoning

• Toxicology: study of toxic substances.
• Poisons: substances that damage body structures.
• Toxins: poisonous substances from bacteria, animals, or plants affecting cell metabolism.
• Substance abuse often leads to overdose.
• Importance of recognizing poisoning and ensuring personal safety during treatment.

Symptoms and Signs

• Vary according to the poison.
• Can affect pulse, pupils, respiration, and may cause skin irritation.

Routes of Poison Entry

• Inhalation: Move patient to fresh air, provide oxygen, be cautious of toxic gases.
• Absorption/Surface Contact: Remove contaminated clothing, wash skin; hazardous materials may require specialized handling.
• Ingestion: Causes vary with type/amount of poison, importance of preventing aspiration during vomiting.
• Injection: Quick absorption, can be life-threatening; monitor airway and provide oxygen.

Patient Assessment

• Scene safety and use of protective measures.
• Primary assessment focuses on ABCs (Airway, Breathing, Circulation).
• History-taking includes substance details, exposure time, amount ingested, and patient weight.

Emergency Medical Care

• Activated Charcoal: Used to prevent absorption of ingested poisons if protocol permits.
• Naloxone/Narcan: Antidote for opioid overdose.
• General Treatments: Support ABCs, provide oxygen, transport to emergency department.

Specific Poisons

• Alcohol: CNS depressant, can cause hypoglycemia, requires evaluation by a physician.
• Opioids: Risk of respiratory depression, treated with Naloxone.
• Sedative Hypnotic Drugs: Depress CNS, risk of respiratory depression.
• Inhalants: Cause CNS effects, risk of sudden cardiac death.
• Hydrogen Sulfide: Toxic gas, requires hazmat intervention for safety.
• Sympathomimetics: Stimulants like cocaine, risks include seizures, cardiac issues.
• Synthetic Cathinones/Bath Salts: Stimulant with euphoria, risk of severe side effects.
• Marijuana: May lead to psychological effects, potential for cannabinoid hyperemesis syndrome.
• Hallucinogens: Cause altered perceptions, risk of anxiety and paranoia.
• Anticholinergic Agents: Cause hyperthermia, agitation; may mimic other drug overdoses.
• Cholinergic Agents: Overstimulate body functions, risk of excessive secretions.
• Miscellaneous Drugs: Includes cardiac medications, aspirin, and acetaminophen overdoses.

Food Poisoning

• Caused by bacteria or toxins in food.
• Symptoms include gastrointestinal distress.
• Botulism is a severe form, requiring intensive care.

Plant Poisoning

• Many household plants are toxic if ingested.
• Symptoms vary, but airway management and quick transport are key.

This chapter provides a comprehensive overview of how to identify, assess, and treat various types of poisonings, emphasizing the importance of scene safety, symptom recognition, and maintaining vital functions until further medical care is available.