Chapter 22. Toxicology. Introduction. Every day, each of us comes in contact with things that are potentially poisonous. This is not surprising when you consider that almost any substance may be a poison in certain circumstances.
Different doses can turn even a remedy into a poison. Consider a common medication such as aspirin. When taken in recommended doses, it is a safe and effective pain reliever.
analgesic. However, too much aspirin can result in death. According to the National Poison Data System, acute poisoning affects over two million people each year. Chronic poisoning, often caused by the long-term abuse of medications, tobacco, and alcohol, is more common. Fortunately, deaths caused by acute poisoning are fairly rare.
Rates of death as the result of acute poisoning in children have decreased steadily since the late 1960s, when child-resistant caps were introduced for drug bottles and containers. However, deaths caused by chronic poisoning in adults have risen in the past few years, primarily as the result of drug abuse. In this chapter, the term poisoning includes acute and chronic poisonings.
As an emergency medical technician, You must recognize that patients with either type of condition may have a variety of symptoms. Although you cannot stop chronic substance abuse in a patient, you may be able to prevent death caused by the acute effects of a poison, simply by providing airway management, and symptomatic care during transport. This chapter discusses how to identify a patient who has been poisoned or exposed to a toxin, and how to gather clues about the substance. Also described are the different ways in which a poison or toxin is introduced into the body. The chapter then discusses the signs, symptoms, and treatment of specific poisons.
Hazardous materials exposure, food poisoning, and plant poisoning are also discussed. Identifying the patient and the poison. Toxicology is the study of toxic or poisonous substances. A poison is any substance whose chemical action can damage 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 them. Toxins can have acute effects. For example, an injection of heroin may cause respiratory arrest, and chronic effects.
For example, years of substance abuse may lead to a weakened immune system. Substance abuse is the misuse of any substance to produce a desired effect, for example, heroin, intoxication. A common complication of substance abuse is overdose, when a patient takes a toxic or lethal dose of a substance.
Your primary responsibility to the patient who has been poisoned is to recognize that a poisoning has occurred. Your own safety plays a key role here as well. Pay attention to your surroundings.
The where, what. and how the exposure is important keep in mind that very small amounts of some poisons or toxins can cause considerable harm or death never let your guard down and allow yourself to become exposed to the same substance if you have even the slightest suspicion that an ingestion swallowing or exposure to a toxic substance has occurred notify medical control and begin emergency treatment immediately A discussion of issues relating to suicide is presented in Chapter 23, Behavioral Health Emergencies. Symptoms and signs of poisoning or overdose vary according to the specific agent, as shown in Table 22-1. Some poisons cause the pulse to speed up, whereas others cause it to slow down. Some poisons cause the pupils to dilate, whereas others cause the pupils to constrict.
If respiration is depressed or difficult. cyanosis may occur some chemical compounds will irritate or burn the skin or mucous membranes resulting in burning or blistering the presence of such injuries at the patient's mouth strongly suggests the ingestion of a poison such as lie if possible ask the patient the following questions while you obtain the sample history signs and symptoms allergies medications pertinent past medical history Last oral intake. Events leading up to the injury or illness.
What substance did you take? When did you take it, or become exposed to it? How much did you ingest? 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? Be extremely careful in dealing with a child who has ingested a poisonous substance. Although such incidents usually do not lead to death, family members may be distraught, and your calm, professional attitude will help to ease the tension. Remember, however, that a single swallow or single pill of some substances can kill a child. Try to determine the nature of the poison.
Look around the immediate area for objects that may provide clues. An overturned bottle. a needle or syringe, scattered pills, chemicals, the remains of food or drink items, or even an overturned or damaged plant.
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. In addition to the name and concentration of the drug, a pill bottle label may list specific ingredients, the number of pills that were originally in the bottle. the name of the manufacturer and the dose that was prescribed this information can help emergency department physicians determine how much has been ingested and what specific treatment may be required for certain food poisonings a food container that lists the name and location of the restaurant or vendor may help save the life of the patient and possibly other customers if the patient vomits examine the contents for pill fragments where proper personal protective equipment for this activity. Note and document anything unusual that you see.
How poisons enter the body. Emergency care for a patient who has been poisoned may range from reassuring an anxious parent or caregiver to performing cardiopulmonary resuscitation. For these patients, definitive treatment can only be provided at the emergency department, so transport promptly whenever poisoning is involved. Often, you will not administer a specific antidote.
a substance that will counteract the effects of a particular poison because most poisons do not have one depending on local protocols the antidote most commonly available to emergency medical technicians is naloxone Narcan which is used to reverse the effects of an opioid overdose naloxone is discussed later in the chapter if you work in a tiered system advanced life support backup may also be appropriate because these providers can administer additional medications and therapies in general the most important treatment you can perform for a poisoning is to dilute and or physically remove the poisonous agent how you do this depends on how the poison entered the patient's body in the first place the four routes to consider are as follows inhalation absorption surface contact ingestion injection All four roots of poisoning can lead to serious and possibly life-threatening conditions. Take care to treat these patients appropriately and to keep yourself safe from harm. If you are uncertain 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.
Always assess the situation, and determine whether the scene is safe before you approach the patient. Inhaled poisons. Patients who have inhaled poison, including natural gas, sewer gas, certain pesticides, carbon monoxide, and chlorine, should be moved to fresh air immediately.
Depending on how long the patient was exposed, he or she may require supplemental oxygen. During the scene size up, if you suspect the presence of a toxic gas, call for specialized resources such as the Hazardous Materials, Hazmat, team. Never approach a contaminated patient unless you have specialized HESMET training, and are using the appropriate personal protective equipment.
Not all patients exposed to toxic gases will have contaminants on them. It will be necessary to use a self-contained breathing apparatus for protection from poisonous fumes if they are present. If you are not specifically trained in the use of this apparatus or do not have appropriately fit tested equipment available, defer to appropriately trained and equipped personnel.
Some patients may need to be decontaminated by the hazmat team after they're removed from the toxic environment. The patient's clothing should be removed in this process because it may contain trapped gases that can be released, exposing you to the substance. You cannot administer emergency care until this step has been completed, and there is no danger of the poison contaminating you.
Some inhaled poisons, such as carbon monoxide, are colorless and odorless and produce severe hypoxia without damaging or even irritating the lungs others such as chlorine are very irritating to the tissues and cause airway obstruction and pulmonary edema The patient may have the following signs and symptoms, burning eyes, sore throat, cough, chest pain, hoarseness, wheezing, respiratory distress, dizziness, confusion, headache, or stridor in severe cases. The patient may also have seizures or an altered mental status. Most inhaled toxins can be treated by removing the patient from the exposure, and applying oxygen. However, some inhaled agents cause progressive lung damage even after the patient has been removed from direct exposure this damage may not be evident for several hours meanwhile it may take two or three days or more of intensive care to restore normal lung function therefore all patients who have inhaled poison require prompt transport to an emergency department Be prepared to use supplemental oxygen via a non-rebreathing mask and or ventilatory support with a bag mask device, if necessary. Remember that pulse oximetry readings may be inaccurate with some inhaled poisons.
Make sure a suction unit is available in case the patient vomits. Some patients use inhaled poisons to commit suicide. A common method is for the patient to sit inside a vehicle with the engine running in an enclosed garage. The exhaust fumes from the vehicle contain high levels of carbon monoxide that will cause the patient to become unconscious and eventually stop breathing. Absorb and surface contact poisons Poisons that come in contact with the surface of the body can affect the patient in many ways.
Many corrosive substances will damage the skin, mucous membranes, or eyes, causing chemical burns, rashes, or lesions. Acids, alkalis and some petroleum hydrocarbon products are very destructive other substances are absorbed into the bloodstream through the skin and have systemic effects just like medications or drugs taken via the oral or injectable routes other substances such as poison ivy or poison oak may cause an itchy rash without being dangerous to the patient's health it is important therefore to distinguish between contact burns contact absorption signs and symptoms of absorbed poisons include a history of exposure liquid or powder on a patient's skin burns itching irritation redness of the skin in light-skinned people or typical odors of the substance emergency treatment for a typical contact poisoning includes the following two steps one avoid contaminating yourself or others 2. While protecting yourself from exposure, remove the irritating or corrosive substance from the patient as rapidly as possible. Remove all clothing that has been contaminated with poisons or irritating substances. If a dry powder has been spilled, thoroughly brush off the chemical, avoid creating a dust cloud, flush the skin with clean water for 15 to 20 minutes, and then wash the skin with soap and water.
If liquid material has been spilled on a patient, Flood the affected part for 15 to 20 minutes. If the patient has a chemical agent in the eyes, irrigate them quickly and thoroughly. To avoid contaminating the other eye as you irrigate the affected eye, make sure the fluid runs from the bridge of the nose outward.
Initiate this action on the scene, and continue it during transport. Keep in mind that you may have to help the patient keep his or her eyes open. Many chemical burns occur in industrial settings. where safety showers and specific protocols for handling surface burns are available.
If you are called to such a scene, a hazmat team should be available to assist you. Always ensure you, your team members, and the exposed patient are thoroughly decontaminated prior to transport. Failure to do so will result in the risk of contaminating the entire emergency department and staff. After effective decontamination has occurred, Promptly transport to the emergency department for definitive care. Obtain a material safety data sheet, or safety data sheet, from industrial sites, and transport it with the patient.
If it is not immediately available, ask the company to send it to the receiving hospital while you are en route. This will help to identify, and quickly make available specific interventions, and potential antidotes. Chapter 40, Incident Management.
discusses hazardous materials and decontamination in detail. Ingested poisons. According to the American Association of Poison Control Centers, over 80% of all poisonings are by mouth. Ingestion. Ingested poisons include liquids, household cleaners, contaminated food, plants, and, in most cases, drugs.
ingested poisoning is usually accidental in children and except for contaminated food deliberate in adults plant poisonings are common among children who like to explore and often bite the leaves of various bushes or shrubs the signs and symptoms of ingested poisons vary greatly with the type of poison the age of the patient and the time that has passed since the ingestion small All children may respond by crying if the poison is an acid or alkaline. and these types of poisons often cause burns around the mouth gastrointestinal pain may be present in some cases and patients may vomit before or after your arrival if the patient has an altered mental status it is critical that you protect the patient from aspirating if he or she vomits other signs and symptoms depend on the substance involved for example some poisons may cause cardiac dysrhythmias whereas others may cause seizures. It is important to treat these signs and symptoms and notify the poison center and medical control of the patient's condition.
Consider whether there is unabsorbed poison remaining in the gastrointestinal tract, and whether you can safely and effectively prevent its absorption. When the patient has ingested a toxin, some emergency medical service systems allow emergency medical technicians to administer activated charcoal by mouth. Activated charcoal is discussed later in the chapter. Although every poison will result in a specific set of symptoms and signs, always immediately assess the X-airway, breathing, and circulations of every patient who has been poisoned.
Many patients have died as a result of conditions related to the X-airway, breathing, and circulations that might have been managed easily. Be prepared to provide aggressive ventilatory support and cardiopulmonary resuscitation, if necessary, to a patient who has ingested an opioid, a sedative. or a barbiturate, each of which can depress the central nervous system, and slow breathing. Injected poisons.
Exposure by injection includes intravenous drug abuse, and envenomation by insects, arachnids, and reptiles. These injuries are covered in Chapter 21, Endocrine and Hematologic Emergencies, and Chapter 33, Environmental Emergencies, respectively. Injected poisons cannot be diluted or removed from the body in the field because they're usually absorbed quickly into the body or cause intense local tissue destruction. When people become ill from an injected poison, their condition can be life-threatening, and you must act quickly.
Signs and symptoms of poisoning by injection depend on the toxin that was injected. They include weakness, dizziness, fever, chills, slow breathing, and unresponsiveness. or the patient may be easily excited if you suspect that rapid absorption has occurred monitor the patient's airway provide high-flow oxygen for any patient with respiratory distress or signs of hypoxia that is oxygen saturation level of less than 94 percent cyanosis and be alert for nausea and vomiting remove rings watches and bracelets from areas around the injection site if swelling occurs Prompt transport to the emergency department is essential.
Take all containers, bottles, and labels with the patient to the hospital. Patient assessment. Scene size up.
When you have a situation that involves a toxicologic emergency, a well-trained dispatcher can obtain important information pertaining to a poisoning call that will help you anticipate the proper protection needed to ensure your safety. The dispatcher may be able to obtain information pertaining to the mechanism of injury or nature of illness, the number of patients involved, whether additional resources are needed, and whether trauma is involved. If this information has been obtained before your arrival, you must assess the scene nevertheless to ensure your safety, and to determine the accuracy of the dispatcher's information.
Because of the risk of possible cross-contamination by poisons that can be inhaled, absorbed, ingested. and injected you must take appropriate standard precautions as you approach the scene think like a detective and look for clues that might indicate the substance involved ask yourself the following questions is there an unpleasant or odd odor in the room if so is the scene safe this could indicate an inhaled poison are there medication bottles near the patient or at the scene if so Is there medication missing that might indicate an overdose? Are there alcoholic beverage containers present? Are there syringes or other drug paraphernalia on the scene?
Is there a suspicious odor and or drug paraphernalia present that may indicate the presence of an illegal drug laboratory? Drug laboratories can be volatile, so ensure scene safety. The location of the patient may help contribute to identifying a suspected poisoning, and other clues such as empty pill bottles or open bottles of household cleaners near the patient may provide further information to help you determine what happened. Keep a constant eye on the surroundings, and keep an open mind when questioning the patient or bystanders to avoid mistaken conclusions. Primary Assessment To best determine the severity of the patient's condition, first obtain a general impression of the patient, assess his or her level of consciousness, and determine any life threats.
With substance abuse and poisonings, do not assume a conscious, alert, and oriented patient is in stable condition, and has no apparent life threats. The patient may have a harmful or even lethal amount of poison in his or her system that has not had time to produce systemic reactions. A primary assessment that reveals a patient with signs of distress and or altered mental status gives you early confirmation that the poisonous substance is causing systemic reactions. Quickly ensure that the patient has an open airway, and adequate ventilation. If the patient is hypoxic, begin oxygen therapy.
In situations where a patient may have an inhalation injury, typically carbon monoxide and or cyanide poisoning, place the patient on high- flow oxygen regardless of the pulse oximetry reading. If the patient is unresponsive to painful stimuli, consider inserting an airway adjunct to ensure an open airway. Have suction available, these patients are susceptible to vomiting. You may also have to assist a patient's ventilations with a bag mask device because some substances act as depressants on the body's systems.
Once the airway and breathing have been assessed and appropriate interventions performed, Assess the patient's circulatory status. You will find variations in a patient's circulatory status depending on the substance involved. Assess the pulse and skin condition. Although paleness, or a decrease in blood flow, can be difficult to detect in dark-skinned people, it may be observed by examining mucous membranes inside the inner lower eyelid, and capillary refill.
On general observation, the patient may appear ashen or gray. Some poisons are stimulants, and others are depressants. Some poisons will cause vasoconstriction and others vasodilation.
Although bleeding may not be obvious, alterations in consciousness may have contributed to trauma and bleeding. Consider prompt transport for patients with obvious alterations in the X-airway, breathing, and circulations or for patients you have determined have a poor general impression. Some industrial settings may have specific decontamination stations and antidotes available at the site. Remember, everyone who is exposed to the hazardous material must be thoroughly decontaminated by the hazmat team before leaving the scene.
History taking. After you have managed the life threats during the primary assessment, investigate the chief complaint or history of present illness. Obtain the patient's medical history.
In many situations, you can perform this in the ambulance en route to the hospital. If your patient is responsive and can answer questions, begin with an evaluation of the exposure and the signs and symptoms, allergies, medications, pertinent past medical history, last oral intake, events leading up to the illness or injury history. If the patient is unresponsive, attempt to obtain the history from co-workers, bystanders, friends, or family members. Medical identification jewelry and wallet cards may also provide information about the patient's medical history. In these situations, the signs and symptoms, allergies, medications, pertinent past medical history, less oral intake, events leading up to the illness or injury history guides you in what to focus on as you continue to assess the patient's complaints, and the physical examination, and vital signs tell you what is happening to the patient's body.
These three assessments give you direction in the interventions your patient might need. In addition to the signs and symptoms, allergies, medications, pertinent past medical history, last oral intake, events leading up to the illness or injury history, ask the following questions. What is the substance involved?
If you know the substance involved, you will be better able to access the appropriate resource, such as the poison center, to determine lethal doses. Time before adverse effects begin, effects of the substance at toxic levels, and appropriate interventions. When did the patient ingest or become exposed to the substance?
This will let you know if and when the adverse effects will begin. This will also let the emergency physician know what adverse effects can be reversed, and which ones cannot because of the length of time the patient has been exposed to the substance. How much did the patient ingest or what was the level of exposure? With this information, the poison center will be able to inform you whether the patient has had a harmful or lethal dose.
Over what period did the patient take or was the patient exposed to the substance? Did the exposure occur all at once or over minutes or hours? Has the patient or a bystander performed any intervention on the patient?
Has the intervention helped? The patient's or bystander's intervention may cause complications. The emergency physician will need to know this information to be able to adjust interventions accordingly.
How much does the patient weigh? If activated charcoal is indicated and permitted by local protocols. you will need to determine the dose based on the patient's weight. The antidote or neutralizing agent given by the emergency physician may be based on the patient's weight as well. Secondary Assessment In some instances, such as a critically ill patient or a short transport time, you may not have time to conduct a secondary assessment.
Your physical examination should focus on the area of the body involved with the route of exposure. and the particular drug or chemical the patient was exposed to. For example, if you suspect a person has ingested a poison, inspect the mouth for indications of poisoning. Are there burns from caustic chemicals?
Are there plant or pill fragments? If the person's skin came in contact with the poison, is there a rash or burns? How large an area is involved?
If a respiratory exposure occurred, auscultate the lungs. Is there good air movement in and out of the lungs? Do you hear any wheezing or crackles? Learn about the effects of general classes of drugs and chemicals so that you will be familiar with specific and common poisons.
Your priority is to manage the ex-airway, breathing, and circulations during the primary assessment. These interventions take precedence over a thorough physical examination. However, once the ex-airway, breathing, and circulations have been addressed and managed, conducting a thorough physical examination will often provide additional information on the exposure the patient experienced. A general review of all body systems may help to identify systemic problems. Perform this review, at a minimum, on patients with extensive chemical burns or other significant trauma, and on patients who are unresponsive.
A complete set of baseline vital signs is important. Many poisons have no outward indications of the seriousness of the exposure. Alterations in the level of consciousness, pulse, respirations, blood pressure, and skin are more sensitive indicators that something serious is wrong.
Reassessment. The condition of patients exposed to poisons may change suddenly and without warning. Continually reassess the adequacy of the patient's ex-airway, breathing, and circulations. Repeat the vital signs and compare them with the baseline set obtained earlier in your assessment Evaluate the effectiveness of interventions you have provided if your assessment has provided necessary information about the poisonous substance You may be able to anticipate changes in the patient's condition if the patient has consumed a harmful or lethal Dose of a poisonous substance reassess the vital signs at least every five minutes if the patient is in stable condition and there are no life threats reassess every 15 minutes if the poison or the level of exposure for example the number and type of pills taken is unknown careful and frequent reassessment is mandatory the treatment you provide for poison patients depends a great deal on what they were exposed to how they were exposed and other signs and symptoms found in your assessment remember supporting the X airway breathing and circulations is your most important task. Contact your medical control or a poison center to discuss treatment options for particular poisonings.
Manage airborne exposures with oxygen if indicated, remove contact exposures with large amounts of water unless contraindicated, and consider activated charcoal for ingested poisons if permitted by local protocol. Once you have completed your primary assessment, history taking secondary assessment contact medical control to request necessary interventions report to the hospital as much information as you have about the poison or chemical to which the patient was exposed if a material safety data sheet is immediately available in a work setting take it with you to the hospital emergency medical care first ensure scene safety by following standard precautions and performing external decontamination suction tablet or pill fragments from the patient's mouth and wash or brush dry poison from the patient's skin treatment focuses on support assess and maintain the patient's ex-airway breathing and circulations provide oxygen to the patient and assist ventilations if necessary keep the patient warm, treat for shock as necessary, and transport promptly to the nearest appropriate hospital. In certain cases, some emergency medical service systems allow emergency medical technicians to give activated charcoal by mouth. Activated charcoal binds to specific toxins, for example, pills that have been ingested, and prevents their absorption by the body.
The toxins are then carried out of the body in the stool. Activated charcoal is not indicated, nor will it be effective, for patients who have ingested alkali poisons, cyanide, ethanol, iron, lithium, methanol, mineral acids, or organic solvents. If the patient has a decreased level of consciousness, and cannot protect his or her airway, do not give activated charcoal.
If local protocol permits, your ambulance will likely carry plastic bottles of premix suspension each containing up to 50 grams of activated charcoal. Some common trade names for the suspension form are Instachar, Actidose, and Lichychar. The usual dose for an adult or child is one gram of activated charcoal per kilogram of body weight, more if food is present. The usual adult dose is 30 to 100 grams, and the usual pediatric dose is 15 to 30 grams for children younger than age 13 years. Before you give a patient charcoal, obtain approval from medical control.
Consider the amount and type of the toxin, and the patient's condition. In most cases, the activated charcoal should be used within one hour of ingestion. Next, shake the bottle vigorously to mix the suspension. The medication looks like mud, so it is best to cover the outside of the container so that the fluid is not visible and ask the patient to drink it with a straw. Some patients may not tolerate the medication due to its gritty texture.
You might need to convince the patient why this intervention is important, particularly if the patient is a child, but never force the patient. If the patient takes a long time to drink the mixture, you will have to shake the container frequently to keep the medication mixed. Once the patient has finished, discard the container from which the charcoal was administered. Be sure to record the time when you administered the activated charcoal. If the patient refuses the activated charcoal, document the refusal, and your attempts to counsel the patient, and transport the patient for further evaluation.
The adverse effects of ingesting activated charcoal include constipation, and black stools. If the patient has ingested a poison that causes nausea, he or she may vomit after taking activated charcoal, and the dose will have to be repeated. As you reassess the patient, be prepared for vomiting, nausea, and possible airway conditions, specific poisons.
Over time, a person who routinely misuses a substance may need increasing amounts of it to achieve the same result. This is called developing a tolerance to the 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 the dose. This does not happen only with the classic drugs of abuse, such as cocaine or heroin. Almost any substance can be abused, including laxatives, nasal decongestants, vitamins, and food.
You should be familiar with the concepts of tolerance, addiction, and abuse and the differences between the terms. The importance of safety awareness when caring for drug users cannot be overemphasized. known drug users have a fairly high incidence of serious and undiagnosed infections including human immunodeficiency virus and hepatitis these patients when intoxicated may bite spit hit or otherwise injure you causing you to come in contact with their blood and other body fluids always wear appropriate personal protective equipment a calm professional approach can defuse frightening situations But keep your safety. and that of your team uppermost in mind. Expect the unexpected and remember, the drug user, not the drug, can pose the greatest threat.
Alcohol. As a new emergency medical technician, you will notice that many calls for service have a connection to alcohol use. Alcohol can damage the liver, whether thorough chronic overuse or occasional heavy use. Binge drinking. According to the Centers for Disease Control and Prevention, 1 in 10 deaths among working-age adults in the United States can be attributed to excessive alcohol use.
Many people dismiss the dangers of drinking, and do not understand that binge use can be more damaging than chronic use, depending on the frequency of the binging and the surrounding circumstances. Binge drinking is a serious health concern in the United States. In a 2018 study, more than one in four participants admitted binge drinking within the past month.
Alcohol is a powerful central nervous system depressant. It is a sedative, a substance that decreases activity and excitement, and a hypnotic, meaning that it induces sleep. In general, alcohol dulls the sense of awareness, slows reflexes, and reduces reaction time.
It may also cause aggressive and inappropriate behavior and lack of coordination. However, a person who appears intoxicated may have other medical conditions as well. Look for signs of head trauma, mental illness, toxic reactions, or uncontrolled diabetes.
Severe acute alcohol ingestion may cause hypoglycemia, which may contribute to the symptoms. You should assume that all intoxicated patients are experiencing a drug overdose and require a thorough examination by a physician. In most states, patients who are impaired in any way, whether by mental illness, medical condition, or intoxication, cannot legally refuse transport.
Always consult with your supervisor, law enforcement, or medical control in these situations. Chapter 23, Behavioral Health Emergencies covers this topic in more detail alcohol increases the effects of many drugs and is commonly taken with other substances over-the-counter drugs including antihistamines and diet medications can cause serious complications when combined with alcohol if a patient exhibits signs of serious central nervous system depression provide respiratory support this may be difficult however because depression of the respiratory system can also cause emesis or vomiting the vomiting may be forceful or even bloody hematemesis because large amounts of alcohol irritate the stomach Internal bleeding should also be considered if the patient appears to be in shock hypoperfusion because blood might not clot effectively in a patient who has a prolonged history of alcohol abuse a patient in alcohol withdrawal may experience frightening hallucinations or delirium tremens. Approximately one to seven days after a person stops drinking or when alcohol consumption levels are decreased suddenly, delirium tremens may develop.
Alcoholic hallucinations come and go. A patient with an otherwise clear mental state may see fantastic shapes or figures or hear odd voices. Such auditory and visual hallucinations often precede delirium tremens, which are a more severe complication Patients may experience one or more of the following signs and symptoms. Agitation and restlessness, fever, sweating, tremors, confusion and or disorientation, delusions and or hallucinations, seizures.
Provide prompt transport after you have completed your assessment, and given necessary care. A person who is experiencing hallucinations or delirium tremens is extremely ill. should seizures develop treat them as you would any other seizure do not restrain the patient although you must protect him or her from self-injury if the patient has difficulty breathing provide supplemental oxygen and watch carefully for vomiting have suction ready hypovolemia may develop because of sweating fluid loss insufficient fluid intake or vomiting associated with delirium tremens if you see signs of hypovolemic shock clear the airway and turn the patient's head to one side to minimize the chance of aspiration during transport these patients may not respond appropriately to suggestions or conversation they are often confused and frightened therefore use a calm and relaxed approach reassure the patient and provide emotional support opiates and opioids a narcotic is a drug that produces sleep or altered mental consciousness An opioid is a type of narcotic medication used to relieve pain. An opiate is a subset of the opioid family, and refers to natural, non-synthetic opioids.
Opioids are named for the opium in poppy seeds, from which the opiate's codeine and morphine are derived. According to the National Institute on Drug Abuse, prescription opioid drugs are among the most commonly abused drugs in the United States. Some people become physically dependent on opioids after taking an appropriate medical prescription.
These drugs include several synthetic, laboratory-manufactured opioids, such as hydromorphone, oxycodone, hydrocodone, and methadone. According to National Institute on Drug Abuse, There were over 46,000 deaths in 2018 from opioid overdoses. These agents are central nervous system depressants, and can cause severe respiratory depression.
However, with intravenous administration, they produce a characteristic high or kick. Tolerance develops rapidly, so some users may require massive doses to experience the same high. In general, emergency medical conditions related to opioids are caused by respiratory depression including a decreased volume of inspired air and decreased respirations this can lead to respiratory and then cardiac arrest if not treated promptly these drugs often cause nausea and vomiting and may lead to hypotension although seizures are uncommon they can occur and an overdose can result in the patient entering a comatose condition Patients typically appear sedated or unconscious and exhibit cyanosis with pinpoint pupils. Whereas all of these signs and symptoms may be present with other drugs, the pinpoint pupils is a classic sign of opiate intoxication. Naloxone, or Narcan, is an antidote that reverses the effects of opiate or opioid overdose.
This medication can be given intravenously, intramuscularly, or intranasally. Ideally, Naloxone is administered intravenously. In many instances, however, intravenous access is difficult to obtain in the chronic user of illicit intravenous drugs such as heroin.
These patients have venous scarring, called track marks, from repeated use of needles on peripheral veins. Therefore, the intranasal route is becoming a preferred alternative route for the administration of naloxone. it is safer than giving an intramuscular injection because a needle is not required to administer the medication emergency medical technicians are permitted to administer pre-filled naloxone by the intramuscular route or by the intranasal route in which the antidote is atomized through the nares onto the nasal mucosa be aware that this drug can cause harm this medication should only be used when the patient has agonal respirations or apnea place an oropharyngeal oral or nasopharyngeal airway and ventilate the patient using a bag mask device prior to administering naloxone.
Adequate ventilation while you prepare to administer naloxone decreases the risk of permanent brain damage related to hypoxia. Watch the patient closely, as the level of consciousness rises, the patient will no longer tolerate the oropharyngeal airway, and you will have to remove it to prevent aspiration. in some areas.
Lay people are permitted to administer naloxone. Be aware that it may have been administered prior to your arrival. Find out from bystanders what has occurred, and who was given naloxone.
When a patient goes into cardiac arrest, follow the algorithm shown in figure 22-9, including administration of naloxone if it is available. However, providing bag-masked ventilations is a critical treatment for these patients as well. Whether or not naloxone is available, provide ventilations and rapid transport. Sedative hypnotic drugs. Barbiturates and benzodiazepines have been a part of legitimate medicine for a long time.
They are easy to obtain, and relatively cheap. People sometimes solicit prescriptions from several physicians for the same hypnotics or a variety of sedative hypnotics. These drugs are central nervous system depressants, and alter the level of consciousness.
with effects similar to those of alcohol so that the patient may appear drowsy, peaceful, or intoxicated. By themselves, these drugs do not relieve pain, nor do they produce a specific high, although users often take alcohol or an opioid at the same time to boost their effects. In general, these agents are taken by mouth. Occasionally, however, contents of capsules are suspended or dissolved in water. and injected to produce a sudden state of ease and contentment.
Use of intravenous sedative hypnotic drugs quickly induces tolerance, so the person requires increasingly larger doses. You are less likely to be called to treat an acute overdose in someone who chronically abuses these drugs. However, you may be called to a scene of an attempted suicide in which the patient has taken large quantities of these drugs.
In these situations, patients will often have marked respiratory depression, and may be in a coma. Sedative hypnotic drugs such as chloral hydrate may also be given to people as a knockout drink, or Mickey Finn, to incapacitate them without their knowledge. Date rape or club drugs such as flunitrazepam, rohypnol or roofies, and ketamine, Keteler or Special K, are often colorless, tasteless, and odorless. they cause an unwary person to become sedated and even unconscious which may facilitate sexual assault or rape the person later awakens confused and unable to remember what happened chapter 24 gynecologic emergencies discusses this topic in more detail in general your treatment of patients who have overdosed with sedative hypnotics and have respiratory depression is to ensure the airway is patent Assist ventilations and give supplemental oxygen when appropriate.
Provide prompt transport and closely monitor the patient's mental status. You may attempt to stimulate the person by speaking loudly or gently shaking him or her. Remember to watch for vomiting.
As multi-drug use becomes more common, you may find it increasingly difficult to determine what agent or agent's patients have taken. Your best approach is to treat any obvious injuries or illnesses. keeping in mind that drug use may complicate the picture and make for life support necessary focus on the x a b c's especially the possibility of airway problems relaxation of the tongue causing obstruction vomiting respiratory depression and in severe cases cardiac arrest abused inhalants many abuse inhalants produce several of the same central nervous system effects as do other sedative hypnotics.
but these agents are inhaled instead of ingested or injected. This method of abuse is known as huffing. Some of the more common agents include acetone, toluene, xylene, and hexane, which are found in glues, cleaning compounds, paint thinners, and lacquers. Similarly, gasoline and various halogenated hydrocarbons, such as freon or difluoroethane, used as propellants in aerosol sprays such as compressed air to dust off electronics. are also abused as inhalants none of these inhalants are medications rather these substances briefly displace oxygen in the brain and cause a rush of euphoria because these are inexpensive products that can be bought in hardware stores they are commonly abused by teenagers and curious adults seeking an alcohol like high the effective dose and the lethal dose are very close making these extremely dangerous drugs long-term abuse can lead to permanent brain damage take special care in dealing with the patient who may have used inhalants affects have inhalants range from mild drowsiness to coma but unlike most other sedative hypnotics these agents often cause seizures the lack of oxygen to the brain may cause a loss of brain function also halogenated hydrocarbon solvents can make the heart hypersensitive to the patient's own adrenaline putting the patient at high risk for sudden cardiac death because of ventricular fibrillation even the action of walking may release enough adrenaline to cause a fatal ventricular dysrhythmia you must try to keep such patients from struggling with you or exerting themselves give supplemental oxygen for patients with respiratory distress or signs of hypoxia and use a stretcher to move the patient prompt transport to the hospital is essential monitor vital signs and root.
Hydrogen sulfide. Hydrogen sulfide is a highly toxic, colorless, and flammable gas with a distinctive rotten egg odor. Poisoning by hydrogen sulfide usually occurs by inhalation.
Hydrogen sulfide affects all organs, but it has the most impact on the lungs and central nervous system. Hydrogen sulfide occurs naturally in sewers, swamps, volcanoes, and crude petroleum. Hydrogen sulfide poisoning is also a method used to commit suicide, referred to as chemical or detergent suicide.
According to the Chemical Hazards Emergency Medical Management Database, this method of self-inflicted exposure to toxic gas originated in Japan and reached the United States via the Internet. The patient may obtain a warning sign to place near the area of the suicide, such as an enclosed vehicle, to warn responders of the deadly gas. If you approach an enclosed vehicle with an unconscious patient inside, be alert for warning signs, as well as containers, buckets, or pots. Remember, do not enter a scene where a toxic gas may be present. Be aware of your surroundings as you approach, and if you suspect the presence of a toxic gas, wait for a hazmat team to tell you the scene is safe.
Workers in industrial settings may experience low-level exposure to hydrogen sulfide over a long period of time, leading to eye, nose, and throat irritation, as well as headaches and bronchitis. Chronic exposure to this gas may cause an inability to smell the gas. When patients are exposed to high concentrations of the gas, they will experience nausea and vomiting, confusion, dyspnea, and a loss of consciousness.
Seizures, shock, coma, and cardiopulmonary arrest may also result. There is no antidote for hydrogen sulfide poisoning. Therefore, a hazmat team must quickly remove the patient from the contaminated area.
Once the patient has been decontaminated, management is largely supportive. monitor and assist the patient's respiratory and cardiovascular functions and provide rapid transport sympathomimetics sympathomimetics are central nervous system stimulants that mimic the effects of the sympathetic fight-or-flight nervous system these stimulants frequently cause hypertension tachycardia and dilated pupils a stimulant is an agent that produces an excited state examples include amphetamine and methamphetamine also called meth or ice, which are commonly taken by mouth or smoked. They are also injected by drug abusers in many cases.
Sympathomimetic drugs are typically taken to make the user feel good, improve task performance, suppress appetite, or prevent sleepiness. They may also produce irritability, anxiety, fear, lack of concentration, or seizures. Paranoia and delusions are common symptoms of sympathomimetic abuse.
Other examples include federman hydrochloride, an appetite suppressant, and amphetamine sulfate, benzadrine, taken for weight control, short-term, narcolepsy, and chronic fatigue syndrome. Caffeine and phenylpropanolamine, a nasal decongestant, are mild sympathomimetics. So-called designer drugs such as 3,4-methylenedioxamethamphetamine, known as Ecstasy or MOLI are also frequently abused in the United States.
Sympathomimetic drugs are known by various street names that change often. Cocaine, also called crystal, snow, freebase, rock, gold dust, blow, and lady, is one of the most addictive substances known. It may be taken several different ways. Classically, it is inhaled into the nose, and absorbed through the nasal mucosa, damaging tissue, causing nosebleeds, and ultimately destroying the nasal septum.
it can also be injected intravenously or subcutaneously skin popping cocaine can be absorbed through all mucus membranes and even across the skin in any form the immediate effects have a given dose including excitement and euphoria last less than one hour another method of abusing cocaine is by smoking it crack is pure cocaine it melts at 93 degrees Fahrenheit 33.9 degrees Celsius vaporizes at a slightly higher temperature therefore crack is easily smoked in this form it reaches the capillary network of the lungs and can be absorbed into the body in seconds the immediate outflow of blood from the heart speeds the drug to the brain so its effect is felt at once smoked crack produces the most rapid means of absorption and therefore the most potent effect Acute cocaine overdose is a genuine emergency because patients are at high risk for seizures, cardiac dysrhythmias, and stroke. You may see blood pressure measurements as high as 250 per 150 millimeters of mercury. Chronic cocaine abuse may cause hallucinations.
Patients with cocaine bugs think that bugs are crawling out of their skin. Be aware that patients who have been poisoned by a sympathomimetic may be paranoid. putting you and other health care providers in danger. Law enforcement officers should be at the scene to restrain the patient, if necessary.
Do not leave the patient unattended and unmonitored during transport. All of these patients need prompt transport to the emergency department. Give supplemental oxygen if necessary and be ready to provide suctioning. If the patient is already having a seizure, protect him or her against self-injury. Synthetic cathinones, bath salts.
Bath salts, or synthetic cathinones, are an emerging class of drugs similar to methylene dioxmethamphetamine. The drug commonly includes the chemical methylene dioxapyr valerone. Bath salts should not be confused with products such as Epsom salt, magnesium sulfate, although selling it under this umbrella label has allowed its manufacturers and users to escape the legal restrictions imposed on illicit drugs. Brand names include Ivory Wave and Cloud 9. Many states are working to make it illegal to manufacture or possess this drug. Bath salts produce euphoria.
increased mental clarity and sexual arousal most users have this drug snort or insufflate the powder nasally the effects reportedly last as long as 48 hours adverse effects include teeth grinding appetite loss muscle twitching lip smacking confusion gastrointestinal conditions paranoia headache elevated heart rate and hallucinations keep the patient calm and transport Consider advanced life support assistance some of these patients may require chemical restraint to facilitate safe transport Marijuana the flowering hemp plant cannabis sativa called marijuana is abused throughout the world According to the Pew Research Center almost one-half 49% of Americans say they have tried marijuana tetrahydrocannabinol or THC is the chemical in the marijuana plant that produces its high inhaling marijuana smoke from a cigarette or pipe produces euphoria relaxation and drowsiness it also impairs short-term memory and the capacity to do complex thinking and work in some people the euphoria progresses to depression and confusion an altered perception of time is common and anxiety and panic can occur with very high doses. some patients may experience hallucinations or become very anxious or paranoid in these cases keep the patient come and provide transport however be aware that marijuana may be used as a vehicle to get other drugs into the body for example it may be laced with crack fentanyl or fencyclidine several states have legalized the recreational use of marijuana and many others allow for the medical use of marijuana and products that contain tetrahydrocannabinol. As the move toward legalization continues, and as people become more aware of the health risks associated with smoking, delivery methods have evolved.
Many medical users opt against smoking marijuana, and instead obtain tetrahydrocannabinol in the form of edibles or baked goods, candies, and other food additives that have been infused with marijuana. These edibles are attractive to children. and have led to an increase in emergency visits related to tetrahydrocannabinol ingestion in children.
The ingestion of marijuana can also lead to cannabinoid hyperemesis syndrome, characterized by chronic marijuana use, and extreme nausea and vomiting that is relieved only by a hot shower or bath. Bathing can become compulsive in these patients. The definitive treatment for this condition is to stop using marijuana, however. These users often believe that more marijuana will help the nausea, and continue to consume it.
Synthetic marijuana or spice refers to a variety of herbal incense or smoking blends that resemble tetrahydrocannabinol and produce a similar high. Synthetic marijuana is often marketed as a safe alternative to that drug under brand names such as K2 and Skunk. However, according to National Institute on Drug Abuse, The chemicals commonly found in spice products have no medical benefit, and have a high potential for abuse. Powerful and unpredictable effects may result, ranging from simple euphoria to complete loss of consciousness.
Hallucinogens A hallucinogen alters a person's sensory perceptions. The classic hallucinogen is lysergic acid diethylamide. of another hallucinogen, phencyclidine, or angel dust. is relatively uncommon among young adults. Thencyclidine is a dissociative anesthetic that is easily synthesized, and highly potent.
Its effectiveness by oral, nasal, pulmonary, and intravenous routes makes it easy to add to other street drugs. It is dangerous because it causes severe behavioral changes in which people often inflict injury on themselves. All these agents cause visual hallucinations, intensify vision and hearing.
and generally separate the user from reality. The user, of course, expects that the altered sensory state will be pleasurable. Often, however, it can be terrifying.
At some point, you are bound to encounter patients who are having a bad trip. They will usually have hypertension, tachycardia, anxiety, and paranoia. Many hallucinogens have sympathomimetic properties. Your care for a patient who is having a bad reaction to a hallucinogenic agent is the same as that for a patient who has taken a sympathomimetic.
Use a calm, professional manner, and provide emotional support. Do not use restraints unless you or the patient is in danger of injury. Follow the guidelines specified.
by local authorities these patients may suddenly experience hallucinations or odd perceptions so watch them carefully throughout transport never leave a patient who has taken a hallucinogen unattended and unmonitored request advanced life support assistance when appropriate anticholinergic agents anticholinergic agents are medications that block the parasympathetic nerves The classic picture of a person who has taken too much of an anticholinergic medication is hot as a hair, blind as a bat, dry as a bone, red as a beet, and mad as a hatter. In other words, the patient will exhibit hyperthermia, dilated pupils, dry skin and mucous membranes, reddened skin, and agitation or delirium. Common drugs with a significant anticholinergic effect include atropine, antihistamines such as diphenhydramine, banadryl.
detouristramonium, gymsin weed, and certain tricyclic antidepressants such as amitriptyline, elaval. With the exception of gymsin weed, these medications usually are not abused drugs but may be taken as an intentional overdose. It is often difficult to distinguish between an anticholinergic overdose and a sympathomimetic overdose.
Both groups of patients may be agitated and have tachycardia and dilated pupils. In addition to its anticholinergic effects, a tricyclic antidepressant overdose may cause more serious and life-threatening effects because the medication may block the electrical conduction system in the heart, leading to lethal cardiac dysrhythmias. Patients with acute tricyclic antidepressant overdose must be transported immediately to the emergency department.
They may appear normal, but seizure and death can occur within 30 minutes. The seizures and cardiac dysrhythmia is caused by a severe tricyclic antidepressant overdose are best treated in the hospital. If you work in a tiered system, consider calling for advanced life support backup when you are en route to the scene.
Cholinergic agents. Cholinergic agents are medications that overstimulate the normal body functions controlled by the parasympathetic nervous system. These agents have been used for chemical warfare.
such as during the sarin gas attack on the Tokyo subway system in 1995. These agents also occur in organophosphate insecticides, which are commonly used for lawn and garden care. A patient who has been poisoned by a cholinergic agent will exhibit excessive salivation or drooling, mucous membrane oversecretion, resulting in a runny nose, rhinorrhea, excessive urination, excessive tearing of the eyes, uncontrolled diarrhea. and an abnormal heart rate the signs and symptoms of cholinergic drug poisoning are easy to remember using the mnemonic dumbbells d diarrhea you urination m miosis constriction of the pupils muscle weakness be bradycardia bronchospasm bronchorrhea discharge of mucus from the lungs he emesis vomiting l acclimation excessive tearing s seizures Salivation, sweating. Alternatively, you can use the mnemonic sludgem.
S. Salivation, sweating. L.
Lacrimation, excessive tearing. U. Urination.
D. Defecation, drooling, diarrhea. G. Gastric upset and cramps.
E. Emesis, vomiting. M. Muscle twitching or meiosis, pinpoint pupils. Patients who have been poisoned will have excessive body secretions.
In addition, patients may have bradycardia. The most important consideration in caring for a patient who has been exposed to a cholinergic agent is to avoid exposure yourself, because these agents may cling to a patient's clothing and skin. Decontamination will take priority over prompt transport to the emergency department. In many jurisdictions, the HESMAD team will provide decontamination, and contain the exposure chemical to care for the exposed patient. Hospital staff or paramedics can use the anticholinergic drug at routine to draw up the patient's secretions, followed by the use of prolidoxime to reverse the nerve agent's effect on the patient's nervous system.
In the meantime, your priorities after decontamination are to decrease the secretions in the mouth and trachea that threaten to suffocate the patient, and provide airway support. The military has developed antidotes to nerve gas agents that responders can self-administer if the agents are available. In some areas across the country, these kits are issued to emergency medical providers depending on local protocols. The most common kit is the Duodote auto-injector. The Antidote Treatment Nerve Agent Auto-Injector is the military form of the Duodote Auto-Injector.
The Duodote Auto-Injector is a single auto-injector containing 2 mg of atropine and 600 mg of prolidoxine. If a known exposure to nerve agents or organophosphates with manifestation of signs and symptoms has occurred, use the antidote kit only on yourself. If your service carries these antidote kits, you should receive training on their proper use prior to administering them miscellaneous drugs accidental or intentional overdose with cardiac medications has become common because there are so many patients who have these medications prescribed for them for example children may ingest these medications at their grandparents house thinking they're candy another common scenario is older patients who have forgotten they have already taken their medication and take a second dose. occasionally people wanting to commit suicide will take an overdose of cardiac medications if that is all they have available the signs and symptoms of cardiac medication overdose depend on the medication ingested these drugs may cause bleeding cardiac dysrhythmias unconsciousness and even cardiac arrest most to these medications are powerful so contact the poison center as soon as possible depending on local protocol. you may be ordered to administer activated charcoal but check with the poison center first aspirin poisoning is a potentially lethal condition ingesting too many aspirin tablets acutely or chronically is an emergency that may result in nausea vomiting hyperventilation and ringing in the ears patients with this condition frequently have anxiety confusion that keep me a and hyperthermia and are in danger of having seizures.
rapidly transport these patients to the hospital when consumed in excess acetaminophen becomes toxic overdosing with acetaminophen and combination medications containing acetaminophen is also common according to the United States Food and Drug Administration acetaminophen is among the top 25 substances with the largest number of fatalities due to poisoning it is essential to determine what medications the patient takes or has taken including over-the-counter medications. Acetaminophen overdose, unintentional or intentional, must be treated promptly and aggressively. Accidental acetaminophen overdose is as serious as intentional overdose. In fact, its effects can be worse because the patient is unaware of the continuous exposure to the toxin.
For example, massive liver failure may not be apparent for a full week. In addition, Patients may not provide the information necessary for a correct diagnosis. For this reason, gathering information at the scene is very important.
By finding an empty acetaminophen bottle, you may save a patient's life. If a specific antidote is given early enough, before liver failure occurs, liver damage may be prevented. Some alcohols, including methyl alcohol and ethylene glycol, are even more toxic than ethyl alcohol. drinking alcohol methyl alcohol is found in dry gas products and stove kits sternal ethylene glycol is found in some antifreeze products both cause a feeling of intoxication left untreated both will also cause severe tachypnea blindness methyl alcohol renal failure ethylene glycol and eventually death even ethyl alcohol can stop a patient's breathing if taken in too high a dose or too fast particularly in children. Although methyl alcohol or ethylene glycol may be used as a substitute by a chronic abuser of alcohol who is unable to obtain ethyl alcohol, they are more often taken by someone attempting suicide.
In either case, prompt transport to the emergency department is essential. Table 22-6 lists the most common fatally ingested poisons. Food poisoning.
The term Tomein poisoning was coined in 1870 to indicate poisoning by a class of chemicals found in rotting food. It is still used currently in many news accounts of food poisoning. Food poisoning is almost always caused by eating food that is contaminated by bacteria.
The food may appear normal, with little or no decay or odor to suggest danger. There are two main types of food poisoning. In one, the organism itself causes disease, in the other, the organism produces toxins that cause disease.
One organism that produces direct effects of food poisoning is the Salmonella bacterium. Salmonellosis is a condition characterized by severe gastrointestinal symptoms within 72 hours of ingestion, including nausea, vomiting, abdominal pain, and diarrhea. In addition, patients with salmonellosis may be systemically ill with fever, and generalized weakness. Some people are carriers of certain bacteria, although they may not become ill themselves, they may transmit diseases, particularly if they work in the food services industry.
Usually, proper cooking kills bacteria, and proper cleanliness in the kitchen prevents the contamination of uncooked foods. The more common cause of food poisoning is the ingestion of powerful toxins produced by bacteria, often in leftovers. The bacterium staphylococcus, a common culprit, is quick to grow and produce toxins in foods that have been prepared in advance, and kept too long, even in the refrigerator.
Foods left unrefrigerated are a common vehicle for the development of staphylococcal toxins. Usually, staphylococcal food poisoning results in sudden gastrointestinal symptoms, including nausea, vomiting, and diarrhea. Although time frames may vary from person to person, these symptoms usually start within 2 to 3 hours after ingestion or as long as 8 to 12 hours after ingestion.
The most severe form of toxin ingestion is botulism. This often fatal disease usually results from eating improperly canned food, in which the spores of Clostridium bacteria have grown and produced a toxin. The symptoms of Botulism are neurologic, blurring of vision, weakness, and difficulty in speaking and breathing.
Botulism can also cause muscle paralysis, and is typically fatal when it reaches the muscles of respiration. Symptoms of botulism may develop as long as four days after ingestion or as early as the first 24 hours. In general, do not try to determine the specific cause of acute gastrointestinal conditions.
After all, severe vomiting may be a sign of food poisoning, a bowel obstruction requiring surgery, or poisoning by substances such as copper, arsenic, zinc, cadmium, scombrotoxin, fish poison, or cliticide or inoside mushrooms. Instead, gather as much history as possible from the patient, and transport him or her promptly to the hospital. When two or more people in one group have the same illness, take along some of the suspected food to the hospital.
In advanced cases of botulism, you may have to assist ventilation, and give basic life support. Plant poisoning. According to the National Poison Data System, tens of thousands of cases of poisoning from plants occur each year.
some severe many household plants are poisonous if ingested children have been known to nibble on the leaves some poisonous plants cause local irritation of the skin others can affect the circulatory system the gastrointestinal tract or the central nervous system it is impossible for you to memorize every plant and poison let alone their effects you can and should do the following 1 assess the patient's airway vital signs to notify the regional poison center for assistance in identifying the plant 3 take the plant to the emergency department for provide prompt transport irritation of the skin and or mucous membranes is a problem with the common houseplant called Diefenbachia which resembles elephant ears when chewed a single leaf may irritate the lining of the upper airway enough to cause difficulty swallowing breathing and speaking for this reason defund Bakia has been called dumb cane in rare circumstances the airway may be completely obstructed emergency medical treatment of defund Bakia poisoning includes maintaining an open airway giving oxygen when necessary and transporting the patient promptly to the hospital for respiratory support Assess the patient for airway difficulties throughout transport. If necessary, provide positive pressure ventilation.