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Toxicology EMT
NREMT Preparation
| Term | Definition |
|---|---|
| Poisonings occur in both adult and pediatric populations. | Accidental pediatric poisonings are more common, but less often fatal. Adult poisonings can be accidental or intentional. They are less frequent, but more often fatal. |
| Addiction: | a physical or psychological need to continue misusing a drug or toxin |
| Tolerance: | the need to take increasing amounts of the drug or toxin to achieve the desired effects |
| Routes of exposure: | ingestion, inhalation, injection, and absorption |
| INGESTED TOXINS | Ingestion is the most common route of exposure. Examples of ingested poisons include drugs, plants, and household chemicals. Ingestion of poisons by children is usually accidental, but most incidences involving adults are intentional |
| Prescription and Over-the-Counter Medications | Accidental overdose is common, especially in pediatric and geriatric patients. Common accidental overdose medications include cardiac medications, psychiatric medications, and acetaminophen. Prescription narcotics are commonly abused. |
| Other Commonly Ingested Toxins | Food. The incidence of food poisonings in the United States has been increasing. Plants. Many plants are poisonous. Examples include oleander, foxglove, castor beans, jasmine, elderberry, mistletoe, nightshade, jimson weed, among many others. |
| Signs and Symptoms. These vary based on what is ingested, | burning to the mouth and airway with acids or alkalis stomach pain, cramps, nausea, vomiting altered level of consciousness (LOC) altered vital signs, seizures |
| Sedatives, Narcotics, Barbiturates | Sedatives, narcotics, and barbiturates are commonly abused drugs. All three can cause a decreased LOC and respiratory depression. Many narcotics also cause pupillary constriction. |
| Specific Interventions for Ingested Toxins | Consider activated charcoal per medical direction. |
| Specific Interventions for Ingested Toxins | Consider contacting medical direction or a Poison Control Center (1-800-222-1222, U.S.) for information about medications you are not familiar with. |
| INHALATION | Examples of inhaled poisons include various chemicals, pesticides, carbon monoxide, and natural gas. |
| Signs and Symptoms | The onset of symptoms may be rapid or delayed. Signs and symptoms may include dyspnea, coughing, dizziness, headache, and abnormal lung sounds. |
| Specific Interventions for Inhaled Toxins | Make sure the scene is safe. Be alert for multiple victims. Administer high-flow oxygen, and monitor lung sounds and respiratory status carefully. |
| INJECTION | It is difficult to diminish, dilute, or inhibit the effects of injected toxins. Most injected poisonings are due to drug abuse. . Onset of effects from injected drugs is typically rapid and can be long-lasting. |
| INJECTION | Be alert for needles. Commonly injected toxins include narcotics (e.g., morphine, heroin) and stimulants (e.g., cocaine, amphetamines). |
| Signs and symptoms of injected stimulants include the following: | Mood elevation, euphoria Restlessness, excitability Tachycardia, rebound depression Can lead to seizures, heart attack, stroke, death |
| Signs and symptoms of injected narcotics include the following: | Decreased level of consciousness, respiratory depression Possible pupillary constriction Can lead to respiratory arrest, seizures, coma, and death |
| ABSORPTION | Examples of absorbed poisons include pesticides, various acids and alkalis, and petroleum-based products. |
| Signs and symptoms | symptoms include burns to the skin, rash or blisters, itching or burning. |
| Specific Interventions for Absorbed Toxins | Decontaminate patient appropriately before initiating care or transport. Most chemicals on the skin or in the eyes should be irrigated with water continuously for about 20 minutes. |
| Specific Interventions for Absorbed Toxins | When irrigating the eyes, be sure not to irrigate toxin into unaffected eye. Some (not many) chemicals react with water. Consult Emergency Response Guidebook, fire department personnel, hazardous materials team, or medical direction if unsure. |
| ASSESSMENT AND MANAGEMENT | Avoid exposure to toxin; remove patient from the source of the toxin if applicable and safe to do so. Decontaminate patient if needed and safe to do so, or request additional resources. Consider activated charcoal for recently ingested poisons per local protocol and with medical direction approval. |
| Alcohol | Alcohol is the most widely abused drug in the United States. Most long-term alcoholics will develop hepatitis. |
| Alcohol | Alcohol is a central nervous system (CNS) depressant and a sedative (calms, tranquilizes) hypnotic (sleep inducing). Ingestion of alcohol increases risk of vomiting. Alcohol withdrawal may cause delirium tremens (DTs). Restless, irritable, agitated Hallucinations, tremors, or seizures |
| Narcotics | Narcotics are widely abused. They are typically ingested or injected. Narcotics, or opioids, include morphine, codeine, heroin, oxycodone, and many more. |
| Narcotics | Narcotics are CNS depressants that can cause coma and severe respiratory depression. Most ALS providers are able to administer Narcan (naloxone), which rapidly reverses the CNS effects of narcotics. |
| Sedative Hypnotic Drugs | Sedative hypnotics are CNS depressants. Sedatives have a calming effect, and hypnotics induce sleep. Sedative hypnotics are usually taken orally but can be injected. |
| Sedative Hypnotic Drugs | Barbiturates such as Amy tal, Seconal, and Luminal are sedative hypnotics. Benzodiazepines such as Valium, Xanax, and Rohypnol are sedative hypnotics. |
| Inhalants | Abused inhalants may include acetones, glues, cleaning chemicals, paints, hydrocarbons, aerosols, and propellants. These chemicals are inhaled to achieve sedative hypnotic effects. |
| Inhalants | The difference between an effective dose and a lethal dose is very narrow. Brain damage and/or cardiac arrest due to abuse is common. Prescription and over-the-counter bronchodilators are also abused. They are taken for stimulant effects or perceived advantage in competitive sports. |
| Stimulants | Stimulants include caffeine, cocaine, amphetamines, methamphetamines, among others. They are taken for stimulant and euphoric effects. They can be taken by any route and are commonly injected, ingested, and inhaled. |
| Marijuana | Marijuana (cannabis) is typically smoked. It is taken to induce euphoria, relaxation, drowsiness. Marijuana use does not usually create an acute medical emergency; however, marijuana users often take other illicit drugs. |
| Hallucinogens | Hallucinogens alter sensory perception. Examples include LSD and PCP. |
| Carbon monoxide (CO) | CO poisoning is a leading cause of death due to fires. Other common sources include home heating devices and vehicle exhaust fumes. Carbon monoxide inhibits the body's ability to transport and use oxygen. |
| Carbon monoxide (CO) | The danger of CO poisoning is greatest when exposed in a confined space. Carbon monoxide is a silent killer. It is tasteless, colorless, odorless, and completely nonirritating when inhaled. Victims are usually unaware they are being exposed and eventually lose consciousness. |
| Acids and alkalis | Both are considered caustic substances. Many household products are acids or alkalis. Acids have a very low pH and burn on contact. Pain is usually immediate. |
| Acids and alkalis | Alkalis have a very high pH and tend to burn deeper than acids. Pain may be delayed. Most caustic ingestion patients are children. Common household caustics include liquid drain openers, bathroom cleaning supplies, ammonia, and bleach. |
| Hydrocarbons | Hydrocarbons are petroleum-based. |
| Hydrocarbons | Hydrocarbons are found in gasoline, paints, solvents, sunscreen, baby oil, makeup remover, kerosene, lighter fluid, and more. Hydrocarbons can be ingested, inhaled, and absorbed. iv. Most hydrocarbon ingestion patients are children. |
| Hydrocarbons | Note that activated charcoal is contraindicated with caustic or hydrocarbon ingestion. |
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