CH 22

• Toxicology


  Study of toxic or poisonous substances
• Poison


  A substance whose chemical action can damage body structures or impair body function
• Toxin


  A poisonous substance produced by bacteria, animals, or plants that acts by changing normal metabolism of cells or destroying them
• Substance abuse


  Misuse of any substance to produce desired effect
• Overdose


  Common complication of substance abuse, lethal dose of a substance
• Higher weight (fat)


  Slower absorption of drugs
• If there is a pill bottle on scene

  1. Take it with you to provide critical information

  2. Examine vomit for pill fragments

  3. Take pictures of containers
• Antidote


  Substance that will counteract the effects of a particular poison
• How poisons enter the body

  • Inhalation
  • Absorption
  • Ingestion
  • Injection
• Inhalation


  • Breathing it in, straight to lungs
  • Patient may require O2
  • Inhaled poison may require immediate trans to emergency dept
  • Suspected gas: HazMat Team
  • Some patients use inhaled poisons to commit suicide in a vehicle
• Absorption

  • Skin, mucous membrane, eye damage
  • Chemical burns
  • Rashes
  • Systemic effects
  • Signs: burns, itching, liquid or powder on skin, redness, typical odors of substance
  • Emergency treatment: avoid contaminating yourself, remove substance, remove all contaminated clothing
  • Eyes: irrigate outward, 15-20 minutes after the burning stops, use saline
• Ingestion

  • About 80% of poisoning is by mouth
  • Ingested poisoning is usually accidental in children
  • Signs and symptoms vary with: type of poison, age, time that has passed since ingestion
  • Signs may include: burns around mouth, gastrointestinal pain, vomiting, and seizures
• Injection

  • Exposure by injection includes intravenous drug abuse or envenomation by insects, arachnids, and reptiles
  • Usually absorbed quickly by body
  • Cannot be diluted or removed from the body in the field
  • Signs and symptoms may include weakness, dizziness, fevers
  • ABCs are a priority in injected poison
  • Envenomation: remove rings, watches, bracelets from the areas around injection site
  • Provide high flow ox, monitor airway, alert for nausea and vomiting
• Primary Assessment

  1. Prompt transport if ABC's have obvious alteration

  2. Chief complaint: investigate

  3. Activated charcoal: binds to specific toxins and prevents absorption by the body

  4. Dosages: 1 gram per 1 kg

  5. Shake vigorously before giving activated charcoal
• Over time, a person may need increasing amounts of substance to achieve the same result
• Alcohol (ETOH)


  • Alcohol can damage the liver, whether through chronic overuse or occasional heavy use
  • Binge use can be more damaging that chronic use, depending on frequency
  • Alcohol is a sedative, substance that decreases activity and excitement
  • Alcohol is also a hypnotic, meaning that it induces sleep
  • Abusing alcohol causes bacteria to grow in your gut, which eventually migrates through the intestinal wall and into the liver, leading to liver damage
  • Can ultimately lead to cirrhosis of the liver
  • Alcohol is a powerful CNS depressant
  • Severe acute alcohol ingestion may cause hypoglycemia
  • Patients with serious signs of depression need to be provided respiratory support
  • Patients may experience delirium tremens (DTs), frightening hallucinations, usually caused by withdrawal symptoms
• Opioids


  • Opioid is type of narcotic medication used to relieve pain
  • An opiate is a subset of the opioid family and refer to natural nonsynthetic opioids
  • Narcotic is a drug that produces sleep or altered mental consciousness
  • Opioids cause slow, shallow respirations, hypotension, may be cyanotic, pinpoint pupils
  • You give narcan to reverse opioid
  • Opioids are CNS depressants and cause severe respiratory depression
• Sedative-Hypnotic Drugs


  • Barbiturates and benzodiazepines
  • These drugs are CNS depressants and alter the level of consciousness
  • Patients may appear drowsy, peaceful, or intoxicated
  • Usually taken by mouth
  • Treatment includes to ensure airway is patent, assist ventilations, provide prompt transport
  • Slurred speech, incoordination, unsteady gait
• Abused Inhalants


  • Acetone, Xylene, Hexane
  • Found in glues, thinners, lacquers
  • Gasoline, aerosol sprays
  • Treatment: give O2, use stretch, prompt transport
• Hydrogen sulfide


  • Highly toxic, smells like rotten eggs, used to commit suicide
  • Signs: nausea, confusion, dyspnea, LOC
• Sympathomimetics


  • CNS stimulants that mimic the effect of the sympathetic nervous system (fight or flight)
  • Stimulant: agent that produces an excited state
  • Example: cocaine, heroine, meth
  • Produces hypertension, tachycardia, and dilated pupils
  • Acute overdose: patients have a high risk of seizures, cardiac dysrhythmia, HTN, stroke
• ACRONYM: MorPHINE: Fine, AmPHETamine: Fat, Morphine overdose: CONSTRICTED, FINE, Amphetamine overdose: DILATED, FAT
• Synthetic Cannabinoids (weed) and synthetic cathinones (bath salts)

  • Emerging class of drugs similar to MDMA
  • Cathinones produce euphoria, increased mental clarity, and sexual arousal
  • Effects reported for as long as 48 hours
  • Signs of bath salts: paranoid, tachycardia, hallucinations, tonic clonic seizures, lip snacking, confusion, teeth grinding
• Marijuana


  • THC chemical in the marijuana plant that produces high
  • Inhaling marijuana causes euphoria, relaxation, drowsiness
  • Marijuana impairs short term memory and the capacity to do complex thinking
  • Ingestion of marijuana can lead to cannabinoid hyperemesis syndrome
  • Synthetic marijuana is called spice
  • CBD Oil: Does not contain THC, gets you same benefit of marijuana without the high
• Hallucinogens


  • LSD, PCP
  • Hallucinogens tend to cause excess strength
  • Hallucinogens can cause long term brain damage and trauma
  • Signs: hypertension, tachycardia, anxiety, paranoia