POISONING, DRUG

1
POISONING, DRUG MEDICATION ABUSE
2
Types of Poisoning

• Ingested Poisons
• Orally (swallowed)
• Inhaled Poisons
• Respiratory system (breathed in)
• Most common cases - carbon monoxide poisoning
• Injected Poisons
• Break in the skin
• Absorption (Surface Contact) Poisons
• Through the skin, often with no visible sign of
  entry

3
Danger of Further Injury

• Poison may enter your body the same way it
  entered your patient's body
• Especially true in cases of absorption or
  inhalation poisoning
• Always attempt to establish the nature of the
  poisoning agent before taking action that could
  endanger yourself or others

4
Common Examples

• Pesticides
• Herbicides
• Gaseous compounds
• Medicines
• Household cleaning products

• Plants
• Paints
• Burning plastics
• Specific poisons
• Perfumes
• Food

5
Signs and Symptoms

• Nausea
• Vomiting
• Abdominal pain
• Constriction or dilation of pupils,
• Excessive salivation

• Excessive sweating
• Abnormal respirations or pulse
• Loss of consciousness
• Convulsions

6
Poison Control Centre

• What is the poisoning agent?
• How much was taken?
• The mechanism of poisoning?
• The patients vital signs?
• Was the poison ingested, inhaled, injected, or
  absorbed through the skin?
• How long ago was the poison taken?
• What is the present status of the patient?

7
Poison Control Centre - 911

• Alberta 1-800-332-1414
• British Columbia 1-800-567-8911
• Manitoba 911
• New Brunswick 911
• Newfoundland [phone]
• Northwest Territories [phone]
• Nova Scotia 1-800-565-8161
• Ontario 1-800-268-9017
• PEI 1-800-565-8161
• Quebec 1-800-463-5060
• Saskatchewan 1-866-454-1212
• Yukon [phone]

8
General Treatment - Unresponsive

• Do not give fluids or induce vomiting
• Check vital signs
• If vitals signs are normal or stable
• Determine the poisoning agent
• Call the Poison Control Centre
• Monitor the vital signs frequently
• Transport as a Load and Go
• If ABC are compromised
• Perform AR or CPR (with appropriate barrier
  device)
• Collect any vomitus and any containers that may
  have held the suspected poisoning agent with the
  patient

9
General Treatment - Responsive

• Check vital signs
• Determine the poisoning agent
• Call the Poison Control Centre
• If directed, induce vomiting
• Monitor the vital signs frequently
• Transport as a Load Go
• Collect any vomitus and any containers that may
  have held the suspected poisoning agent with the
  patient

10
Ingested Poison

• Induce vomiting only if directed by the Poison
  Control Centre
• Do not induce vomiting if
• The patient is unresponsive or convulsing
• The poison is a known corrosive agent such as
  acid, lye, drain cleaner, or if it has caused
  burns to the lips, mouth or throat. a poison that
  contains petroleum distillates

11
Inhaled Poisons

• Additional signs and symptoms
• Respiratory distress
• Coughing
• Pain and burning in the throat
• Pain in the chest
• Cyanosis

12
Treatment

• Remove the patient from the contaminated
  atmosphere
• Check and monitor vital signs
• Ensure that the airway, breathing and circulation
  are maintained
• Initiate AR/CPR as necessary
• Administer oxygen, if available
• Identify the poisoning agent
• Contact the Poison Control Centre and follow
  their instructions
• Transport to medical aid

If the environment is unsafe, do not intervene,
call the EMS and inform them of the situation
13
Injected Poisons

• Signs and symptoms
• Confusion
• Disorientation
• Delusions
• Pain
• Tenderness/swelling at the site of entry
• Unresponsive
• Diminished function or failure of the respiratory
  or circulatory systems

14
Treatment

• If swelling is apparent, remove all rings,
  watches and jewellery from the affected limbs
• Apply a constriction band
• Check, maintain and monitor vital signs
• Identify the poisoning agent
• Call the Poison Control Centre and follow the
  directions
• Transport the patient to medical aid

15
Pressure Immobilization Bandage

• is a tourniquet-like (venous tourniquet) device
• applied proximally (closer to the heart) to the
  injured or poisoned region of an extremity.

16
Pressure Immobilization Bandage

• A pressure immobilization bandage must
• completely encircle the extremity
• be narrow enough to impede circulation
• be wide enough that the skin is not damaged
• Impedes circulation sufficiently to impede venous
  return to the heart, but not to completely
  eliminate arterial supply
• Peripheral pulse should still be palpable

17
Absorbed Poison

• Common absorption poisons include
• Pesticides
• Herbicides
• Corrosives
• Acids
• Alkalis
• Some petroleum distillates

18
Signs and Symptoms

• Nausea
• Sweating
• Skin irritation
• Burns
• Abdominal and substernal tightness
• Abdominal cramps
• Profuse salivation
• Respiratory distress
• Muscle twitching
• Seizures
• Paralysis

19
Treatment

• Protect yourself from skin contamination
• Remove the agent from continued skin contact by
• Removing any contaminated clothing from the
  patient
• If substance is not reactive to water, wash the
  area including directing a stream of water
• If the poison is solid or in granular form,
  remove as much of it as possible by brushing
  before washing with water
• Identify the poison
• Call the Poison Control Centre and follow the
  directions given
• Transport the patient to medical aid

20
Insect Stings

• Stings from insects such as bees, wasps, and
  hornets are prevalent particularly during the
  warmer months and are more common among children
• The body reacts to insect stings on two different
  levels, local and systemic

21
Reaction to stings

• Local
• Pain
• Redness
• Itching
• Swelling

• Systemic
• Breathing difficulty
• Swelling around throat
• Skin welts or hives
• General itching
• Weakness
• Headache
• Abdominal pain
• Anxiety
• Restlessness

22
Treatment

• Local
• For bee stings scrape surface to remove stinger
  and venom sack
• Apply ice

• Systemic
• Monitor and be prepared to provide critical
  intervention
• Scrape surface to remove stinger and venom sack
• Apply ice to the area
• If possible, collect insect for identification
• Transport to next level of EMS

23
Snake Bite

• North American poisonous snakes
• Coral Snakes
• Rattlesnakes
• Copperheads
• Water Moccasins
• The venom of rattlesnakes, copperheads and water
  moccasins alters normal characteristics of blood,
  particularly its ability to clot
• Coral snake's venom affects the nervous system

24
Signs and Symptoms

• Bleeding under the skin and purplish
  discolouration after several hours
• Blood blisters
• Sweating
• Vomiting
• Rapid pulse
• Limb numbness
• Weakness

• Faintness
• Low blood pressure
• Severe burning pain and immediate swelling at the
  bite site, increasing over the next six-to-eight
  hours
• If no swelling has occurred after one hour,
  injection of venom is unlikely to have occurred

25
Treatment

• Calm and reassure the patient
• Have them lie down and keep them quiet throughout
  transportation to hospital
• Do not give them any alcohol
• Rings, watches and constricting clothing should
  be removed
• Clean the bite site with soap and water or an
  antiseptic solution, if available

26
Treatment

• Locate the fang marks and place a pressure
  immobilization bandage around the entire length
  of the bitten extremity
• Immobilize the extremity in a splint to reduce
  circulation in the limb
• Check and monitor vital signs
• Ensure that the ABCs are maintained

27
Treatment

• Under no circumstances should an ice pack or cold
  pack be applied to the area. Some types of snake
  venom are activated by cold
• Transport to medical aid
• If possible, advise the medical facility prior to
  the patient's arrival in order that anti-venom
  may be awaiting them

28
Drug Abuse

• Drug
• any chemical that modifies the function of living
  tissues resulting in physiological or behavioural
  changes
• Drug use
• usage of therapeutic or non-therapeutic
  substances to produce a desired effect with
  minimum hazard
• Drug abuse
• whenever drugs are taken or administered under
  circumstances and at doses that significantly
  increase their hazard potential

29
Commonly Abused Drugs

• Tranquilizers
• Antidepressants
• Analgesics
• Alcohol
• Prescription medication
• Solvents

30
Alcohol - Signs and Symptoms

• Breath odour
• Nausea
• Vomiting
• Lack of coordination
• Slurred of speech
• Emotional instability
• Loss of inhibitions

• Aggressive, violent behaviour and abusive
  language
• Deep respiration
• Facial flushing
• Dilated pupils

31
Solvents - Signs and Symptoms

• Characteristic strong odour of glue or of other
  chemicals
• Symptoms of intoxication similar to alcohol
• Euphoria
• Uncoordinated gait
• Slurred speech

32
Barbiturates - Signs and Symptoms

• Decreased blood pressure
• Decreased respiration rate
• Slurred speech
• Involuntary horizontal eye movement
• Lack of physical coordination
• Absence of alcohol odour

33
Narcotics-Signs and Symptoms

• Nausea
• Vomiting
• Constricted pupils
• Constipation
• Decreased respiration rate
• Unresponsiveness to pain
• Lethargy
• Numerous injection sites along veins of the arms
  or legs

34
Stimulants - Signs and Symptoms

• Dilated pupils
• Loss of appetite
• Over- or hyperactivity
• Rapid speech
• Belligerence
• Suspiciousness

• Confusion
• Rapid and strong pulse
• Shallow respiration
• Dry mouth
• Profuse perspiration

35
Cannabis - Signs and Symptoms

• Intoxication and euphoria without drastic change
  in judgement or gait
• Reddening of the eyes
• Increased pulse rate
• Unusual hilarity
• Increased appetite

36
Hallucinogens - Signs and Symptoms

• Markedly-dilated pupils
• Unusual hilarity
• Emotional swings
• Suspiciousness
• Bizarre behaviour

• Nausea and vomiting
• Increased pulse rate and blood pressure,
• Sweating
• Anxiety

37
Treatment - Conscious

• Introduce yourself attempt to carry on a
  conversation
• Attempt to establish their current state of mind
• If possible, attempt to "talk them down" and
  place them in a quiet, dimly lit room
• Try to establish the causative drug for the
  patient's current state
• Be aware of sudden changes in personality or
  behaviour
• Transport to medical aid

38
Treatment - Unconscious

• Establish the presence of vital signs
• Maintain and monitor vital signs
• Question bystanders and/or search the
  surroundings to establish the patient's past
  medical and drug history
• Transport the patient to medical aid
• Transport any findings to hospital with the
  person

39
Assume the Worst

• Never assume that any altered level of
  consciousness or personality changes are the
  result of drug ingestion
• Treat as per any other casualty with an altered
  level of consciousness

40
Remember

• Further danger
• Protect yourself and others from the poison
• Use barrier devices
• Control / avoid the source of the poison