Chapter 19
Substance Abuse and Poisonings
• List various ways poisons enter the body.
• List signs and symptoms associated with poisoning.
• Discuss care for the patient with possible overdose.
• Establish the relationship between the poisoning or overdose
patient and airway management.
• State the indications, form, dose, action, contraindications,
administration, and side effects for activated charcoal.
• Recognize the need for medical direction in caring for overdose
or poisoning patients.
Poison
• Any substance whose chemical action can damage body structures or
impair body functions
Substance Abuse
• The knowing misuse of any substance to produce a desired effect
Identifying the Patient
and the Poison
If you suspect poisoning, ask the patient the following questions:
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What substance did you take?
When did you take it or become exposed to it?
How much did you ingest?
What actions have been taken?
How much do you weigh?
How Poisons Enter the Body
• Ingestion
– 80% of all poisoning is by mouth.
• Inhalation
– Breathing in gases, toxins, or chemicals
• Injection
– Mostly from deliberate drug overdose
• Absorbed
– Corrosive substances that contact the skin
Emergency Medical Care
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• Remove the patient from the source of the poisoning or remove
the poisoning if possible.
• Care focuses on support and assessing and monitoring ABCs.
• You may be permitted to give activated charcoal for ingested
poisons.
Emergency Medical Care
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• Charcoal is not indicated for ingestion of corrosive agents,
patients with decreased LOC, or patients who can’t swallow.
• Usual dosage is 25 to 50 grams for adults and 12.5 to 25 grams
for pediatrics.
• Follow local protocols and monitor patient’s airway and
breathing.
Activated Charcoal
Alcohol
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Most commonly abused drug in the US
Kills more than 200,000 people a year
Alcohol is a powerful CNS depressant.
Acts as a sedative and hypnotic
A person that appears intoxicated may have a medical problem.
Alcohol
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• Intoxicated patients should be transported and seen by a
physician.
• Patients may also experience hypoglycemia, trauma, internal
bleeding respiratory, depression, and shock.
• A patient with alcohol withdrawal may experience delirum
tremors (DTs).
Alcohol
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• Patients with DTs may experience:
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Agitation and restlessness
Fever
Sweating
Confusion/disorientation
Delusions or hallucinations
Seizures
Opoids
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• Drugs containing opium
• Many of these, such as demerol, Darvon, and methadone, have
medicinal purposes.
• Some, such as heroin, are illegal.
• Opoids are CNS depressants causing severe respiratory distress.
Opoids
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• Care includes supporting airway and breathing.
• You may try to wake the patient by talking loudly or shaking
them gently.
• Always give supplemental oxygen and prepare for vomiting.
• Request for ALS back up.
Sedative - Hypnotic Drugs
• These drugs are CNS depressants and alter level of
consciousness.
• Patients may have severe respiratory depression and even coma.
• The main concern is respiratory depression and airway
clearance, ventilatory support, and transport.
Abused Inhalants
• Common household products inhaled by teenagers for a “high”
• Effects may include drowsiness, coma, seizures, and even
cardiac arrest.
• Keep the patient from moving and give oxygen.
• Transport to hospital while monitoring vitals.
Sympathomimetics
• CNS stimulants causing hypertension, tachycardia, and dilated
pupils
• Amphetamine and metamphetamine are commonly taken by
mouth.
• Cocaine most abused substance
• Can lead to seizures and cardiac disorders
• Give oxygen, transport, and monitor vitals.
• Be aware of personal safety.
Marijuana
• Smoked by 20,000 people daily in the US
• Produces short term memory loss, relaxation, and drowsiness
• Transport to hospital is rarely needed unless very high doses
have been taken.
• Marijuana can be used as vehicle for other drugs, i.e., it can be
covered with crack.
Hallucinogens
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Alter an individual’s sense of perception
LSD and PCP are potent hallucinogens.
Sometimes, people experience a “bad trip.”
Patient will be hypertensive, tachycardic, anxious, and probably
paranoid.
• Provide comfort and transport. Only restrain if danger of injury
exists.
Cholinergic Agents
• Commonly used as nerve agents for warfare
• Overstimulate body functions controlled by the parasympathetic
nervous system
• May encounter organophosphate insecticide or wild mushrooms
also in this category
Signs and Symptoms of Cholinergic Drugs
• S Salivation
• L Lacrimation
• U Urination
• D Defecation
• G GI irritation
• E Eye constriction
Care for Cholinergic Poisoning
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Main concern is to avoid exposure.
May require field decontamination.
This may be treated as a Hazmat incident.
Main concern is airway and breathing.
Transport and notify hospital of situation.
Food Poisoning
• Salmonella bacteriun causes severe GI symptoms within 72
hours.
• Staphylococcus is a common bacteria that grows in foods kept
too long.
• Botulism is often a fatal disease resulting from improperly
canned foods.
Care for Food Poisoning
• Try to obtain as much history as possible.
• Transport patient to hospital promptly.
• If more than one person experiences symptoms, suspect food
poisoning.
• If possible, bring some of the suspected food to the hospital.
Plant Poisoning
• Several thousand cases of plant poisonings occur each year.
• If you suspect plant poisoning:
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Assess the patient’s airway and vitals.
Notify poison control center.
Transport the patient to hospital promptly.
Take the plant to the hospital, avoiding contamination.