Adapted From Temple College
EMS Professions
Poisons

Substance which when introduced into
body in relatively small amounts causes in
structural damage or functional
disturbances
Suspect with:

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
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

GI signs/symptoms (nausea, vomiting,
diarrhea, pain)
Altered LOC, seizures, unusual behavior
Pupil changes, salivation, sweating, other
signs/symptoms of disturbed autonomic
nervous system function
Respiratory depression
Burns, blisters of lips, mucous membranes
Unusual breath odors
Treat Patient, Not Poison
Proper support of ABCs is first step in
management
 Contact with Poison Control Center
 Priority action plan
 Symptomatic treatments
 Time management

Try to determine:
What?
 How much?
 How long ago?
 What has already been done?
 Psychiatric history?
 Underlying illness?

When in doubt. . .
Assume containers were full
 Entire contents were ingested
 Patient may not be telling you the truth

If several patients involved. . .
Assume each ingested entire container
contents
 Triage
 Additional resources

Always. . .
Bring sample of material if possible
 Save for analysis, if patient vomits

Poisoning Management

Based on route of entry
 Ingested
 Absorbed
 Inhaled
 Injected
Ingested Poisons

Prevent absorption of toxin from GI tract
into bloodstream
 Positioning
 Rapid Transport to definitive treatment
center
Absorbed Poisons

Dry chemicals
 dust skin, then
 wash

Liquid chemicals
 wash with large amounts of H20
 avoid “neutralizing” agents
CAUTION
Don’t accidentally expose yourself!
Inhaled Poisons
Remove patient from exposure
 Maximize oxygenation, ventilation

CAUTION
Don’t accidentally expose yourself!
Injected Poisons

Attempt to slow absorption
Venous constricting bands
Dependent position
Splinting of injected body part
Cold packs (+) [May worsen local injury by
concentrating poison]
Substance Abuse

Self administration of a substance in a
manner not in accord with approved
medical or social practices
Substance Abuse
Psychological dependence
 Physical dependence
 Compulsive drug use
 Tolerance
 Addiction

Psychological Dependence
Habituation
 Substance needed to support user’s
sense of well-being

Physical Dependence

Substance must be present in body to
avoid physical symptoms (withdrawal)
Compulsive Drug Use

Use of drug and rituals/culture
associated with its use become an
overwhelming desire
Tolerance
Increasing amounts of drug needed to
produce same effects
 Tolerance contributes to addiction by
keeping user “chasing the last high”

Addiction
Combination of psychological
dependence, physical dependence,
compulsive use, and tolerance
 Patient becomes totally consumed with
obtaining, using drug to exclusion of all
other things

Ethyl Alcohol
A CNS Depressant Drug
Decreased Reaction
Time
Increased Accidental
Trauma Risk
Decreased Social
Inhibitions
Increased Intentional
Trauma Risk
Potentiation of Other
CNS Depressants
Lethal Overdoses in
Combination with Other
Drugs
Irritation, Gastritis,
Ulcer Disease, GI
Bleeds
Respiratory
Depression, Shock
Slowed GI Tract
Activity
Toxic Overdose
Ethanol Intoxication Signs

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Breath odor
Swaying, unsteadiness
Slurred speech
Nausea, vomiting
Flushed face
Drowsiness
Violent, erratic behavior
Ethanol
Clouds signs, symptoms
 Complicates assessment
 Head trauma, diabetes, drug toxicity, CNS
infection can mimic EtOH intoxication and
vice versa

Patient is NEVER “just
drunk” until all other
possibilities are
excluded
Alcohol Addicts

Experience alcohol withdrawal syndrome if
they reduce intake:
 Restlessness, tremulousness
 Hallucinations
 Seizures
 Delirium tremens--all of above plus tachycardia,
nausea, vomiting, hypertension, elevated body
temperature
Delirium Tremens
Life threatening condition!
 Occurs 1 days to 2 weeks after intake is
decreased
 5 to 15% mortality
 Control airway, prevent aspiration, monitor
for hypovolemia

Narcotics
Opium
 Opium derivatives
 Synthetic compounds that produce opiumlike effects

Narcotics
Opium
 Heroin
 Morphine
 Demerol
 Dilaudid

Percodan
Codeine
Darvon
Talwin
Narcotics

Medical Uses
 analgesics
 anti-diarrheal agents
 cough suppressants
Narcotics

Overdose
Coma
Respiratory depression
Constricted (pin-point) pupils
Narcotics

Withdrawal
 Agitation
 Anxiety
 Abdominal pain
 Dilated pupils
–Sweating
–Chills
–Joint pains
–Goose flesh
Resembles severe influenza
Not a life-threat
Barbiturates
Nembutal
 Seconal
 Pentobarbital
 Amytal
 Tuinal
 Phenobarbital

Barbiturates
Induce sleepiness, state similar to EtOH
intoxication
 Medical uses

 Anesthetics
 Sedative
 Hypnotics
Barbiturates

Overdose
 Coma
 Respiratory depression
 Shock

Extremely dangerous in combination with
EtOH
Barbiturates

Withdrawal
 Resembles EtOH withdrawal (DTs)
 Extremely dangerous
Barbiturate-like Non-barbiturates
Doriden, Placidyl, Quaalude, Methyprylon
 Effects similar to barbiturates
 Overdose can cause sudden, very
prolonged respiratory arrest
 Withdrawal resembles ETOH; extremely
dangerous

Tranquilizers
Valium, Librium, Miltown, Equanil,
Tranxene
 Low doses relieve anxiety, produce
muscle relaxation
 High doses produce barbiturate-like
effects

Tranquilizers

Overdose:
Unlikely to cause respiratory arrest alone
Extremely dangerous with EtOH

Withdrawal
 Resembles EtOH withdrawal
 Extremely dangerous
CNS Stimulants: Amphetamines
Dexedrine, Benzedrine, Methyl
amphetamine
 Relieve fatigue, promote euphoria,
reduce appetite

CNS Stimulants: Amphetamines

Overdose
 Restlessness, paranoia
 Tachycardia
 Hypertension
 Hyperthermia

Withdrawal
 Lethargy
 Depression
CVA, Heart failure
Heat stroke
CNS Stimulants: Cocaine
Stronger stimulant effects than
amphetamines
 Can cause respiratory/cardiovascular
failure, heat stroke, lethal arrhythmias

CNS Stimulants: Cocaine
“Snorting” can destroy nasal septum,
cause massive nosebleed
 Airway issue
 Withdrawal:

 lethargy
 depression
Hallucinogens
LSD, psilocybin, peyote, mescaline, DMT,
MDMA
 Enhance perception
 Wrong setting may induce “bad trips” with
extreme anxiety
 True toxic overdose rare

Phencyclidine
PCP, angel dust
 Produces bizarre, violent behavior
 Reduces pain sensation
 Patients may be capable of feats of
extreme strength
 Keep patient in quiet environment,
minimize stimulatin

Solvents
Glue, paint, gas, light fluid, toluene
 Inhalation produces state similar to EtOH
intoxication
 Patient may asphyxiate if consciousness
lost while “sniffing”

Solvents
Increase risk of arrhythmias
 May cause liver damage, bone marrow
depression
 Chronic abuse causes CNS damage paranoia, violent behavior
