Emergency Care and Transportation of the Sick and Injured ...



Chapter 11

Poisoning and Substance Abuse

Unit Summary

After students complete this chapter and the related coursework, they will be familiar with various poisoning emergencies, including those caused by ingested, inhaled, absorbed, and injected poisons, as well as the assessment and treatment for poisoning emergencies.

National EMS Education Standard Competencies

Medicine

Recognizes and manages life threats based on assessment findings of a patient with a medical emergency while awaiting additional emergency response.

Toxicology

Recognition and management of

• Carbon monoxide poisoning (pp 223-225)

• Nerve agent poisoning (p 228; 230)

How and when to contact a poison control center (pp 222-223; p 228 )

Immunology

Recognition and management of shock and difficulty breathing related to

• Anaphylactic reactions (pp 225-227)

Pharmacology

Uses simple knowledge of the medications so that the EMR may self-administer or administer to a peer in an emergency.

Medication Administration

Within the scope of practice of the EMR, how to

• Self-administer medication (p 223; pp 225-228; pp 231-233)

• Peer-administer medication (p 223; pp 225-228; pp 231-233)

Emergency Medications

Within the scope and practice of the EMR

• Names (p 223; pp 225-228; pp 231-233)

• Effects (p 223; pp 225-228; pp 231-233)

• Indications (p 223; pp 225-228; pp 231-233)

• Routes of administration (p 223; pp 225-228; pp 231-233)

• Dosages for the medication administered (p 223; pp 225-228; pp 231-233)

Knowledge Objectives

1. Define poison. (p 221)

2. Describe the signs and symptoms of ingested poisons. (p 222)

3. Explain how to treat a patient who has ingested a poison. (pp 222-223)

4. Describe the signs and symptoms of inhaled poisons. (p 224)

5. Explain how to treat a patient who has inhaled a poison. (p 225)

6. Describe the signs and symptoms of injected poisons. (p 226)

7. Explain how to treat a patient who has been injected with a poison. (pp 226-227)

8. Explain how to assist a patient with an auto-injector. (p 226)

9. Describe the signs and symptoms of absorbed poisons. (p 228)

10. Explain how to treat a patient who has absorbed a poison. (p 228)

11. Describe how to brush off a dry chemical from a patient and then flush with water. (p 228)

12. Describe how to use water to flush a patient who has come in contact with liquid poison. (p 228)

13. Describe the signs and symptom of exposure to a nerve agent. (p 228)

14. Describe the role of emergency medical responders (EMRs) in an incident involving exposure to a nerve agent. (p 228)

15. Explain how to administer a nerve agent auto-injector kit. (p 230)

16. Describe the signs and symptoms of a drug overdose caused by amphetamines, opioids, hallucinogens, and inhalants. (pp 231-232)

17. Explain the general treatment of a patient who has experienced a drug overdose. (p 223)

18. Explain how to administer intranasal naloxone for an opioid overdose. (pp 231-232)

Skills Objectives

1. Demonstrate treatment of a patient who has ingested a poison. (pp 222-223)

2. Demonstrate treatment of a patient who has inhaled a poison. (p 225)

3. Demonstrate treatment of a patient who has been injected with poison. (pp 226-227)

4. Demonstrate how to assist a patient with an auto-injector. (p 227)

5. Demonstrate treatment of a patient who has absorbed a poison. (p 228)

6. Demonstrate how to brush off a dry chemical from a patient and then flush with water. (p 228)

7. Demonstrate how to use water to flush a patient who has come in contact with liquid poison. (p 228)

8. Demonstrate administration of nerve agent auto-injector kits. (p 228)

9. Demonstrate treatment of a patient who has experienced a drug overdose. (p 233)

10. Demonstrate administration of intranasal naloxone for an opioid overdose. (pp 231-232)

Readings and Preparation

Review all instructional materials, including Emergency Medical Responder, Sixth Edition, Chapter 11, and all related presentation support materials.

• Review local EMT treatment protocols for the emergency care of patients with poisoning and overdose.

Support Materials

• Lecture PowerPoint presentation

• Examples of various forms of unit doses of activated charcoal

• Poison control stickers and brochures

• Local toxicology guidelines and protocols for administration of activated charcoal and various forms of unit doses of activated charcoal

• EpiPen trainer

Enhancements

• Direct students to visit Navigate 2.

• Contact a representative from the closest regional poison control center to provide literature and speak to the class about the services provided by the center.

• Contact one or more of the following:

• A representative of a local health clinic for the homeless

• A narcotics officer from the local police department

• A drug and alcohol counselor

These individuals can provide very current information on local “drugs of choice” and signs and symptoms.

• Have students bring in “poisons” from home and determine if the labels include appropriate actions and information.

• Contact the local police department for a presentation on current street drugs, including what they look like, what their side effects are, and what is “hot” locally.

• Contact the local DARE program speaker (who may be a police department member) for a presentation on the program’s aims and activities.

• Contact the local suicide hot line for a presentation on suicide (intentional poisoning).

• Farming communities: Contact the local Farm Bureau for farm safety course information.

Teaching Tips

• The importance of scene safety is a vital part of this chapter. Encourage students to utilize their hazardous materials book, which should be available in each vehicle. A member of the local hazardous materials team may be willing to assist in this presentation.

• Check with poison control and be familiar with pediatric poisonings. Remember that children who accidentally poison themselves often do so again within 3 to 6 months. It is important that students understand that children’s sense of taste and smell are not refined, which helps explain why they often consume strong-smelling chemicals.

• If you are not familiar with the current street drugs, consider having an expert come in to enhance your lecture. Many police departments have poster boards of common street drugs displayed and can inform the students about each drug’s effects on the body.

• Check with the local suicide hot line and determine if it has any information or a speaker who might assist with the questions and concerns that may arise about suicide (intentional poisoning). Be careful to screen the students prior to this type of presentation, as some may have a friend or relative who committed suicide. They may wish either to be absent or to share their experience and add to the discussion.

Unit Activities

Writing assignments: Assign each student the name of a specific street drug to research and write a short essay about, including the category of the drug, the common effects, and so on.

Group activities: Create a “game show,” such as Jeopardy, using questions and answers pertinent to the chapter. Divide the class into two teams and engage in a friendly competition.

Medical terminology review: Create flash cards with pertinent terminology. Divide the class into groups of three or four and have the students quiz one another using the flash cards.

Visual thinking: Create blank charts titled “opioids,” “sedative-hypnotic drugs,” and so on. Write the names of specific drugs on strips of paper, turn the strips face-down, and mix them up. Have each student choose a strip of paper and attach it to the appropriately titled chart.

Pre-Lecture

You are the Provider

“You are the Provider” is a progressive case study that encourages critical thinking skills.

Instructor Directions

1. Direct students to read the “You are the Provider” scenario found throughout Chapter 11.

2. You may wish to assign students to a partner or a group. Direct them to review the discussion questions at the end of the scenario and prepare a response to each question. Facilitate a class dialogue centered on the discussion questions.

3. You may also use this exercise as an individual activity and ask students to turn in their comments on a separate piece of paper.

Lecture

I. Introduction

A. A poison is a substance that causes illness or death when eaten, drunk, inhaled, injected, or absorbed in relatively small quantities.

B. EMRs can save patients’ lives by quickly recognizing and promptly treating serious poisonings.

II. Patient Assessment for Poisoning

A. Poisoning can be classified according to the way the poison enters the body.

1. Ingestion occurs when a poison enters through the mouth and is absorbed by the digestive system.

2. Inhalation occurs when a poison enters through the mouth or nose and is absorbed by the mucous membranes lining the respiratory system.

3. Injection occurs when a poison enters through a small opening in the skin and spreads through the circulatory system.

4. Absorption occurs when a poison enters through intact skin and spreads through the circulatory system.

B. Even though poisons can be introduced into the body by different routes, some effects on the body may be similar.

C. General assessment and treatment

1. Follow the patient assessment sequence.

2. Obtain a thorough history from the patient or from bystanders.

3. Be alert for visual clues that may indicate poisoning, including

a. Traces of the substance on the patient’s face and mouth

b. Traces of the substance on the skin

c. Needle pricks or sting marks

d. Respiratory distress

4. Much of the emergency care for poisoning depends on the patient’s signs and symptoms.

III. Ingested Poisons

A. More than 80% of all cases of poisoning are caused by ingestion.

1. Chemical burns, odors, or stains are often found around the patient’s mouth.

2. Signs and symptoms of ingested poisons

a. Nausea

b. Vomiting

c. Abdominal pain

d. Diarrhea

e. Abnormal or decreased respirations

f. Loss of consciousness

g. Seizures

B. Treatment for ingested poisons

1. To treat a person who has ingested a poison:

a. Identify the poison.

b. Call the National Poison Center (1-800-222-1222) for instructions, and follow these instructions.

c. If you are unable to contact the poison center, dilute the poison by giving water, provided the patient is conscious and able to swallow.

d. Arrange for prompt transport to a hospital.

2. Activated charcoal

a. Activated charcoal is a finely ground powder that is mixed with water to make it easier to swallow.

b. It works by binding to the poison, thereby preventing the poison from being absorbed in the patient’s digestive tract.

c. Activated charcoal may be used by some EMR systems if the nearest medical facility is a long distance away.

d. Use activated charcoal only if you are trained in its use and have approval from your medical director or poison control center.

e. Do not give activated charcoal if the patient

i. Has ingested an acid or an alkali

ii. Has ingested a base, such as liquid drain cleaner

iii. Is unconscious

f. The usual dose of activated charcoal is

i. 25 to 50 grams for an adult patient

ii. 12.5 to 25 grams for a pediatric patient

g. Because the mixture looks like mud, serve it in a covered cup and give the patient a straw.

4. Vomiting

a. Do not do anything to induce vomiting.

b. In the past, syrup of ipecac was used to induce vomiting.

c. Today, the American Association of Poison Control Centers does not endorse using ipecac in children or adults.

d. Activated charcoal is considered more effective and safer than syrup of ipecac.

IV. Inhaled Poisons

A. Poisoning by inhalation occurs if a toxic substance is breathed in and absorbed through the lungs.

B. Some toxic substances such as carbon monoxide are very poisonous but not irritating.

1. Carbon monoxide is an odorless, colorless, tasteless gas that cannot be detected by the normal senses.

C. Other toxic gases (eg, chlorine gas, ammonia) are very irritating to the respiratory tract and cause coughing and severe respiratory distress.

1. These gases can be classified as irritants.

D. Signs and symptoms of inhaled poisons

1. Respiratory distress

2. Dizziness

3. Cough

4. Headache

5. Hoarseness

6. Confusion

7. Chest pain

8. Any of the other signs and symptoms of poisoning listed in Table 10-1

E. Carbon monoxide

1. Common causes of carbon monoxide poisoning include

a. Improperly vented heating appliances

b. Smoke (burning building)

2. Inhaling relatively small quantities of carbon monoxide gas can result in severe poisoning.

a. Carbon monoxide combines with red blood cells about 200 times more readily than oxygen does.

b. A small quantity of carbon monoxide can “monopolize” the red blood cells and prevent them from transporting oxygen to all parts of the body.

3. Signs and symptoms of carbon monoxide poisoning include

a. Headache

b. Nausea

c. Disorientation

d. Unconsciousness

e. Flulike symptoms

4. If you find several patients together who all report these symptoms (especially in winter), suspect carbon monoxide poisoning and remove everyone from the structure or vehicle.

F. Irritants

1. Two of the more frequently encountered irritants are ammonia and chlorine.

a. Ammonia

i. Often found in agricultural settings

ii. Strong, irritating odor and is highly toxic

iii. Causes violent coughing

iv. Can severely burn the skin

v. Anyone who enters an environment containing ammonia must wear a proper encapsulating suit with a self-contained breathing apparatus (SCBA).

b. Chlorine

i. Found around swimming pools and water treatment plants

ii. Severely irritating to the lungs and the upper respiratory tract, causing violent coughing

iii. Can cause skin burns

iv. Anyone who enters an environment containing chlorine must wear a proper encapsulating suit with a SCBA.

2. The presence of hazardous materials that are toxic and those in which there is danger of fire or explosion should be indicated by the appropriate hazardous materials warning placard.

G. Treatment for inhaled poisons

1. Remove the patient from the source of the gas.

2. If the patient is not breathing, begin mouth-to-mask breathing.

3. If the patient is breathing, administer large quantities of oxygen (if available).

4. Arrange for prompt transport to a medical facility for further examination.

5. In some situations, your first response is to evacuate people.

a. Once the evacuation is complete, evaluate and treat the evacuees as necessary.

V. Injected Poisons

A. Two major causes of poisoning by injection

1. Animal bites and stings

2. Toxic injection

B. Signs and symptoms of injected poisons from bites and stings include the following:

1. Obvious injury site (bite or sting marks)

2. Tenderness

3. Swelling

4. Red streaks radiating from the injection site

5. Weakness

6. Dizziness

7. Localized pain

8. Itching

9. Any other signs and symptoms of poisoning listed in Table 11-1

C. Treatment for insect stings and bites

1. Keep the patient calm and still.

a. This will help slow the spread of the poison throughout the patient’s body.

2. Wash the site with soap and water.

3. Remove the stinger using gauze wiped over the area or by scraping a fingernail over the area.

a. Never squeeze the stinger or use tweezers.

4. Apply ice packs to reduce swelling and pain.

5. Some people experience an extreme allergic reaction to stings and bites and may go into anaphylactic shock.

6. Signs and symptoms of anaphylactic shock include

a. Itching

b. Hives

c. Swelling

d. Wheezing and severe respiratory distress

e. Generalized weakness

f. Loss of consciousness

g. Rapid, weak pulse

h. Rapid, shallow breathing

i. Decrease in blood pressure

j. Hypovolemic shock

k. Cardiac arrest

7. Treatment for anaphylactic shock

a. Maintain the patient’s airway, breathing, and circulation.

b. Administer oxygen if available.

c. Treat for shock in some cases.

d. Remove the allergen if possible.

e. Monitor the patient’s vital signs.

f. If the patient’s condition progresses to the point of respiratory or cardiac arrest, begin mouth-to-mask breathing or cardiopulmonary resuscitation (CPR).

g. Immediately arrange for rapid transport to a medical facility.

h. If the patient has a prescribed auto-injector, help the patient to use it.

i. Support the patient’s thigh and place the tip of the auto-injector against the outer thigh.

ii. Using a quick motion, push the auto-injector firmly against the thigh and hold it in place for several seconds.

D. Snake bites

1. There are four kinds of venomous snakes in the United States.

a. Rattlesnake

b. Cottonmouth

c. Copperhead

d. Coral snake

2. When a snake bites, it injects its poison into a person’s skin and muscles with its fangs.

a. This poison can cause local injury to the skin and muscle and may even involve the entire extremity.

3. Signs and symptoms may affect the entire body.

4. A bite from a venomous snake is rarely fatal.

a. 7,000-8,000 people are bitten each year in the United States.

b. Only about five people die from these bites each year.

c. Permanent injury can sometimes result from a poisonous snake bite.

5. Signs and symptoms of snake bites include the following:

a. Immediate pain at the bite site

b. Swelling and tenderness around the bite site

c. Fainting (from the emotional shock of the bite)

d. Sweating

e. Nausea and vomiting

f. Shock

6. The bite of the coral snake delivers a slightly different poison that may cause these additional problems

a. Respiratory difficulties

b. Slurred speech

c. Paralysis

d. Coma

e. Seizures

E. Treatment for snake bites

1. The field treatment for a poisonous snake bite is basically the same as the treatment for shock.

2. Keep the patient calm and still; have the patient lie down and try to relax.

3. Wash the bite area with soap and water.

4. If the bite occurred on the arm or leg, splint the affected extremity to decrease movement.

a. Place the splinted arm extremely below the level of the patient’s heart to decrease the absorption of the poison.

5. Treat the patient carefully and arrange for prompt transport to the hospital or medical facility.

6. The only effective treatment for poisonous snake bites is the administration of antivenin in the hospital.

VI. Absorbed Poisons

A. Poisoning by absorption occurs when a poisonous substance enters the body through the skin.

B. Insecticides and toxic industrial chemicals are two common absorbed poisons.

C. Signs and symptoms of absorbed poisons include the following:

1. Traces of powder or liquid on the skin

2. Inflammation or redness of the skin

3. Chemical burns

4. Skin rash

5. Burning

6. Itching

7. Nausea and vomiting

8. Dizziness

9. Shock

10. Any other signs and symptoms of poisoning listed in Table 11-1

D. Treatment for absorbed poisons

1. Ensure that the patient is no longer in contact with the toxic substance.

2. Brush—do not wash—any dry chemical off the patient.

a. Contact with water may activate the dry chemical and result in a burning or caustic reaction.

3. After removing all the dry chemical, wash the patient completely for at least 20 minutes.

a. Use any water source that is available.

b. Do not forget to wash out the patient’s eyes if they have been in contact with the poison.

4. If additional EMS personnel are delayed, contact the poison control center or your medical director for additional treatment information.

5. If the patient is experiencing shock, have the patient lie down and elevate the legs.

6. If the patient is having difficulty breathing, administer oxygen if it is available and you are trained to use it.

VII. Nerve Agents

A. Nerve agents can be absorbed through the skin, inhaled, or injected.

B. Nerve agents are among the most deadly chemicals developed.

1. Small quantities of these chemicals can kill large numbers of people by causing cardiac arrest within minutes of exposure.

2. Four of the most commonly mentioned nerve agents are

a. Sarin (GB)

b. Soman (GD)

c. Tabun (GA)

d. V agent (VX)

3. Nerve agents, like insecticides, block an essential enzyme in the nervous system and cause these SLUDGEM-like symptoms:

a. Salivation, sweating

b. Lacrimation (excessive tearing)

c. Urination

d. Defecation, diarrhea

e. Gastric upset

f. Emesis (vomiting)

g. Muscle twitching, miosis (pinpoint pupils)

4. Additional symptoms of organophosphate poisoning include

a. Shortness of breath

b. Slow heart rate

c. Muscle weakness, twitching, or paralysis

d. Slurred speech

e. Seizures

f. Loss of consciousness

.

C. If you are called to the scene of an organophosphate or nerve agent poisoning, your primary responsibility is to keep yourself, other rescuers, and bystanders from being contaminated.

1. A well-trained hazardous materials team in special protective equipment is needed to remove and decontaminate people exposed to these agents.

2. SCBA and encapsulating suits are needed to prevent exposure to rescuers.

D. Treatment

1. Assess and support the patient’s airway, breathing, and circulation.

2. Nerve agent antidote kits permit you to administer these antidotes to yourself or to exposed patients.

a. Use these kits only if the patient has signs and symptoms of organophosphate or nerve agent poisoning.

b. You must have the approval or your medical director and have received proper training in their use.

c. The DuoDote kit contains one auto-injector syringe that contains two drugs, atropine and pralidoxime chloride.

VIII. Substance Abuse

A. According to the National Survey on Drug Use, 8.1% of the US population, or 21.5 million people, have a substance abuse disorder or are dependent on alcohol or other drugs.

B. Substance abuse results in an increased incidence of injuries and illness.

C. Even if the primary reason for the call is not substance abuse, it may still be a contributing factor in many calls.

D. Alcohol

1. Alcohol is the most commonly abused drug in the United States today.

a. Alcohol intoxication may be seen in people of any age, including children, teenagers, and older adults.

b. Alcohol use is present in a significant number of traffic fatalities, murders, and suicides.

2. The symptoms of alcohol intoxication are similar to those of other medical illnesses or severe injuries.

a. Be extra careful with your examination.

b. Arrange for prompt transport to an appropriate medical facility.

3. Alcohol is an addictive, depressant drug.

a. Persons who are physically dependent on alcohol can develop severe withdrawal symptoms, such as convulsions or seizures.

b. The most severe withdrawal symptoms are delirium tremens (DTs).

c. Signs and symptoms of DTs include:

i. Shaking

ii. Restlessness

iii. Confusion

iv. Hallucinations

v. Gastrointestinal distress

vi. Chest pain

vii. Fever

d. DTs is a serious medical emergency that can be fatal.

E. Drugs

1. Drugs may be ingested, inhaled, injected, or absorbed into the body.

2. As you perform your scene assessment, look for clues that can indicate which type of drug was used and how it was administered.

3. In recent years, abuse of prescription drugs has increased.

4. Amphetamines

a. Amphetamines stimulate the central nervous system (CNS).

b. They include speed, ice, crystal, and cocaine (coke).

c. Signs of amphetamine use include

i. Restlessness

ii. Irritability

iii. Talkativeness

d. Keep patients from harming themselves and transport them to a facility where they can be monitored.

5. Pain relievers (opioids) and heroin

a. An opioid is a type of medication used to relieve pain by reducing the intensity of pain signals reaching the brain.

b. They also affect the areas of the brain that control emotion

c. They include

i. Hydrocodone (Vicodin)

ii. Oxycodone (OxyContin)

iii. Morphine

iv. Codeine

d. Heroin is an illegal street drug that is powerful and addictive.

i. Made from morphine

ii. Particularly deadly when combined with fentanyl

e. Signs and symptoms of opioid drug overdose include

i. Slow, difficult, shallow breathing, or no breathing

ii. Small or pinpoint pupils

iii. Weak pulse

iv. Low blood pressure

v. Bluish nails and lips

vi. Drowsiness

vii. Disorientation

viii. Delirium

ix. Coma

f. An overdose of opioid drugs can result in respiratory depression or arrest.

i. If the patient is not breathing, begin mouth-to-mask resuscitation.

ii. If cardiac arrest occurs, begin CPR immediately.

iii. Arrange for prompt transport to an appropriate medical facility.

g. Naloxone (Narcan)

i. A medication that can rapidly reverse the effects of opioid drugs on the CNS.

ii. In the past, naloxone was administered exclusively by injection or through an intravenous (IV) line, and the use of this drug was limited to advance life support (ALS) providers.

iii. Naloxone is now available in a form that can be administered by spraying it into the patient’s nostrils (intranasal administration).

iv. Naloxone is also available in the form of an auto-injector.

v. EMRs can give this medication only if they are trained in its use and have approval from their medical director.

6. Hallucinogens

a. Common hallucinogens include PCP, LSD, peyote, mescaline, and some mushrooms.

b. Hallucinogens are chemicals that cause people to see things that are not there.

c. A patient who is hallucinating may become frightened and unable to distinguish between reality and fantasy.

d. People taking PCP may feel no pain and may seriously injure themselves or others.

e. Signs and symptoms of PCP overdose include

i. Convulsions

ii. Coma

iii. Heart and lung failure

iv. Stroke

f. EMS treatment is primarily supportive.

i. Try to reduce auditory and visual stimulation.

ii. Approach each emergency scene with caution.

iii. Arrange for transport to an appropriate medical facility for treatment.

7. Abused inhalants

a. Volatile chemicals may be intentionally inhaled.

b. Many of these substances can be bought in hardware stores:

i. Gasoline

ii. Paint thinners

iii. Cleaning compounds

iv. Lacquers

v. Aerosol propellants

c. Inhalants may cause drowsiness, unresponsiveness, seizures, or sudden cardiac death.

d. Treat these patients carefully.

i. Try to keep them calm and still.

ii. Support the airway, breathing, and circulation.

iii. Give high-flow oxygen as soon as it is available.

iv. Carefully monitor vital signs.

v. Arrange for prompt transport to an appropriate medical facility.

8. Toxic injection from drugs

a. Drugs that are injected into the bloodstream can result in toxic injection.

b. The patient’s reaction depends on the quantity and type of drug injected.

c. Signs and symptoms of toxic injection include

i. Weakness

ii. Dizziness

iii. Fever

iv. Chills

d. Treatment of toxic injection

i. Support the patient.

ii. Treat the symptoms.

iii. Provide transport to an appropriate medical facility.

iv. Check the injection site for redness, swelling, and increased skin temperature (indications of infection).

F. General treatment for a drug overdose

1. Essentials of EMS care:

a. Provide basic life support (clear the airway and perform mouth-to-mask breathing or CPR, as necessary).

b. Keep the patient from hurting self and others.

c. Provide reassurance and emotional support.

d. Arrange for prompt transport to a medical facility for treatment.

2. The effects of some drugs can be counteracted only by other drugs administered by a paramedic or a physician.

3. If a patient is acting out, speak to him or her in a calm, reassuring tone and try to keep the patient from harming anyone.

4. Administer naloxone if you have been trained in its use and have the approval of your local medical director.

5. EMS personnel should be aware of local facilities that are equipped to deal with patients who are experiencing adverse reactions from a drug overdose.

6. Try to avoid classifying or judging the patient.

IX. Intentional Poisoning

A. Intentional self-poisoning is attempted suicide and may involve ingested poisons/drugs or inhaled poisons (such as carbon monoxide)

B. The emergency treatment is the same, although the patient who has attempted suicide will also need both medical and emotional support.

X. Summary

A. EMRs should be familiar with the signs, symptoms, and treatment of patients who have experienced accidental or intentional poisoning.

B. The four primary routes by which poisons enter the body are ingestion, inhalation, injection, and absorption.

C. An ingested poison is taken by mouth. Often, chemical burns, odors, or stains are found around the mouth. The person may also experience nausea, vomiting, abdominal pain, or diarrhea.

D. An inhaled poison is breathed in and absorbed through the lungs. Some toxic substances, such as carbon monoxide, are very poisonous but not irritating to the respiratory tract. Other toxic gases, such as chlorine gas and ammonia, are very irritating and will cause coughing and severe respiratory distress.

E. The two major causes of poisoning by injection are (1) animal bites and stings and (2) toxic injection.

F. Poisoning by absorption occurs when a poisonous substance enters the body through the skin. A person experiencing absorption poisoning may have both localized and systemic signs and symptoms.

G. Many nerve agents are the same types of chemicals as insecticides. Your role in incidents involving nerve agents is to keep yourself and others from becoming exposed.

H. It is important to pay special attention to scene safety and not enter a hazardous environment without the proper training and equipment.

I. Naloxone (Narcan) is a medication that can rapidly reverse the effects of opioid drugs on the CNS.

Post-Lecture

This section contains various student-centered end-of-chapter activities designed as enhancements to the instructor’s presentation. As time permits, these activities may be presented in class. They are also designed to be used as homework activities.

Assessment in Action

This activity allows the student an opportunity to analyze an emergency care scenario and develop responses to critical-thinking questions. This scenario is designed to assist the student in gaining a further understanding of the issues surrounding poisonings.

Instructor Directions

1. Direct students to read the “Assessment in Action” scenario located in the Prep Kit at the end of Chapter 11.

2. Direct students to read and individually answer the quiz questions at the end of the scenario. Facilitate a class review and discussion of the answers, allowing students to correct their responses as needed. Use the quiz question answers noted here to assist in building this review.

3. You may wish to ask students to complete the activity on their own and turn in their answers on a separate piece of paper.

Answers to Assessment in Action Questions

1. Answer: B Carbon monoxide poisoning.

2. Answer: C Itching

3. Answer: B Inhalation

4. Answer: C Oxygen.

5. Answer: D Amphetamine

6. Answer: B an increase in the rate of respiration.

7. Answer: A Amphetamines

8. Answer: D Hallucinogen

9. Answer: You should alert specially trained and equipped personnel—usually the fire department—to investigate the source of the carbon monoxide and to verify that everyone is out of the building.

10. Answer: A patient who exhibits a weak pulse, shallow or absent breathing, delirium or coma, and blue lips is most likely suffering from an opioid (pain reliever) overdose.

Lesson Review

A. List the four ways in which poisons enter the body. (Lecture II-A)

B. Eighty percent of all poisonings occur through which means? (Lecture III-A)

C. True or false: Carbon monoxide is an odorless, colorless, tasteless, and nonirritating gas. (Lecture IV-B)

D. What is the treatment for carbon monoxide poisoning? (Lecture IV-G)

E. An insect bite or sting can result in which condition? (Lecture V-C)

F. If a person has come into contact with a toxic dry chemical, what is the first thing you should do? (Lecture VI-D)

G. List the symptoms of an exposure to an organophosphate insecticide or nerve agent. (VII-B)

H. What is the most commonly abused drug in the United States today? (Lecture VIII-D)

I. What is another name for intentional self-poisoning? (Lecture IX-A)

Assignments

A. Complete all the Student Workbook activities for Chapter 11.

B. Review all materials from this lesson and be prepared for a lesson quiz to be administered (date to be determined by the instructor).

C. Read Chapter 12: Behavioral Emergencies for the next class session.

Unit Assessment Keyed for Instructors

1. Poisons may enter the body through any of the following routes except:

A. inhalation.

B. ingestion.

C. injection.

D. excretion.

Answer: D

p 221

2. General treatment for a person who has ingested a poison includes all of the following except:

A. trying to get the patient to vomit.

B. arranging for prompt transport to a hospital.

C. calling the poison control center for instructions.

D. trying to identify the poison.

Answer: A

p 223

3. You respond to a residence for the report of an illness. When you arrive, you find three family members suffering from headache, nausea, and disorientation. The most likely cause of this illness is

A. food poisoning.

B. flu.

C. allergies.

D. carbon monoxide poisoning.

Answer: D

p 224

4. The primary concern when responding to a victim of an inhaled poison is to

A. determine the inhaled substance.

B. contact poison control.

C. remove the patient from the source of the gas.

D. ensure that the patient has an open airway.

Answer: C

p 225

5. While cleaning out the crawl space below a house, a patient experiences blotchy skin, redness in the arm, weakness, and localized pain. It is possible that this patient

A. is developing heatstroke.

B. was bitten by a poisonous spider.

C. is having a diabetic reaction.

D. is having a stroke.

Answer: B

p 226

6. You suspect that your patient has been bitten by a snake. You should do all of the following except:

A. arrange for prompt transport.

B. clean the injection site with soap and water.

C. have the patient lie down.

D. capture the live snake and bring it in the ambulance to the emergency department.

Answer: D

p 227

7. The treatment for insect stings and bites includes

A. placing a tourniquet above the site of the sting or bite.

B. placing ice packs at the site of the sting or bite.

C. having the patient run around to increase the pulse rate and dilute the poison.

D. attempting to suck the poison from the site of the sting or bite.

Answer: B

p 226

8. If a poisonous powder has contaminated a patient, how should he or she be treated?

A. Brush off as much powder as possible, then irrigate with water.

B. Immediately start irrigation with very cold water.

C. Leave the powder in place and transport immediately.

D. Irrigate with water for 20 minutes.

Answer: A

p 228

9. Delirium tremens (DTs) is a syndrome patients may experience after withdrawal from which substance?

A. cocaine

B. PCP

C. LSD

D. alcohol

Answer: D

p 230

10. List the four steps to treat a patient suspected of a drug overdose.

Answer: Provide basic life support (clear the airway and perform mouth-to-mask breathing or CPR, as necessary). Keep the patient from hurting self and others. Provide reassurance and psychological support. Arrange for prompt transport to a medical facility for treatment.

p 233

Unit Assessment

1. Poisons may enter the body through any of the following routes except:

A. inhalation.

B. ingestion.

C. injection.

D. excretion.

2. General treatment for a person who has ingested a poison includes all of the following except:

A. trying to get the patient to vomit.

B. arranging for prompt transport to a hospital.

C. calling the poison control center for instructions.

D. trying to identify the poison.

3. You respond to a residence for the report of an illness. When you arrive, you find three family members suffering from headache, nausea, and disorientation. The most likely cause of this illness is

A. food poisoning.

B. flu.

C. allergies.

D. carbon monoxide poisoning.

4. The primary concern when responding to a victim of an inhaled poison is to

A. determine the inhaled substance.

B. contact poison control.

C. remove the patient from the source of the gas.

D. ensure that the patient has an open airway.

5. While cleaning out the crawl space below a house, a patient experiences blotchy skin, redness in the arm, weakness, and localized pain. It is possible that this patient

A. is developing heatstroke.

B. was bitten by a poisonous spider.

C. is having a diabetic reaction.

D. is having a stroke.

6. You suspect that your patient has been bitten by a snake. You should do all of the following except:

A. arrange for prompt transport.

B. clean the injection site with soap and water.

C. have the patient lie down.

D. capture the live snake and bring it in the ambulance to the emergency department.

7. The treatment for insect stings and bites includes

A. placing a tourniquet above the site of the sting or bite.

B. placing ice packs at the site of the sting or bite.

C. having the patient run around to increase the pulse rate and dilute the poison.

D. attempting to suck the poison from the site of the sting or bite.

8. If a poisonous powder has contaminated a patient, how should he or she be treated?

A. Brush off as much powder as possible, then irrigate with water.

B. Immediately start irrigation with very cold water.

C. Leave the powder in place and transport immediately.

D. Irrigate with water for 20 minutes.

9. Delirium tremens (DTs) is a syndrome patients may experience after withdrawal from which substance?

A. cocaine

B. PCP

C. LSD

D. alcohol

10. List the four steps to treat a patient suspected of a drug overdose.

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