Author: Jonathan

JF 1

14-5-1HSB

Author: Jonathan

Teacher: Brankline

Course: EMT Basic

December 6, 2013

Poisoning & Overdosing

Poisons are various types of substances that cause mild to life-threatening harm to the body, though typically thought of as chemicals many living organisms produce a substance called a toxin which are poisonous to humans. Poisons have varying effects on people in the sense that some people are more drastically affected by poisons than others, generally young children and the elderly are more susceptible to the effects than the bulk of the population; despite the varying potency, origin, and effects of poisons all are enter the body in one of four ways, they are either ingested, inhaled, absorbed, or injected and each of these paths of entry need to be addressed procedures and treatments unique to them.

Poisons that are ingested, another term for swallowed, typically come in the form of industrial chemicals, plant materials, agricultural products, medications (both over the counter and prescription), improperly stored or prepared foods, and/or petroleum products. To assess the patient in an instance of ingested poisoning the EMT must first determine the substance that was involved, it is vital to properly identify the substance because some substances may have similar names but require different treatment and care if at all possible the EMT should safely contain the substance and bring it to the hospital alongside the patient. Following this it should be determined when did the exposure to the substance occur, how much was ingested, and over how long a period did said ingestion occur. Time of exposure is necessary because some poisons have a delayed effect where as others will affect the patient near instantaneously, the amount of poison ingested will help give an idea of how sever the damage will be but if the EMT is unable to get an exact determination of amount it is best to assume the maximum amount was ingested, the period of ingestion helps determine the treatment needed since a patient who chronically uses a medication may require a different approach than one who has never used it before. Next an estimation of the patients weight needs to be acquired, this may be critical in the amount and type of treatment given at a hospital. Finally the effects the patient is currently and has experienced should be noted because this can help determine the type of poison ingested. The usual treatment for ingested poisons is giving the patient activated charcoal, activated charcoal adsorbs, causing one substance to adhere to the surface of another, the poison which will reduce or prevent damage being done. It is, however, not an antidote and should be used at the discretion of medical direction. In some instances medical direction will call for the dilution of a poison by ingestion of either water or milk, water will help slow adsorption of poison to the body and milk may aid in soothing an upset stomach. It is important to note that most poisons do not have an antidote and the ones that do are not always applicable, for example acetaminophen overdosing is one of the most common poisoning and it has antidote but its symptoms are delayed and the antidote must be administered within 4-12 hours of ingestion it’s generally not used.

Inhaled poisons require a slightly different approach; the exact name of the substance needs to found out so that the hospital can be properly prepared, when and how long exposure occurred is vital to proper care of the patient because the more exposure the patient received the more poison was likely absorbed, any interventions taken need to be addressed such as removal of the patient from the hazardous area, and as always what effects is the patient suffering from. Two of the most common inhalation poisonings are carbon monoxide poisoning and smoke inhalation. The treatment for these would be immediate removal of the patient from the unsafe area, administration of oxygen through a non-rebreather mask, possibly assisting the patient in breathing, and timely transportation to the hospital.

Absorption of poisons occurs when a substance is exposed to the skin or eyes, in some cases but not all the poison does not damage the skin during absorption. The treatment for poisoning cases through absorption are immediate treatment of all life-threating problems, then remove the remaining substance by brushing it off and then irrigating the affected are with clean water for a minimum of 20 minutes preferably continuing en route to the hospital. In cases of acids or alkalis on the skin some people will want to attempt to neutralize the substance by putting solutions such as vinegar or baking soda on it. It is important to avoid this at all costs because although it may neutralize the substance a product of the chemical reaction of neutralization is heat which will not only unnecessarily cause harm the patient by burning the skin, but the damage to the skin may facilitate further absorption of the poison.

Poisoning by injection generally only occurs in instances of substance abuse, snakebites, or bug bites and stings. Snake and bug bites cause damage by directly injecting varying types venom into the body. The treatment an EMT can give to these types of poisoning is very limited because anti-venom is required to properly care for a bite. The EMT can, however, do his or her best to help limit the spread and damage caused by the venom. To do this the patient must first be treated for shock even if he or she shows no signs of going into shock. In the case of bug bites or stings the venom sac needs to be removed, traditional knowledge dictated that it was best to scrape the sac of as opposed to removing it with tweezers to avoid injecting more venom recent studies, however, have found that the means of removal are not as important as the speed of removal. Removal of all jewelry from the affected limb is required because the limb may swell a great deal and cause jewelry to be difficult and potentially dangerous to remove. If local protocols allow a constrictive bandage should be placed about the site of injection as an aide to keep the venom from spreading through blood vessels. The affected area should be immobilized and the patient be made still to prevent any further spreading of the venom. If possible identify the type of creature that caused the bite to aid in anti-venom treatment but do not attempt to capture and transport the animal. The patient should be transported to the hospital as soon as possible.

Overdoses can be caused by any type of poison absorption but are typically caused by substance abuse, an attempt at suicide or in some rare cases an attempt at homicide. If the EMT is able to ascertain the reason of the overdose he or she should proceed accordingly, e.g. being very nonjudgmental, understanding, and kind to someone who attempted suicide. To care for a patient suffering from an overdose the first thing done should be performing a primary assessment, once that is completed treatment for shock should begin immediately. The EMT should speak kindly and respectfully to the patient by maintaining eye contact, introducing his or herself to the patient, addressing the patient by their name, and speaking directly to the patient to try to comfort and try to find out information about the cause and the events leading up to the overdose. A physical assessment should be performed to look for signs of injury paying special attention to the patients head. During this assessment the EMT should check for gross soft-tissue damage or “track marks” as these would indicate injection as the means of overdose. In some cases it may become necessary to restrain the patient in order to prevent their harming of themselves or others, law enforcement should be contacted if needed. Transport to the hospital should begin as soon as possible to give the patient the best chances of survival. Throughout treatment the EMT should be constantly monitoring the patient’s vital signs, breathing rate, airway, as well as staying alert for seizures and reassuring the patient.

Treatment for poisonings has only changed slightly over the years. The main improvement over the years has been preventive such as increased education about how to properly use medications, how to safely handle chemicals, and poisonous chemicals have much better warning labels than they previously did although they are still not completely accurate in all cases. There have been some more specific changes in certain cases, such as the drifting away from using Syrup of Ipecac to induce vomiting because of how ineffective it is compared to other treatments or the rarity of inducing vomiting in general, this is because if the patient swallowed a caustic substance it can cause esophageal and oral damage.

Poisons vary greatly both in types and severity of the effects, this in tandem with the variety of ways they can get into the body creates a plethora of different situations that each come with their own unique set of problems and complications that every EMT must not only be adequate at treating but needs to excel in treating.

Sources

Limmer, Daniel, and Michael F. O'Keefe. Emergency Care. 12th ed. New Jersey: Julie Levin Alexander,

2012. Print.