Toxicology & Substance Abuse

135 Pages·2014·12.28 MB·English

CChhaapptteerr 3344
TTooxxiiccoollooggyy && SSuubbssttaannccee
AAbbuussee
TTooppiiccss
(cid:1) Epidemiology (cid:1)(cid:1) IInnhhaalleedd TTooxxiinnss
(cid:1) Poison Control Centers (cid:1)(cid:1) SSuurrffaaccee--AAbbssoorrbbeedd TTooxxiinnss
(cid:1) Routes of Toxic Exposure (cid:1)(cid:1) SSppeecciiffiicc TTooxxiinnss
(cid:1) General Principles of (cid:1)(cid:1) IInnjjeecctteedd TTooxxiinnss
Toxicology Assessment
(cid:1)(cid:1) SSuubbssttaannccee AAbbuussee aanndd
and Management
OOvveerrddoossee
(cid:1) Ingested Toxins
(cid:1)(cid:1) AAllccoohhooll AAbbuussee
EEppiiddeemmiioollooggyy
(cid:1) Over 2 million unintentional poisonings occur
annually
(cid:1) More than 90% of accidental poisonings occur
in the home
(cid:1) Just over 51% of accidental poisonings occur in
children under 6 years old
EEppiiddeemmiioollooggyy
(cid:1) Intentional (cid:1) Accidental
(cid:1) Suicide (cid:1) Dosage errors
(cid:1) Chemical (cid:1) Adverse/allergic reactions
warfare/terrorism
(cid:1) Occupational exposure
(cid:1) Assault/homicide
(cid:1) Neglect/abuse
(cid:1) Childhood
Drug/ETOH abuse
PPooiissoonn CCoonnttrrooll CCeenntteerrss
(cid:1) Poison Control
(cid:2) National network of specially trained providers
(cid:2) Typically regional or statewide (Milwaukee)
(cid:2) Statewide # = 1-800-222-1222
(cid:1) Contact Poison Control early
(cid:2) Assist in determining potential toxicity
(cid:2) Advise on prehospital treatment
(cid:2) Advise the receiving facility and Medical Control
GGeenneerraall PPrriinncciipplleess ooff TTooxxiiccoollooggiicc
AAsssseessssmmeenntt aanndd MMaannaaggeemmeenntt
(cid:1) Standard toxicologic emergency procedures
(cid:2) Recognize a poisoning promptly
(cid:2) Assess the patient thoroughly to identify the toxin and
measures required to control it
(cid:2) Initiate standard treatment procedures
Protect rescuer safety
•
Remove the patient from the toxic environment
•
Support ABCs
•
Decontaminate the patient
•
Administer antidote if one exists
•
GGeenneerraall AAsssseessssmmeenntt
(cid:1) Scene size-up
(cid:2) Be alert to the potential for violence
(cid:2) Look for signs of hazardous-material
involvement
Enter a hazardous-materials scene only if properly
•
trained and equipped to do so
(cid:1) Initial assessment
(cid:2) Airway and respiratory compromise are common
in toxicologic emergencies
(cid:2) Manage life-threatening conditions
GGeenneerraall AAsssseessssmmeenntt
(cid:1) History, Physical Exam, and Ongoing
Assessment
(cid:2) Identify the toxin and length of exposure
(cid:2) Contact Poison Control and Medical Control
according to local policy
(cid:2) Complete appropriate physical exams
(cid:2) Monitor vital signs closely
GGeenneerraall TTrreeaattmmeenntt
(cid:1) Initiate supportive treatment
(cid:1) Decontamination
(cid:2) Reduce intake of the toxin
(cid:2)Remove the individual from the toxic environment
(cid:2) Reduce absorption of toxins in the body
(cid:2)Use gastric lavage and activated charcoal
(cid:2) Enhance elimination of the toxin
(cid:2)Use cathartics to enhance GI motility
GGeenneerraall TTrreeaattmmeenntt
Monitor for complications
(cid:1) Respiratory system (cid:1) Cardiovascular system
(cid:1) Secure airway (cid:1) Cardiac dysrhythmias
(cid:1) Bronchospasm (direct or (cid:1) Hypo-/hypertension
indirect effect)
(cid:1) Neurological
(cid:1) Ensure adequate
oxygenation (cid:1) Baseline exam
(cid:1) Noncardiogenic (cid:1) Deviations may be from
pulmonary edema the toxin itself…or from a
metabolic or perfusion
disorder side effect