Transcript Chapter 12

Chapter 12
Substance Abuse
and Poisoning
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
12.1 List and describe the four ways a drug
enters and moves through the body.
12.2 List the four routes of absorption.
12.3 Define the following terms:
a.
b.
c.
d.
poison
substance
substance abuse
toxin
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
12.4 List and describe three commonly
abused substances.
12.5 List the signs and symptoms associated
with commonly abused substances and
with common poisonings.
12.6 Describe and demonstrate the proper
care of a patient who has abused a
substance or been poisoned.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
12.7 List and describe two emergency
sources for poison-related or chemicalrelated information.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Topics
 Anatomy
and Physiology
 Commonly Abused Substances and
Poison Related Emergencies
 Assessment
 Management
 Chapter Summary
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Presentation
You are doing some pre-season scouting in
mountainous terrain and you notice an unkempt
middle-aged man coming down the trail toward you.
He is stumbling as he walks, has slurred speech and
seems quite agitated.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology
 Physiologic
actions
◦ Absorption: the way the substance or
poison enters the body.
•
•
•
•
Ingestion – through gastrointestinal tract.
Inhalation – through lung tissue.
Transdermal absorption – through the skin.
Injection – through placement of substance
in or near bloodstream.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology
 Physiologic
actions
◦ Distribution: transport of substance to
site where it will exert its effects.
◦ Metabolism: body breaks down the
substance.
◦ Elimination: body purges itself of
substance.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology
 Affected
body systems
◦ Nervous system: can affect central or
peripheral nervous system; can be
localized or general.
◦ Myocardial: can affect heart muscle –
increase or decrease in contractility,
change heart rate or conduction system.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology
 Affected
body systems
◦ Ocular: can affect pupillary dilation or
constriction or muscles that coordinate
eye movement.
◦ Hematological: can affect blood’s ability
to clot or carry O2, can destroy red cells,
can inhibit or destroy bone marrow
production of red cells.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Commonly Abused Substances
and Poison-Related Emergencies
 Substance
abuse
◦ Intentional
misuse resulting
in impairment or
distress
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Commonly Abused Substances
and Poison-Related Emergencies
 Categories:
◦ Acids or bases – common in household
and industrial cleaning solutions; can
cause direct tissue damage.
◦ Antianxiety drugs (sedatives) – common
use for excessive emotion, panic or
social disorders; central nervous system
depressant.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Commonly Abused Substances
and Poison-Related Emergencies
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Commonly Abused Substances
and Poison-Related Emergencies
 Categories:
◦ Antidepressants – used to treat
depression, anxiety and panic.
◦ Antipsychotics (tranquilizers) – used to
treat psychosis; affects BP and heart.
◦ Depressants – used to decrease central
nervous system activity; can cause
respiratory depression and death.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Commonly Abused Substances
and Poison-Related Emergencies
 Categories:
◦ Designer drugs – impair brain function;
can cause seizures and coma; combined
with alcohol, causes sedation &
amnesia.
◦ Hallucinogens – distort sensory
perception and impair emotion, judgment
and memory.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Commonly Abused Substances
and Poison-Related Emergencies
 Categories:
◦ Inhalants – chemical vapors from
household products; mind-altering
effects similar to alcohol use, loss of
sensation, unresponsiveness, shock and
death.
◦ Nerve agents – chemicals used in
warfare and terrorism; interrupt nerve
impulses; absorbed through lungs or continued
skin.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Commonly Abused Substances
and Poison-Related Emergencies
 Categories:
◦ Opiates (narcotics) – affect central
nervous system, relieve pain, and can
affect mood, emotion and wakefulness;
can cause respiratory depression and
death.
◦ Organophosphate – affect similar to
nerve agents; found in insecticides,
pesticides and herbicides.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Commonly Abused Substances
and Poison-Related Emergencies
 Categories:
◦ Stimulants – increase central nervous
system activity resulting in increased
heart rate, BP, metabolism, excitement,
agitation, erratic or dangerous behavior.
◦ Prescription drugs – ordered by a
physician and increasingly misused;
overdose often accidental when
therapeutic dose close to toxic dose. continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Commonly Abused Substances
and Poison-Related Emergencies
 Common
Substances Encountered
◦ Acetaminophen (Tylenol)
• Ccommonly combined with other drugs and
results in poisoning, causing irreversible liver
damage.
◦ Alcohol
• Most commonly abused drug in the world,
causing accidents, injuries and death;
inhibits central nervous system function,
affecting judgment, motor coordination, continued
respiratory rate and depth.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Commonly Abused Substances
and Poison-Related Emergencies
 Common
Substances Encountered
◦ Aspirin (acetylsalicylic acid)
• Common ingredient; can cause respiratory
depression, acidosis and death.
◦ Carbon monoxide (CO)
• Odorless, colorless, tasteless gas is
byproduct of incomplete combustion;
displaces O2 carrying ability of red cells.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Commonly Abused Substances
and Poison-Related Emergencies
 Common
Substances Encountered
◦ Cocaine (coke, crack, snow, rock, nose
candy)
• Addictive stimulant of nervous and
cardiovascular systems.
◦ Ethylene glycol
• Found in household and automotive
products (antifreeze); can cause organ
damage, shock and death.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Commonly Abused Substances
and Poison-Related Emergencies
 Common
Substances Encountered
◦ Iron supplements
• Found in a variety of supplements; can
cause liver and kidney failure and death.
◦ LSD (lysergic-diethylamide, acid)
• Causes mood-changes, delusions and visual
hallucinations; increase in heart rate, BP and
temperature, sleeplessness.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Commonly Abused Substances
and Poison-Related Emergencies
 Common
Substances Encountered
◦ Marijuana (pot, weed, cannabis, THC,
hashish)
• Most commonly used illegal drug in U.S.;
affects perceptions, thinking, memory and
learning; smoked/ingested.
◦ Methamphetamine (Speed, Meth)
• Addictive stimulant; heightened arousal and
physical activity, decrease appetite; chronic
continued
use may lead to psychotic behavior,
hallucinations and stroke.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Commonly Abused Substances
and Poison-Related Emergencies
 Common
Substances Encountered
◦ Methane
• Highly flammable gas that displaces O2 in
closed areas, leads to hypoxia.
◦ PCP (phencyclidine, angel dust)
• Veterinary tranquilizer; mixed with other
drugs such as marijuana; overdose may
cause violent or suicidal behavior or lead to
serious traumatic injury.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Commonly Abused Substances
and Poison-Related Emergencies
 Common
Substances Encountered
◦ Toxic plants
• Most commonly affects children, foragers,
herbalists, pleasure seekers and suicidal
patients.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Update
Patient appears confused. Responding to basic
questions, you find he is oriented to his name and
situation only. He has been camping for 2 days and
consumed 2 fifths of whiskey, but none in last 10
hours. He denies injury or medical history. You find
pupils dilated, warm skin, rapid pulse, shaky hands
and unsteady on feet.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
 Scene
size-up: assess hazards.
 Primary assessment: ABCDs, AVPU,
GCS, reassess frequently.
 Secondary assessment: SAMPLE,
Vital Signs,look for signs (containers,
pill bottles, paraphernalia) at the
scene, collect all signs, avoid
contamination of self, determine
quantity/time, physical exam.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 Summon
assistance as needed, i.e.
fire department, law enforcement,
HAZMAT. Reduce substance
exposure.
◦ Only dilute ingested poisons IF:
• Instructed to do so by your medical director
or poison control center, and
• No contraindication to do so, i.e.
• Nausea/vomiting
• Depressed level of responsiveness
BRADY
continued
◦ NEVER induce vomiting in the field
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 For
topical poisons, brush off dry
particles and rinse away any
remaining with water.
 For liquid poisons, thoroughly rinse
with water.
 For ocular exposure, immediately
irrigate with sterile water or irrigation
solutions.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 For
inhaled poisons, immediately
remove patient from source of
poisoning.
 Maintain airway, high-flow O2,
consider ALS transport.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
continued
Copyright Edward McNamara
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
continued
Copyright Edward McNamara
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 Reduce
substance absorption with
activated charcoal IF:
◦ Authorized by your medical advisor,
local or state EMS authority to
administer.
◦ Poison was ingested < 60 minutes ago.
◦ Patient is awake and responsive.
◦ Transport time is prolonged.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 Arrange
rapid transport to definitive
care facility.
 Help is only a phone call away:
◦ National Poison Center (24/7 service)
• 1-800-222-1222
◦ Chemical Transportation Emergency
Center (CHEMTREC)
• 1-800-262-8200
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Disposition
You suspect the patient is exhibiting signs of alcohol
withdrawal. You make the patient comfortable and
administer high-flow O2. You arrange evacuation by
rescue team. You calm the patient.
Later, you hear that the patient had a seizure on the
way to hospital but made a full recovery, entering
rehabilitation.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
 Personal
safety is always first.
 Alcohol is the most abused drug.
 Carbon monoxide is a silent killer.
 Antidotes exist for many types of
drugs
 Three most deadly for children –
aspirin, acetaminophen and iron.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
 Always
try to identify the poison.
 National Poison Control: 1-800-2221222
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ