Toxicology

2-9 Toxicology

2-9-a. General Management

1) Get a specific history of the poisoning, if available.

2) Collect pill bottles or containers at the scene.

3) Give supportive care if the cause of the poisoning is unknown.

4) Consider scene safety and personal protective equipment /PPE.

2-9-b. Toxidromes

1) Depressant (opiates, benzodiazepines, alcohol).

2) Stimulants (cocaine, methamphetamine, other street drugs).

3) Hallucinogens (may be combined with other toxidromes, like stimulants).

4) Anticholinergic (caused by atropine, antihistamines, antidepressants, antiparkinsonians, antipsychotics)

• Symptoms: AMS, dilated pupils, fever, red dry skin).

5) Cholinergic: SLUDGE syndrome (Salivation, Lacrimation = teary eyes, Urination, Diaphoresis, GI upset = diarrhea, Emesis) Caused by some insecticides, eating tobacco, e-cig liquid, mushroom poisoning.

2-9-c. Other Toxicology Topics

1) Carbon Monoxide “CO”: can be inhaled in a structure fire and is treated with high flow O2. Some cardiac monitors can test for CO.

2) Cyanide: can be inhaled in a structure fire and causes very serious but nonspecific illness. The best antidote is hydroxocobalamin = IV vitamin B12, and this is stored at the hospital. If available: Sodium Thiosulfate 12.5 g IV over 10 min.

3) Naloxone: reverses the opiates/narcotics but may have a shorter half-life than the ingested drug and should be titrated / dosed to get the desired effect of improved respiration, while avoiding abrupt narcotic withdrawal.

Dose is 0.4 mg – 2 mg by IN/IV/IO, titrated up to 8 mg.

4) Nerve Agents: terrorist weapons, with special antidotes (pralidoxime/ 2- PAM, atropine, auto-injectors).

5) Mass Psychogenic Illness: consider this when groups of several people have dramatic symptoms but not specific objective signs of severe illness.