Toxic Ingestion, Inhalation, Overdose

Definition/Etiology:

• Toxin Ingestion/Inhalation/Overdose
  • Ingestion – Exposure to a substance by swallowing
    • Tylenol
  • Inhalation – Exposure through the respiratory tract, typically a gas inhalation
    • Carbon Monoxide
  • Overdose – Opioids vs cocaine and amphetamine
• Etiology
  • Unintentional
    • Occupational – Work in a garage
    • Therapeutic error – Too much Tylenol
  • Intentional
    • Substance abuse
      • Prescription/Illicit drugs
    • Overdose
      • Intent to die

Pathophysiology:

• Poisoning involves four elements:
  • The poison – cause
  • The poisoned organism – subject
  • The injury to the cells – effect
  • The symptoms and signs of death – consequence
• Variables of poisoning
  • Substance involved
  • Time of exposure
  • Intent of exposure
  • Route of exposure (ingested vs inhaled)
  • Amount of ingested or inhaled

Noticing: Assessment & Recognizing Cues:

• Tylenol
  • Anorexia
  • N/V
  • Malaise
  • Hepatotoxic – Tylenol has affinity for the liver!
    • RUQ pain
    • Jaundice
    • Signs/Sx Hypoglycemia
• Carbon Monoxide
  • Confusion/ ↓LOC
  • Skin = bright red/pink
  • blurred vision
  • SOB
  • poor 02 Sat
• Overdose
  • Excitatory (Cocaine, LSD, Meth)
    • Dilated pupils
    • Tachycardia
    • Hyperthermia
    • Tremors
    • Delirium/Hallucinations/Agitation
  • Inhibitory (Opioids, Benzodiazepines)
    • Constricted pupils
    • Bradycardia
    • Hypothermia
    • Sedation/Stupor/Coma

Interpreting: Analyzing & Planning:

• Labs (as indicated)
  • Liver Function
    • ↑ AST & ALT
  • Tylenol Levels
    • Suspected Overdose = High
  • Carboxyhemoglobin
    • complex of carbon monoxide and hemoglobin (Hb) that forms in red blood cells upon contact with carbon monoxide.
  • Culprit Drug
    • Serum Toxicology
    • Urine Drug Screen
• Diagnostics
  • CXR – inhalation injury (pulm edema)
  • ECG – Arrhythmias
  • CT head – R/O other cause altered mental status

Responding: Patient Interventions & Taking Action:

• Poison Control
  • Doctor usually calls – expert algorithms
• Inhalation Interventions
  • Maintain airway -inhalation causes airway edema
    • Gag reflex
    • Aspiration risk
    • Suction Ready
    • Supplemental 02
    • Possible ventilator
• Ingestion Interventions
  • Gastric Lavage “Stomach Pump
    • OG or NG tube
    • Confirm with X Ray
    • Saline, Tap Water or Activated charcoal
• Pharmacological
  • N-acetylcysteine (NAC) – Tylenol Antidote
  • 100% Oxygen – Carbon Monoxide poisoning
  • Benzos – Cocaine
  • Narcan – reverses Opioid Respiratory and/or CNS depression
  • IV dextrose
    • Most drugs are liver toxic!
    • Symptoms of hypoglycemia (e.g., altered mental status, cool, clammy skin, coma
• Nonpharmacological
  • Hemodialysis
  • Hemoperfusion
    • Blood is pumped through a cartridge containing activated charcoal and/or carbon, which absorbs toxins

Reflecting: Evaluating Patient Outcomes:

• Maintain adequate airway and ventilation
• Patient remains hemodynamically stable
• Patient returns to baseline neurologic status
• Return of core temperature to within a normal temperature range of 36.1°C to 37.2°C (97°F–99°F).

Linchpins (Key Points):

• Notice – Rute and intent
  • Inhalation vs Ingestion vs Overdose
• Interpret -History & Labs
  • Dictates the Intervention
• Respond – Pharmacology & Interventions
  • Airway and/or Gastric Lavage
• Reflect – Hemodynamics & LOC
  • Temperature is another huge factor with overdose