toxicology and substance abuse ray taylor valencia community college department of emergency medical...

ToxicologyToxicologyandand

Substance AbuseSubstance Abuse

Ray TaylorRay TaylorValencia Community CollegeValencia Community College

Department of Emergency Medical ServicesDepartment of Emergency Medical Services

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TopicsTopics

EpidemiologyEpidemiology Poison Control CentersPoison Control Centers Routes of Toxic Routes of Toxic

ExposureExposure General Principles of General Principles of

Toxicology Assessment Toxicology Assessment and Managementand Management

Ingested ToxinsIngested Toxins

Inhaled ToxinsInhaled Toxins Surface-Absorbed Surface-Absorbed

ToxinsToxins Specific ToxinsSpecific Toxins Injected ToxinsInjected Toxins Substance Abuse and Substance Abuse and

OverdoseOverdose Alcohol AbuseAlcohol Abuse

EpidemiologyEpidemiology

Over 4 million poisonings Over 4 million poisonings occur annually.occur annually.

10% of ED visits and EMS 10% of ED visits and EMS responses involve toxic responses involve toxic exposures.exposures.

70% of accidental 70% of accidental poisonings occur in children poisonings occur in children under 6 years old.under 6 years old.

80% of attempted suicides 80% of attempted suicides involve a drug overdose.involve a drug overdose.

Poison Control CentersPoison Control Centers

Poison ControlPoison Control National network of specially trained providers.National network of specially trained providers. Typically regional or statewide.Typically regional or statewide. Accessed by telephone.Accessed by telephone.

Contact poison control early.Contact poison control early. Assist in determining potential toxicity.Assist in determining potential toxicity. Advise on prehospital treatment.Advise on prehospital treatment. Advise the receiving facility and medical direction.Advise the receiving facility and medical direction.

Routes of Toxic ExposureRoutes of Toxic Exposure

IngestionIngestion Common agents:Common agents:

Household productsHousehold products Petroleum-based agentsPetroleum-based agents Cleaning agentsCleaning agents CosmeticsCosmetics Drugs, plants, or foodsDrugs, plants, or foods

Absorption occurs in Absorption occurs in the stomach and small the stomach and small intestine.intestine.


InhalationInhalation Common agents:Common agents:

Toxic gases, vapors, Toxic gases, vapors, fumes, aerosolsfumes, aerosols

Carbon monoxide, Carbon monoxide, ammonia, chlorineammonia, chlorine

Tear gas, freon, nitrous Tear gas, freon, nitrous oxide, methyl chlorideoxide, methyl chloride

Carbon tetrachlorideCarbon tetrachloride Absorption occurs Absorption occurs

via the capillary-via the capillary-alveolar membrane alveolar membrane in the lungs.in the lungs.

Inhaled poisoningInhaled poisoningInhaled poisoningInhaled poisoning Injury is directly proportional Injury is directly proportional

to the concentration of the to the concentration of the chemical in the airchemical in the air

Solubility of chemical also Solubility of chemical also influences injuryinfluences injury Soluble chemicalsSoluble chemicals i.e.: i.e.:

chlorine and anhydrous chlorine and anhydrous ammonia cause injuries early ammonia cause injuries early (upper airways)(upper airways)

Insoluble chemicalsInsoluble chemicals i.e.: i.e.: nitrogen dioxide need to nitrogen dioxide need to metabolize before injury metabolize before injury occurs (alveoli and occurs (alveoli and bronchioles) bronchioles)

Injury is directly proportional Injury is directly proportional to the concentration of the to the concentration of the chemical in the airchemical in the air

Solubility of chemical also Solubility of chemical also influences injuryinfluences injury Soluble chemicalsSoluble chemicals i.e.: i.e.:

chlorine and anhydrous chlorine and anhydrous ammonia cause injuries early ammonia cause injuries early (upper airways)(upper airways)

Insoluble chemicalsInsoluble chemicals i.e.: i.e.: nitrogen dioxide need to nitrogen dioxide need to metabolize before injury metabolize before injury occurs (alveoli and occurs (alveoli and bronchioles) bronchioles)

InhalantsInhalantsInhalantsInhalants Classifications of toxic Classifications of toxic

gasesgases Simple asphyxiantsSimple asphyxiants

lowers Olowers O22 concentrations concentrations ie: Methane, propane, other ie: Methane, propane, other

inert gasesinert gases Chemical asphyxiantsChemical asphyxiants

systemic toxicitysystemic toxicity ie: Carbon Monoxide, ie: Carbon Monoxide,

cyanidecyanide Irritants or corrosivesIrritants or corrosives

cellular destruction on cellular destruction on contactcontact

ie: chlorine, ammoniaie: chlorine, ammonia

Classifications of toxic Classifications of toxic gasesgases Simple asphyxiantsSimple asphyxiants

lowers Olowers O22 concentrations concentrations ie: Methane, propane, other ie: Methane, propane, other

inert gasesinert gases Chemical asphyxiantsChemical asphyxiants

systemic toxicitysystemic toxicity ie: Carbon Monoxide, ie: Carbon Monoxide,

cyanidecyanide Irritants or corrosivesIrritants or corrosives

cellular destruction on cellular destruction on contactcontact

ie: chlorine, ammoniaie: chlorine, ammonia

General ManagementGeneral Management

Protect yourself !! Scene Safety!!Protect yourself !! Scene Safety!!


Surface AbsorptionSurface Absorption Common agents:Common agents:

Poison ivy, oak, or sumacPoison ivy, oak, or sumac OrganophosphatesOrganophosphates

Absorption occurs through Absorption occurs through capillaries in the skin.capillaries in the skin.


InjectionInjection Common agents:Common agents:

Animal bites or Animal bites or stingsstings

Intentional injection Intentional injection of illicit drugsof illicit drugs

Substance enters Substance enters directly into the directly into the body through a body through a break in the skin.break in the skin.

RoutesRoutes

Ingestion - *induce emesis only if Poison Control Ingestion - *induce emesis only if Poison Control advises (79.2%)advises (79.2%)

Inhalation - *freon; *chlorine most often (5.1%)Inhalation - *freon; *chlorine most often (5.1%) Surface Absorption - *pesticides; Surface Absorption - *pesticides;

*organophosphates (6.3%)*organophosphates (6.3%)

- ophthalmic absorption (5.3%)- ophthalmic absorption (5.3%) Injection – most common for anaphylaxis (3.1%)Injection – most common for anaphylaxis (3.1%) 5% have antidotes5% have antidotes

General Principles of Toxicologic General Principles of Toxicologic Assessment and ManagementAssessment and Management

Standard Toxicologic Emergency Standard Toxicologic Emergency ProceduresProcedures

Recognize a poisoning promptly.Recognize a poisoning promptly. Assess the patient thoroughly to Assess the patient thoroughly to

identify the toxin and measures identify the toxin and measures required to control it.required to control it.

Initiate standard treatment Initiate standard treatment procedures.procedures.

Protect rescuer safety.Protect rescuer safety. Remove the patient from the Remove the patient from the

toxic environment.toxic environment. Support ABCs.Support ABCs. Decontaminate the patient.Decontaminate the patient. Administer antidote if one Administer antidote if one

exists.exists.

General AssessmentGeneral Assessment Scene Size-upScene Size-up

Be alert to the potential for Be alert to the potential for violence.violence.

Look for signs of hazardous Look for signs of hazardous material involvement.material involvement.

Enter a hazardous materials Enter a hazardous materials scene only if properly scene only if properly trained and equipped to do trained and equipped to do so.so.

Initial AssessmentInitial Assessment Airway and respiratory Airway and respiratory

compromise are common in compromise are common in toxicologic emergencies.toxicologic emergencies.

Manage life-threatening Manage life-threatening conditions.conditions.

General AssessmentGeneral Assessment History, Physical Exam, History, Physical Exam,

and Ongoing Assessmentand Ongoing Assessment Identify the toxin and Identify the toxin and

length of exposure.length of exposure. Contact poison control Contact poison control

and medical direction and medical direction according to local policy.according to local policy.

Complete appropriate Complete appropriate physical exams.physical exams.

Monitor vital signs Monitor vital signs closely.closely.

General TreatmentGeneral Treatment

DecontaminationDecontamination Reduce intake of the toxin.Reduce intake of the toxin.

Remove the individual from Remove the individual from the toxicthe toxic environment. environment.

Reduce absorption of toxins Reduce absorption of toxins in the body.in the body.

Use gastric lavage and Use gastric lavage and activated charcoal.activated charcoal.

““The treatment for The treatment for pollution is dilution.”pollution is dilution.”

Enhance elimination of the Enhance elimination of the toxin.toxin.

Use cathartics (defecation).Use cathartics (defecation).


AntidotesAntidotes Useful only if the substance is known.Useful only if the substance is known. Rarely 100% effective.Rarely 100% effective. Must be used in conjunction with other therapies Must be used in conjunction with other therapies

to ensure effectiveness.to ensure effectiveness.


Suicidal Patients and Suicidal Patients and Protective CustodyProtective Custody Involve law Involve law

enforcement.enforcement. Involve medical Involve medical

direction.direction. Know local procedures Know local procedures

and laws.and laws. Laws for protective Laws for protective

custody vary widely.custody vary widely.


AssessmentAssessment HistoryHistory

What was ingested?What was ingested? When was it ingested?When was it ingested? How much was ingested?How much was ingested? Did you drink any alcohol?Did you drink any alcohol? Have you attempted to treat yourself?Have you attempted to treat yourself? Have you been under psychiatric care? Why?Have you been under psychiatric care? Why? What is your weight?What is your weight?


Physical ExamPhysical Exam SkinSkin EyesEyes MouthMouth ChestChest CirculationCirculation AbdomenAbdomen

Exposure to Multiple ToxinsExposure to Multiple Toxins Suicide attempt, experimentationSuicide attempt, experimentation

Ingested ToxinsIngested Toxins ManagementManagement

Contact poison control/medical direction.Contact poison control/medical direction. Prevent aspiration.Prevent aspiration. Administer fluids and drugs.Administer fluids and drugs.

IV accessIV access Use of DUse of D5050W, naloxone, and thiamineW, naloxone, and thiamine DecontaminationDecontamination

Do NOT induce vomiting.Do NOT induce vomiting.

Inhaled ToxinsInhaled Toxins AssessmentAssessment

History and Physical ExamHistory and Physical Exam Evaluate the scene.Evaluate the scene. Central nervous system effects include dizziness, Central nervous system effects include dizziness,

headache, confusion, seizure, hallucinations, coma.headache, confusion, seizure, hallucinations, coma. Respiratory effects include cough, hoarseness, stridor, Respiratory effects include cough, hoarseness, stridor,

dyspnea, retractions, wheezing, chest pain or tightness, dyspnea, retractions, wheezing, chest pain or tightness, crackles, rhonchi.crackles, rhonchi.

Cardiac effects include dysrhythmias.Cardiac effects include dysrhythmias.

Inhaled and Surface Absorbed Inhaled and Surface Absorbed ToxinsToxins

ManagementManagement Ensure your personal safety.Ensure your personal safety.

Do not enter a hazardous Do not enter a hazardous scene unless properly trained scene unless properly trained and equipped to do so.and equipped to do so.

Remove the patient from the Remove the patient from the environment.environment.

Remove the patient’s Remove the patient’s contaminated clothing.contaminated clothing.

Perform the initial assessment, Perform the initial assessment, history, and physical exam.history, and physical exam.

Initiate supportive measures.Initiate supportive measures. Contact poison control and Contact poison control and

medical direction according to medical direction according to local protocol.local protocol.

Specific ToxinsSpecific Toxins

CyanideCyanide

ExposureExposure Fast-acting toxinFast-acting toxin Usually ingested or absorbedUsually ingested or absorbed

Signs and SymptomsSigns and Symptoms Burning sensation in the mouth and throatBurning sensation in the mouth and throat Headache, confusion, and combativenessHeadache, confusion, and combativeness Hypertension and tachycardiaHypertension and tachycardia Seizures and comaSeizures and coma Pulmonary edemaPulmonary edema

CyanideCyanide

ManagementManagement Ensure rescuer safety.Ensure rescuer safety. Initiate supportive care.Initiate supportive care. Administer antidote:Administer antidote:

Cyanide antidote kitCyanide antidote kit amyl nitriteamyl nitrite sodium nitritesodium nitrite sodium thiosulfatesodium thiosulfate Hydroxocobalamin Hydroxocobalamin (Cyanokit)(Cyanokit)

Carbon MonoxideCarbon Monoxide

ExposureExposure Inhaled colorless, odorless gas, infinity 200-250xInhaled colorless, odorless gas, infinity 200-250x

Poorly ventilated heating systemsPoorly ventilated heating systems Confined spacesConfined spaces

Signs and SymptomsSigns and Symptoms HeadacheHeadache Nausea and vomitingNausea and vomiting Confusion or other altered mental statusConfusion or other altered mental status TachypneaTachypnea

Carbon MonoxideCarbon Monoxide ManagementManagement

Ensure rescuer safety.Ensure rescuer safety. Remove the patient Remove the patient

from the contaminated from the contaminated area.area.

Initiate supportive Initiate supportive measures.measures. High-flow, high-High-flow, high-

concentration oxygenconcentration oxygen

Hyperbaric therapyHyperbaric therapy

Cardiac MedicationsCardiac Medications ExposureExposure

Commonly due to dosage Commonly due to dosage errorserrors

Signs and SymptomsSigns and Symptoms Nausea, vomiting, headache, Nausea, vomiting, headache,

dizziness, confusiondizziness, confusion Profound hypotension, Profound hypotension,

cardiac dysrhythmiascardiac dysrhythmias Bronchospasm, pulmonary Bronchospasm, pulmonary

edemaedema ManagementManagement

Standard toxicologic Standard toxicologic emergency proceduresemergency procedures

AntidotesAntidotes

Caustic SubstancesCaustic Substances

ExposureExposure Typically occurs by ingestion or surface Typically occurs by ingestion or surface

absorption.absorption. AcidsAcids

Cause significant damage at sites of exposure.Cause significant damage at sites of exposure. Are rapidly absorbed into the bloodstream.Are rapidly absorbed into the bloodstream.

AlkalisAlkalis Slower onset of symptoms allows for longer contact Slower onset of symptoms allows for longer contact

and more extensive tissue damage.and more extensive tissue damage.

Caustic SubstancesCaustic Substances

Signs and SymptomsSigns and Symptoms Facial burnsFacial burns Pain in the lips, tongue, throat, or gumsPain in the lips, tongue, throat, or gums Drooling, trouble swallowingDrooling, trouble swallowing Hoarseness, stridor, or shortness of breathHoarseness, stridor, or shortness of breath Shock from bleeding, vomitingShock from bleeding, vomiting

ManagementManagement Perform standard toxicologic emergency procedures.Perform standard toxicologic emergency procedures. Maintain an adequate airway.Maintain an adequate airway. Do not neutralize!!!Do not neutralize!!!

Hydrofluoric AcidHydrofluoric Acid

ExposureExposure Highly toxic; used to clean and etch glass.Highly toxic; used to clean and etch glass.

Signs and SymptomsSigns and Symptoms Burning at site of contact.Burning at site of contact. Confusion, palpitations, muscle cramps.Confusion, palpitations, muscle cramps.

ManagementManagement Perform standard toxicologic emergency procedures.Perform standard toxicologic emergency procedures. Irrigate and immerse the affected area.Irrigate and immerse the affected area. Transport immediately for definitive care.Transport immediately for definitive care.

HydrocarbonsHydrocarbons

Compounds of Carbon and HydrogenCompounds of Carbon and Hydrogen May be ingested, inhaled, or adsorbedMay be ingested, inhaled, or adsorbed

Signs and SymptomsSigns and Symptoms Burns due to local contactBurns due to local contact Wheezing, dyspnea, hypoxia, pneumonitisWheezing, dyspnea, hypoxia, pneumonitis Headache, dizziness, slurred speech, ataxia, obtundation, Headache, dizziness, slurred speech, ataxia, obtundation,

cardiac dysrhythmiascardiac dysrhythmias Foot and wrist drop with numbness and tinglingFoot and wrist drop with numbness and tingling

ManagementManagement Standard toxicologic emergency proceduresStandard toxicologic emergency procedures

Contaminated FoodContaminated Food

Bacteria, Viruses, and Toxic ChemicalsBacteria, Viruses, and Toxic Chemicals Bacterial toxinsBacterial toxins

Exotoxins (affect cell metabolism) and enterotoxins Exotoxins (affect cell metabolism) and enterotoxins (kills cells by destroying cell membrane)(kills cells by destroying cell membrane)

Seafood poisoningsSeafood poisonings Signs and SymptomsSigns and Symptoms

Nausea, vomiting, diarrhea, and abdominal painNausea, vomiting, diarrhea, and abdominal pain Facial flushing and respiratory distressFacial flushing and respiratory distress

Contaminated FoodContaminated Food TreatmentTreatment

Perform assessment.Perform assessment. Collect samples of the suspect food source.Collect samples of the suspect food source. Maintain the airway and support breathing.Maintain the airway and support breathing.

Intubate and assist ventilations if indicated.Intubate and assist ventilations if indicated. Administer high-flow, high-concentration Administer high-flow, high-concentration

oxygen.oxygen. Establish IV access.Establish IV access. Consider medications.Consider medications.

Antihistamines, antiemetics.Antihistamines, antiemetics.

Poisonous Plants and MushroomsPoisonous Plants and Mushrooms

Decorative PlantsDecorative Plants Common source of Common source of

accidental poisoning in accidental poisoning in childrenchildren

Signs and SymptomsSigns and Symptoms Excessive salivation, Excessive salivation,

lacrimation, diaphoresis, lacrimation, diaphoresis, abdominal cramps, nausea, abdominal cramps, nausea, vomiting, diarrhea, and vomiting, diarrhea, and altered mental statusaltered mental status

TreatmentTreatment Follow treatment guidelines Follow treatment guidelines

for contaminated food.for contaminated food.

Injected ToxinsInjected Toxins General Principles of ManagementGeneral Principles of Management

Protect rescuers.Protect rescuers. Remove the patient from danger.Remove the patient from danger. Identify the organism that caused Identify the organism that caused

the injury.the injury. Perform an initial assessment and Perform an initial assessment and

rapid physical exam.rapid physical exam. Prevent or delay absorption of the Prevent or delay absorption of the

poison.poison. Initiate supportive measures as Initiate supportive measures as

indicated.indicated. Watch for anaphylactic reactions.Watch for anaphylactic reactions. Transport the patient rapidly.Transport the patient rapidly. Contact poison control and Contact poison control and

medical direction.medical direction.

Insect Bites and StingsInsect Bites and Stings

Insect StingsInsect Stings Signs and SymptomsSigns and Symptoms

Localized pain, redness, swelling, skin wheal.Localized pain, redness, swelling, skin wheal. Idiosyncratic reactionsIdiosyncratic reactions

Observe for signs of an allergic reaction.Observe for signs of an allergic reaction. Localized pain, redness, swelling, skin whealLocalized pain, redness, swelling, skin wheal Generalized flushing of the skin or itchingGeneralized flushing of the skin or itching Tachycardia, hypotension, bronchospasm, laryngeal edema, Tachycardia, hypotension, bronchospasm, laryngeal edema,

facial edema, uvular swellingfacial edema, uvular swelling


Insect StingsInsect Stings TreatmentTreatment

Wash the area.Wash the area. Remove stingers, if present.Remove stingers, if present.

Use care not to disturb the venom sac.Use care not to disturb the venom sac.

Apply cool compresses to the injection site.Apply cool compresses to the injection site. Observe for and treat allergic reactions and/or Observe for and treat allergic reactions and/or

anaphylaxis.anaphylaxis.

Spider BitesSpider BitesSpider BitesSpider Bites Two types common to USTwo types common to US

Black Widow and Brown Black Widow and Brown RecluseRecluse

Types of reactions to bitesTypes of reactions to bites neurotoxic reaction (Black neurotoxic reaction (Black

Widow)Widow) local tissue necrosis local tissue necrosis

(Brown Recluse)(Brown Recluse)

Two types common to USTwo types common to US Black Widow and Brown Black Widow and Brown

RecluseRecluse Types of reactions to bitesTypes of reactions to bites

neurotoxic reaction (Black neurotoxic reaction (Black Widow)Widow)

local tissue necrosis local tissue necrosis (Brown Recluse)(Brown Recluse)


Brown RecluseBrown Recluse Found primarily in the Found primarily in the

South and MidwestSouth and Midwest FeaturesFeatures

““Fiddleback”Fiddleback” 1” body, long thin legs1” body, long thin legs Painless bitePainless bite Halo bleb to necrosisHalo bleb to necrosis

Debride – Debride – steroid/xylocaine; steroid/xylocaine; BenadrylBenadryl


Brown Recluse Spider BiteBrown Recluse Spider Bite Signs and SymptomsSigns and Symptoms

Localized, white-ringed Localized, white-ringed macule.macule.

Progresses to localized Progresses to localized pain, redness, and pain, redness, and swelling over next 8 swelling over next 8 hours.hours.

Chills, fever, nausea, Chills, fever, nausea, vomiting, and joint pain vomiting, and joint pain may also develop.may also develop.


Brown Recluse Spider BiteBrown Recluse Spider Bite Signs and SymptomsSigns and Symptoms

Tissue necrosis develops Tissue necrosis develops over subsequent days over subsequent days and weeks.and weeks.

TreatmentTreatment Follow general treatment Follow general treatment

guidelines.guidelines. Provide supportive care.Provide supportive care.

Black WidowBlack Widow

Adult female injects venom with pincer-like teethAdult female injects venom with pincer-like teeth No pain after mild bite, then lymph nodes No pain after mild bite, then lymph nodes

draining site become painfuldraining site become painful Within 1Within 1stst ½ hour, local erythema, sweating & ½ hour, local erythema, sweating &

piloerection at wound sitepiloerection at wound site Over next few hrs white, blanched plaque visible Over next few hrs white, blanched plaque visible

@ center and lymphangitis@ center and lymphangitis Cramping muscle spasms to thighs, lumbar Cramping muscle spasms to thighs, lumbar

region, abdomen or thorax *due to excessive region, abdomen or thorax *due to excessive release of neurotransmittersrelease of neurotransmitters

Musculature becomes hypertonic & abdominal Musculature becomes hypertonic & abdominal rigidity, trismus, opisthotonusrigidity, trismus, opisthotonus


Respirations shallow, tachy, irregularRespirations shallow, tachy, irregular Dysarthria, hoarsenessDysarthria, hoarseness Priapism & ejaculation possiblePriapism & ejaculation possible Pain produced by tissue hypoxia from muscular Pain produced by tissue hypoxia from muscular

spasm and vasoconstrictionspasm and vasoconstriction Venom causes depletion of acetylcholine at Venom causes depletion of acetylcholine at

motor nerve endings & provokes release of motor nerve endings & provokes release of catecholamines at adrenergic nerve endingscatecholamines at adrenergic nerve endings

*Calcium gluconate, 10 ml of 10% solution, may *Calcium gluconate, 10 ml of 10% solution, may repeat X1 for pain/antivenin & MS for pain if not repeat X1 for pain/antivenin & MS for pain if not relieved by calcium/IV diazepamrelieved by calcium/IV diazepam


Hourglass on abdomen Hourglass on abdomen (ventral)(ventral)

Egg cases spiked Egg cases spiked

golf ballgolf ball Under chairs, in Under chairs, in

garages, machinesgarages, machines Bite can look like Bite can look like

puncturepuncture


Black Widow Spider Black Widow Spider BiteBite TreatmentTreatment

Follow general treatment Follow general treatment guidelines.guidelines.

Provide supportive care.Provide supportive care. Consider using muscle Consider using muscle

relaxants to relieve severe relaxants to relieve severe muscle spasms.muscle spasms.

Diazepam 2.5–10 mg Diazepam 2.5–10 mg IV or 0.1–0.2 mg/kg IV or 0.1–0.2 mg/kg of a 10% calcium of a 10% calcium gluconate solution IVgluconate solution IV

ScorpionsScorpions Nocturnal arachnids Nocturnal arachnids

– love shoes, boots, – love shoes, boots, under rocks, logsunder rocks, logs

Venom injection Venom injection structure located in structure located in a bulb-like a bulb-like enlargement at the enlargement at the tip of its long tailtip of its long tail

Venom acts on CNS Venom acts on CNS by affecting cardiac by affecting cardiac & respiratory & respiratory centers – directly centers – directly cardiotoxiccardiotoxic

ScorpionsScorpions Initial burning & tingling Initial burning & tingling

– progresses to – progresses to numbness, *slurred numbness, *slurred speech, restlessness, speech, restlessness, muscle twitching, muscle twitching, salivation, *abdominal salivation, *abdominal cramping, nausea & cramping, nausea & vomiting and seizuresvomiting and seizures

Management – Management – constricting band wound constricting band wound site to occlude lymph site to occlude lymph flow only, avoid flow only, avoid analgesics which may analgesics which may increase toxicity & increase toxicity & potentiate the venom’s potentiate the venom’s effect on A/W controleffect on A/W control

Florida ScorpionFlorida Scorpion

Tick BitesTick BitesTick BitesTick Bites Normally not an emergencyNormally not an emergency Treatment would include tick removal and Treatment would include tick removal and

transporttransport

Normally not an emergencyNormally not an emergency Treatment would include tick removal and Treatment would include tick removal and

transporttransport

SnakebitesSnakebites

Pit Viper BitesPit Viper Bites Venom destroys proteins and other tissue Venom destroys proteins and other tissue

components.components. Coral Snake BitesCoral Snake Bites

Venom is a neurotoxin that results in paralysis.Venom is a neurotoxin that results in paralysis.

Pit Viper BitesPit Viper Bites

CopperheadCopperhead

Milk Snake (not Copperhead)Milk Snake (not Copperhead)

Eastern DiamondbackEastern Diamondback

Facial pits – 1 behind eye & nostril on each side of headFacial pits – 1 behind eye & nostril on each side of headElliptical pupil, broad V-shaped head, characteristic color patternElliptical pupil, broad V-shaped head, characteristic color pattern

E. Hognose (Adder)E. Hognose (Adder)

Eastern Hognose - GoodEastern Hognose - Good

FL Diamondback RattlesnakeFL Diamondback Rattlesnake

FL Canebrake RattlesnakeFL Canebrake Rattlesnake

Pigmy/Pygmy RattlesnakePigmy/Pygmy Rattlesnake

FL CottonmouthFL Cottonmouth

Cottonmouth - BadCottonmouth - Bad

Pit Viper BitesPit Viper Bites TreatmentTreatment

Keep the patient supine.Keep the patient supine. Immobilize the injured Immobilize the injured

limb and maintain it in a limb and maintain it in a neutral position.neutral position.

Shock managementShock management Apply high-flow, high-Apply high-flow, high-

concentration oxygenconcentration oxygen Pulse oximetryPulse oximetry CapnographyCapnography

Pit Viper BitesPit Viper Bites TreatmentTreatment

Monitor the ECGMonitor the ECG Establish IV access.Establish IV access.

Transport.Transport. DO NOT apply DO NOT apply

constricting bands, ice, constricting bands, ice, cold packs, tourniquets, cold packs, tourniquets, or electrical stimulation or electrical stimulation to the wound.to the wound.

Coral Snake BitesCoral Snake Bites Signs and SymptomsSigns and Symptoms

Localized numbness, Localized numbness, weakness, drowsiness, weakness, drowsiness, ataxia, slurred speech, ataxia, slurred speech, excessive salivation, excessive salivation, paralysis of the tongue and paralysis of the tongue and larynxlarynx

Drooping of the eyelids, Drooping of the eyelids, double vision, dilated double vision, dilated pupils, abdominal pain, pupils, abdominal pain, nausea, vomiting, loss of nausea, vomiting, loss of consciousness, seizures, consciousness, seizures, respiratory failure, respiratory failure, hypotensionhypotension

Coral Snake BitesCoral Snake Bites TreatmentTreatment

Treat similarly to a pit Treat similarly to a pit viper viper

Shock managementShock management

Red touch YellowRed touch Yellow

Kill a FellowKill a Fellow

FL Scarlet KingsnakeFL Scarlet Kingsnake

Red touch BlackVenom Lack

Corn Snake - GoodCorn Snake - Good

Happy GatorHappy Gator

Unhappy Gator VictimUnhappy Gator Victim

Marine Animal InjectionMarine Animal Injection Signs and SymptomsSigns and Symptoms

Intense local pain and Intense local pain and swellingswelling

Nausea and vomitingNausea and vomiting DyspneaDyspnea TachycardiaTachycardia Hypotension or shock in Hypotension or shock in

severe casessevere cases

TreatmentTreatment Deactivate with HeatDeactivate with Heat Catfish – hot soapy waterCatfish – hot soapy water Urchins – do not attempt Urchins – do not attempt

to removeto remove Man o’War – remove Man o’War – remove

tentacle(s)tentacle(s) AmmoniaAmmonia

Thank you!

toxicology and substance abuse ray taylor valencia community college department of emergency medical...

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