Poisoning and Overdose in Teens and Children

HCFAS REVIEW TRAINING

OCTOBER 2016

Poisoning and Overdose in Teens and Children

HCFAS receives many alarms each year categorized as “Poisonings/Overdose”. For our particular geographic area, these patients are more often than not, an abuser of alcohol and kind citizen has alerted us to their location.

In other, less common instances these “Poisoning” alarms are of a different nature, where an teenagers take their parents prescription meds, a young adult may ingest the contents of a Tylenol bottle in a suicide attempt, or a child may get into the cabinet of cleaning supplies and ingested a seemingly tasty looking packet of detergent.

The most common poisoning in children

• cosmetics and personal care products
• cleaning substancesand laundry products
• pain medicine
• foreign bodies such as toys, coins, thermometers
• topical preparations
• vitamins
• antihistamines
• pesticides
• plants
• antimicrobials

Single Load Liquid Laundry Detergent

Poison centers and 911 receive many calls each year about children getting into laundry detergent. Swallowing it often causes mild stomach upset, if there are any symptoms at all, but poison center experts say the new highly concentrated single-load liquid laundry detergent packets seem to be different.

Some children who have gotten the product in their mouths have had excessive vomiting, wheezing and gasping. Some get very sleepy. Some have had breathing problems serious enough to need a ventilator to help them breathe. There have also been reports of corneal abrasions (scratches to the eyes) when the detergent gets into a child’s eyes.

In 2016, through September 30, poison centers received reports of8,845 exposures to highly concentrated packets of laundry detergent by children 5 and younger.

Poison Control 888-222-1222

Common drug use/abuse among Teens/Young Adults:

Cocaine/ Crack Cocaine (Blow, Flake, Powder, Coke, Dime, Rock, Snow White, Speedball)

Cocaine is classified as a stimulant. It is an alkaloid that is extracted from the leaves of the Erythroxylum coca plant, which grows in South America. Cocaine is a powerfully addictive drug, with users often becoming hooked after only one use.

Cocaine has two forms, cocaine and crack cocaine. Cocaine is a powder and is often mixed with sugar/cornstarch/ vitamins/flour and is typically snorted. Crack cocaine looks like a small rock, chunk or chip and is often off-white or pink in color. Crack is heated up and then smoked.

If ingested, cocaine can cause serious gangrene of the intestinal track. When taken in conjunction with alcohol, cocaethylene is produced. Cocaethylene produces a sense of increased and prolonged euphoria. Cocaethylene has a long duration of action and is more toxic than either drug taken alone.

Signs and symptoms:

Dilated Pupils

Elevated Heart Rate

Elevated Blood Pressure

Dry Mouth

Sensitivity to Light

Elevated Temperature

Excitation/Talkative

Mood Swings

Paranoia

Hallucinations

Compulsive/Combative Behavior

Depending on the route of ingestion a person who abuses cocaine or crack may have visible needle marks, burns on their lips and/or fingers from the crack pipe or a runny nose and may present with a bloody nose in long term abuse. NOTE: Nalaxone (Narcan) is not effective on cocaine overdoses.

Methamphetamine (Crystal Meth, Ice, Speed, Crank, Tweak)

Methamphetamine is classified as a stimulant. Methamphetamine is a manufactured/ synthetic drug that stimulates the central nervous system to constrict blood vessels. The manufacturing process poses numerous dangers to first responders, as these “meth labs” are often founds in occupied homes/buildings. Most of the ingredients to make methamphetamines are easy to accessible (ephedrine, ammonia, iodine, brake fluid, Drano, butane and hydrochloric acid) and most are highly flammable and combustible.

Methamphetamine is a white to light brown crystalline powder, but may also be in the form of clear chunky crystals or a liquid. Methamphetamines may be swallowed, snorted, smoked and injected. Children are now being enticed to use methamphetamines by using Strawberry Nestle Quik. The meth is put into the Strawberry Quik and is called “MethliesQuik.”

Signs and Symptoms:

Dry Mouth

Elevated Heart Rate

Elevated Blood Pressure

Dilated Pupils

Profuse Sweating

Elevated Temperature

Irregular Pulse

Rotted/ Brown Teeth

Excitation/ Talkative

Tremors

Paranoid Hallucinations

Agitation

Gaunt/ Thin/ Undernourished.

The use of methamphetamines causes delusions and hallucinations. In one example of delusions, a person may often present with sores on their face and body. These sore are caused by the person trying to pick off the bugs that are “crawling under” their skin.

NOTE: Nalaxone (Narcan) will not be effective on methamphetamine overdoses.

MDMA (Ecstasy, X, XTC, Molly, Happy Pills, E, Love Drug)

MDMA is classified as a club drug. MDMA is an abbreviation of 3,4-methylendioxy-N-methamphetamine. Ecstasy is a manufactured/ synthetic drug and is a chemical “cousin” to crystal meth.

Ecstasy has both hallucinogenic and stimulant properties. The effect of the drug lasts 3-6 hours where as the side effects can last for weeks. Ecstasy is accessed in pills or powder and may also be laced with other drugs such as cocaine, heroin, LSD, or methamphetamines.

Signs and symptoms:

Sweating

Elevated Heart Rate

Elevated Blood Pressure

Nausea/Vomiting

Elevated Temperature

Chills

Blurry Vision

Decreased InhibitionsTremors

Paranoia

Confusion

Continuous Speech

Increase Tactile Sensitivity

Involuntary Teeth Clenching

A person on Ecstasy will be happy, friendly, clenching their teeth and will want to touch everything that feels good to them.

NOTE: Nalaxone (Narcan) will not be effective on most Ecstasy overdoses.

Heroin (Dope, H, White Lady, China White, Black Tar, Dragon)

Heroin is an opioid pain killer. Heroin is used as a recreational drug for its euphoric effects. Frequent and regular use is associated with tolerance and physical dependence. Heroin (like opium and morphine) is made from the resin of poppy plants. Milky, sap-like opium is first removed from the pod of the poppy flower. This opium is refined to make morphine, and then further refined into different forms of heroin.Most heroin is injected, creating additional risks for the user, who faces the danger of AIDS or other infection on top of the pain of addiction.

Heroin is two to four times more potent than morphine and is faster in its onset of action.

Signs and symptoms:

• Pinpoint pupils
• Lethargy
• Decreased respirations
• Flushed skin

• Vomiting
• Scratching
• Slurred speech

Synthetic Drugs (Spice, K2, Bath Salts, Incense, Potpourri)

Synthetic drug use is on the rise nationally. These chemical compounds are difficult for law enforcement to trace and hard for hospitals to identify and treat. The abuse of this class of drug is not only dangerous and potentially addictive to the user, it can be fatal. In Washington State, bath salts abuse resulted in the deaths of a four-year-old boy and both parents.. A mother in Kentucky who had used bath salts tried to kill her two-year-old when she became convinced he was a demon, but he survived. A Hawaiian man used Spice (synthetic cannabis) and then tried to throw his girlfriend off an eleventh-floor balcony.

Signs and symptoms:

• Seizures
• Hallucinations
• Suicidal tendencies and attempts
• Homicidal tendencies
• Delusions
• Overstimulation
• Aggression
• Paranoia
• Chest pain
• Heart attack
• Death
• Overheating that causes a person to tear off his clothes
• Other self-destructive behavior like bashing one’s body or head against walls

• Agitation
• Anxiety
• Sweating

References:

Poisoning

Caution:

Take precautions not to contaminate self or others!

I. General Approach

1. If possible, identify the product or substance that the patient has ingested, inhaled or come in contact with.
2. Estimate the amount of product or substance ingested, if applicable.
3. Estimate the duration of exposure to the product or substance.
4. Attempt to obtain information about the product from the container’s label. If

possible, bring the product or substance and it’s container with the patient to the

hospital.

II. Patient who is conscious and alert, perform an initial assessment and:

Caution:

Poisoned patients may deteriorate rapidly.

Be especially alert for respiratory insufficiency or arrest!

Consider calling Advanced Life Support if available.

A. Swallowed Poisons:

1. Administer oxygen.
2. **Contact Medical Control for instructions on treatment, which may include the administration of Activated Charcoal, milk, water, and/or Syrup of Ipecac for the induction of vomiting, etc.
3. Transport, keeping the patient warm.
4. Ongoing assessment. Obtain and record the patient’s vital signs, repeat enroute as often as indicated.
5. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR).

B. Inhaled Poisons:

1. Assure that the scene is safe for entry. If danger of poisonous gases, vapor, or sprays or an oxygen-deficient environment is present, it may be necessary to obtain assistance from trained rescue personnel.
2. Remove the patient to fresh air.
3. Perform initial assessment.
4. Assure that the patient’s airway is open and breathing and circulation are adequate.
5. Place the patient in a position of comfort.

1. Administer high concentration oxygen.
2. Ongoing assessment. Obtain and record the patient’s vital signs, repeat enroute as often as the situation indicates.
3. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR).

C. Skin or Eye(s) Contamination:

1. Refer to the Burns/Contaminations (Chemical) Protocol).

III. Patient who is unconscious or has altered mental status:

1. Perform initial assessment.
2. Assure that the patient’s airway is open and that breathing and circulation are adequate; suction as necessary.
3. Administer high concentration oxygen.
4. Ongoing assessment. Obtain and record the vital signs, repeat enroute as often as the situation indicates.
5. Transport, keeping the patient warm.
6. Record all patient care information, including the patient’s medical history and all treatment provided, on a Prehospital Care Report (PCR).

Altered Mental Status

(including, but not limited to hypoglycemia and opioid overdose)

I. Assess the situation for potential or actual danger. If the scene/situation is not safe, retreat to

a safe location, create a safe zone and obtain additional assistance from a police agency.

II. Perform primary assessment. Assure that the patient’s airway is open and that breathing and

circulation are adequate. Suction as necessary.

III. Administer high concentration oxygen. In children, humidified oxygen is preferred.

IV. Obtain and record patient’s vital signs, including determining the patient’s level of

consciousness. Assess and monitor the Glasgow Coma Scale.

1. If the patient is unresponsive (U) or responds only to painful stimuli (P), prepare for transport while continuing care.

Note:Request Advanced Life Support if available.Do NOT delay transport to the appropriate hospital.

Note:This protocol is for patients who are NOT alert (A), but who areresponsive to verbal stimuli (V), responding to painful stimuli (P),or unresponsive (U).

Note:Emotionally disturbed patients must be presumed to have anunderlying medical or traumatic condition causing the alteredmental status.

Note:All suicidal or violent threats or gestures must be taken seriously.These patients should be in police custody if they pose a danger tothemselves or others.If the patient poses a danger to themselves and/or others, summonpolice for assistance.

1. If the patient has a known history of diabetes controlled by medication, is conscious and is able drink without assistance, provide an oral glucosesolution, fruit juice or non-diet soda by mouth, then transport, keeping the patientwarm. If regionally approved to obtain blood glucose levels utilizing aglucometer, follow your regionally approved protocol.

1. If patient has a suspected opioid overdose:

1. If patient does not respond to verbal stimuli, but either responds topainful stimuli or is unresponsive; and

1. Respirations less than 10/minute and signs of respiratory failure orrespiratory arrest, refer to appropriate respiratory protocol.

1. If regionally approved and available, obtain patient’s blood glucose (BG)level.

1. If BG is less than 60, in adult and pediatric patients, follow IV (B)above.

2. If BG is more than 60 in adult and pediatric patients, proceed tonext step.

1. Administer naloxone (Narcan®) via a mucosal atomizer device (MAD).

1. Relative contraindications:

1. Cardiopulmonary Arrest,
2. Seizure activity during this incident,
3. Evidence of nasal trauma, nasal obstruction and/orepistaxis.

2. Insert MAD into patient’s left nostril and for;

1. ADULT: inject 1mg/1ml.
2. PEDIATRIC: inject 0.5mg/0.5ml.

3. Insert MAD into patient’s right nostril and

1. ADULT: inject 1mg/1ml.
2. PEDIATRIC: inject 0.5mg/0.5ml

4. Initiate transport. After 5 minutes, if patient’s respiratory rate isnot greater than 10 breaths/minute, administer a second dose ofnaloxone following the same procedure as above and contactmedical control

V. If underlying medical or traumatic condition causing an altered mental status is not apparent;the patient is fully conscious, alert (A) and able to communicate; and an emotionaldisturbance is suspected, proceed to the Behavioral Emergencies protocol.

VI. Transport to the closest appropriate facility while re-evaluating vital signs every 5 minutesand reassess as necessary.

VII. Record all patient care information, including the patient’s medical history and all treatmentprovided, on a Prehospital Care Report (PCR).

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