Management of Toxicologic Emergencies
in Paramedicine
Toxicologic emergencies - ANS Can be categorized as either unintentional or intentional.
Toxidromes - ANS Help identify the toxic substance in situations where that information is not
readily available.
Primary methods of toxin entry - ANS Ingestion, inhalation, injection, and absorption.
Alcohol use disorder - ANS A condition characterized by a physical and psychological addiction
to ethanol that can range from mild to severe.
Amphetamines - ANS A class of drugs that increase alertness and excitation (stimulants);
include methamphetamine (crank or ice), methylenedioxyamphetamine (MDA, Adam), and
methylenedioxymethamphetamine (MDMA, Eve, Ecstasy).
Antagonist - ANS A molecule that blocks the ability of a given chemical to bind to its receptor,
preventing a biologic response.
Antidote - ANS Something to counteract the effect of a poison.
Barbiturates - ANS Potent sedative-hypnotics historically used as sleep aids, as antianxiety
drugs, and as part of the regimen for seizure control; include drugs such as thiopental
(Pentothal, Trapanal) and methohexital (Brevital).
Hydrocarbons - ANS May be inhaled or ingested; primary treatment goals include removal from
the exposure environment, administration of high-concentration oxygen, and prompt transport.
Benzodiazepines - ANS The family of sedative-hypnotics that provide muscle relaxation and
mild sedation; most commonly used to treat anxiety, seizures, and alcohol withdrawal; include
drugs such as diazepam (Valium) and midazolam (Versed).
Caladium - ANS A common house plant that contains calcium oxalate crystals; ingestion leads
to nausea, vomiting, and diarrhea.
Castor bean - ANS A seed that contains the poison ricin; its ingestion causes a variety of toxic
effects including burning of the mouth and throat, nausea, vomiting, diarrhea, severe stomach
pains, prostration, failing vision, and kidney failure.
, Basic airway management - ANS Important in patients with toxicologic emergencies and is a
mainstay of the primary survey.
Management for toxicologic emergencies - ANS Includes advanced life support care built on
the basics such as ensuring scene safety, maintaining the airway, ensuring adequate breathing
and circulation, and maintaining adequate blood/oxygen saturation levels (95%).
Naloxone (Narcan) - ANS May be administered to improve the patient's spontaneous
respiratory effort in cases of opioid overdose.
ECG monitoring - ANS Required for additional management of stimulant misuse and in cases
of carbon monoxide poisoning.
Decontamination for organophosphate poisoning - ANS An additional step prior to assessment
and management that may require specific medications such as atropine and pralidoxime.
Activated charcoal - ANS Contact medical control regarding its use; it is often contraindicated
when the exact ingested substance(s) is unknown.
Transporting the patient - ANS Should be done as soon as possible, placing the patient in the
left lateral recumbent position if any risk of vomiting exists to reduce the risk of aspiration.
Management for caustic ingestion - ANS Identify the specific substance and contact the poison
control center or online medical control for further instructions.
Supportive care for marijuana use - ANS Primarily includes benzodiazepines for sedation.
Emergency medical care for hallucinogens - ANS Primarily supportive, with scene safety
remaining a concern; intramuscular sedatives may be necessary.
Sedative-hypnotics - ANS Include barbiturates and benzodiazepines; airway management is
critical in patients who have used barbiturates.
Opioids - ANS Have become the driving cause of most overdose deaths; management focuses
on airway management.
caustics - ANS Chemicals that are acids or alkalis; cause direct chemical injury to the tissues
they contact.
chemical suicide - ANS A method of suicide that involves mixing certain household chemicals in
an enclosed space to create toxic gases, such as hydrogen sulfide and hydrogen cyanide, as
the chemicals combine; also called detergent suicide.
in Paramedicine
Toxicologic emergencies - ANS Can be categorized as either unintentional or intentional.
Toxidromes - ANS Help identify the toxic substance in situations where that information is not
readily available.
Primary methods of toxin entry - ANS Ingestion, inhalation, injection, and absorption.
Alcohol use disorder - ANS A condition characterized by a physical and psychological addiction
to ethanol that can range from mild to severe.
Amphetamines - ANS A class of drugs that increase alertness and excitation (stimulants);
include methamphetamine (crank or ice), methylenedioxyamphetamine (MDA, Adam), and
methylenedioxymethamphetamine (MDMA, Eve, Ecstasy).
Antagonist - ANS A molecule that blocks the ability of a given chemical to bind to its receptor,
preventing a biologic response.
Antidote - ANS Something to counteract the effect of a poison.
Barbiturates - ANS Potent sedative-hypnotics historically used as sleep aids, as antianxiety
drugs, and as part of the regimen for seizure control; include drugs such as thiopental
(Pentothal, Trapanal) and methohexital (Brevital).
Hydrocarbons - ANS May be inhaled or ingested; primary treatment goals include removal from
the exposure environment, administration of high-concentration oxygen, and prompt transport.
Benzodiazepines - ANS The family of sedative-hypnotics that provide muscle relaxation and
mild sedation; most commonly used to treat anxiety, seizures, and alcohol withdrawal; include
drugs such as diazepam (Valium) and midazolam (Versed).
Caladium - ANS A common house plant that contains calcium oxalate crystals; ingestion leads
to nausea, vomiting, and diarrhea.
Castor bean - ANS A seed that contains the poison ricin; its ingestion causes a variety of toxic
effects including burning of the mouth and throat, nausea, vomiting, diarrhea, severe stomach
pains, prostration, failing vision, and kidney failure.
, Basic airway management - ANS Important in patients with toxicologic emergencies and is a
mainstay of the primary survey.
Management for toxicologic emergencies - ANS Includes advanced life support care built on
the basics such as ensuring scene safety, maintaining the airway, ensuring adequate breathing
and circulation, and maintaining adequate blood/oxygen saturation levels (95%).
Naloxone (Narcan) - ANS May be administered to improve the patient's spontaneous
respiratory effort in cases of opioid overdose.
ECG monitoring - ANS Required for additional management of stimulant misuse and in cases
of carbon monoxide poisoning.
Decontamination for organophosphate poisoning - ANS An additional step prior to assessment
and management that may require specific medications such as atropine and pralidoxime.
Activated charcoal - ANS Contact medical control regarding its use; it is often contraindicated
when the exact ingested substance(s) is unknown.
Transporting the patient - ANS Should be done as soon as possible, placing the patient in the
left lateral recumbent position if any risk of vomiting exists to reduce the risk of aspiration.
Management for caustic ingestion - ANS Identify the specific substance and contact the poison
control center or online medical control for further instructions.
Supportive care for marijuana use - ANS Primarily includes benzodiazepines for sedation.
Emergency medical care for hallucinogens - ANS Primarily supportive, with scene safety
remaining a concern; intramuscular sedatives may be necessary.
Sedative-hypnotics - ANS Include barbiturates and benzodiazepines; airway management is
critical in patients who have used barbiturates.
Opioids - ANS Have become the driving cause of most overdose deaths; management focuses
on airway management.
caustics - ANS Chemicals that are acids or alkalis; cause direct chemical injury to the tissues
they contact.
chemical suicide - ANS A method of suicide that involves mixing certain household chemicals in
an enclosed space to create toxic gases, such as hydrogen sulfide and hydrogen cyanide, as
the chemicals combine; also called detergent suicide.
