Certified Emergency Nurse (CEN) Exam Review TOXICOLOGICAL AND ENVIRONMENTAL EMERGENCIES

Document Content and Description Below

Objectives: At the completion of this section, the learner will be able to:  Identify the type of substance ingested based on the signs and symptoms demonstrated  Treatment recommendations fo... r various drugs of abuse  List antidotes for common medicinal overdoses  Describe decontamination procedures for chemical and radiation exposures  Verbalize body temperatures that are considered life-threatening  Describe treatment modalities appropriate for various poisonous animal envenomations  Differentiate between various parasitical infections based on the symptoms presented Environmental Emergencies Toxicological Emergencies  Burns  Envenomation emergencies (e.g. spiders, snakes, aquatic animals)  Food poisoning  Organophosphates and insecticides  Parasite and fungal infections (e.g. giardia, ringworm, tineas, tape worms, pine worms, lice, maggots, scabies)  Plants (e.g. contact dermatitis, ingestion)  Radiation/hazardous material exposure  Submersion injury  Temperature-related emergencies (e.g. hot, cold, and systemic)  Rabies  Acids and alkalis  Carbon monoxide  Cyanide  Overdose and ingestions  Substance abuse  Major Toxidromes Sympathomimetics Anti-Cholinergics Cholinergics Sedative-hypnotics Opioids BP  Or  Usually    HR   Ventricular arrhythmia  or RR   /normal  Skin condition Red hot dry Moist, vasodilated Normal/cool Pruritis Temperature  Normal   Pupils Mydriasis Miosis ? enlarged Miosis Mental status Confusion, seizure, hallucination, coma Weakness, paralysis Coma Depressed to coma Special notes Dry mouth, urinary retention, bowel ileus Lacrimation, diarrhea, urinary incontinence N/A N/A Certified Emergency Nurse (CEN) Exam Review Jeff Solheim Page | 2 Pharmacological agents normally used to reduce temperature, such as acetaminophen, aspirin and dantrolene will be ineffective with sympathomimetic overdoses. Mnemonic for cholinergic effects: Salivation Lacrimation Urination Defecation/diarrhea GI distress Emesis Cocaine causes intense vasoconstriction which can lead to MI, stroke, hypertension, aortic dissection, lactic acidosis, pregnancy complications, perforated nasal septum, muscular rigidity, ,rhabdomyolysis hyperglycemia  Sympathomemetics o Examples  Illegal street drugs (cocaine, amphetamines, methamphetamine)  Illicit designer drugs (MDMA – ecstasy)  Lysergic Acid Diethylamide (LSD)  Over the counter cold agents containing ephedrine  Dietary supplements (ephedra, alkaloids)  Prescription drugs: Albuterol, dopamine, tricyclic antidepressants, monoamine oxidase inhibitors o Treatment  Initial management goals:  Patient sedation  Control of blood pressure and pulse  Non-pharmacological cooling  Pharmacological agents normally used: Pharmacological agent Rationale for use Benzodiazepines Agitation, seizures, cardiovascular symptoms Nitroprusside Reduction of blood pressure Haldol Psychotic symptoms Paralyzing agents Extreme hyperthermia  Anti-Cholinergics o Examples  Atropine  Scopolamine (Hyoscine)  Ipratroprium bromide (Atrovent)  Antiparkinsonian drugs (Benapryzine, Benzhexol, Orphenadrine, Bornaprine )  Various plants (Jimson weed, Nightshade, leaves of the potato plant) [Show More]

Last updated: 1 year ago

Preview 1 out of 15 pages