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Signs and symptoms

  • Altered mental status - look out for euphoria or drug induced "highs" which indicate drug abuse.
  • Unusual body or breath odors, due to contact or ingestion of chemicals.
  • Burns around the mouth, lips, and oral mucosa indicates ingestion of poison.
  • Chemical substances around the mouth or in sputum.
  • Nausea and vomiting.
  • Abdominal pain.
  • Diarrhea.
  • Respiratory distress with possible coughing, stridor, wheezing, crackles, which suggest inhalation of poisons. This may lead to signs of hypoxia.
  • Inadequate breathing, pulse, and blood pressure due to nervous system depressants.
  • Altered heart rate and/or blood pressure, either high or low depending on the type of poison.
  • Dilated or constricted pupils, depending on the type of poison.
  • Needle tracks or marks at the site of poison entry (or injection site).
  • Local swelling, irritation, redness at the site of contact with poison.
  • Hypoxia possibly from carbon monoxide poisoning or lung damage from inhaling caustic substances.
  • CO poisoning will also cause the puls-ox reading to be high even though the patient is suffering from hypoxia.


  • Open the airway and clear any obstructions.
  • Suction any secretions obstructing airway.
  • Maintain airway with airway adjunct.
  • Administer oxygen.
  • PPV if needed.
  • Brush dry chemicals or solid toxins from the skin.
  • For liquids, rinse with water for at least 20 minutes. Shower, garden hose, or eye wash are some examples of the apparatus used for rinsing.
    • When rinsing the eye, let the water fall to the side of the face, and not into the other eye.
    • Take care of "hidden" areas such as nail beds, creases, and remove any jewelry.
  • Wash or rinse affected area to clear the poison and prevent further injury.
  • Administer activated charcoal to soak up all the poison or overdosed drug - contact medical direction.
  • Bring a sample of the poison to the receiving facility.
  • Narcan (naloxone) reverses the effects of a narcotic overdose. This is an ALS intervention.
  • Position in the recovery position if vomiting is likely.

Medical conditions and mechanisms

  • Overdose is a special type of poisoning, where a medication is taken in such excess quantity that it becomes toxic to the body.
  • Poisons and toxins can enter the body by ingestion, inhalation, injection, or absorption through the skin or mucous membrane.
  • Ingestion: most common route of poisoning. Poison passes through the esophagus into the stomach, where it is kept for a period of time before it empties into the small intestines, where it is absorbed into the body. Thus, you want to treat the patient fast, before the poison is absorbed into the body. Since the poison is held in the stomach, severe damage can be done to the stomach lining.
  • Inhalation: the poison crosses the alveolar-capillary membrane and enters the bloodstream. Lung tissue is damaged during the process, which may lead to pulmonary edema, causing inadequate gas exchange, hypoxia and hypoperfusion.
  • Injection: poison causes a local reaction at the site of injection such as edema, redness, irritation and pain. Systemic reactions may occur after the local reaction when the poison is distributed throughout the body via systemic circulation. Injection can occur from drug abuse, insect bites or stings, which can lead to anaphylaxis.
  • Absorption: toxins from crosses the skin or mucous membrane and enter the body. Local irritation occurs at the site of absorption. Systemic reactions may occur when the absorbed poison travels through systemic circulation. Poisons that absorb through the skin include poison ivy, organophosphates, pesticides, and other chemicals.
  • Carbon monoxide poisoning: hypoxia caused by CO binding to hemoglobin, which prevents oxygen to be bound and delivered to cells. CO-bound hemoglobin turns read just like O2-bound hemoglobin, which triggers a high puls-ox reading. This is why CO poisoning creates hypoxia that cannot be detected by a puls-ox reading.
  • Cyanide poisoning: cyanide interferes with aerobic respiration, which starves cells.
  • Acids cause surface burns that cause immediate pain. They don't stick to surfaces, which is why ingestion of acids burns the stomach more than the esophagus.
  • Alkalis cause deep burns that do not cause immediate pain. Solid alkali sticks to surfaces, which burns the esophagus. Liquid alkalis will travel to the stomach and burn there.
  • Methanol: causes blindness when metabolized by the body.
  • Isopropanol and ethylene glycol: toxic when metabolized by the body. Ethylene glycol is especially toxic and can cause death in small amounts.


  • Oliguria: very little urine.
  • Anuria: no urine.
  • Hematuria: bloody urine.