1015 seventeen

These bacteria here that you see, many of these bacteria we have as part of the normal flora and fauna of our digestive system. In our digestive system we have Acidophilus, Lactobacillus, Streptococcus, Staphylococcus, you might have Esterichia, you might have some of those you would, Campylobac, you might have that in there. A lot of these you wouldn't, but some of them you might have as part of your normal flora and fauna. And when you eat something, especially like E.coli, you might have E.coli in your intestines but it's at a normal measured amount. Now you eat E.coli, now it takes over because it's got so much more and it begins to grow and that's when you get sick. And what does your body do when it has an invading organism in the intestines? It sucks food from your, the rest of your interstitial fluid from your vascular system into it and it washes it out. That's why you get diarrhea. That's why people have food poisoning, the most common symptom is diarrhea and vomiting. Your body is trying to clear out the vascular system. And that's what kills people. When you see movies, when you read about two year old dies of food poisoning, that's why he dies. He died of hypovolemia, hypovolemia shock. Thalamnosis characterized by severe GI symptoms within 72 hours of ingestion including nausea, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, vomiting, If you have a patient, like if I go to a home and she's sick and he's not, okay, it might be a virus or something. But if I go to a home and three of you and you're all sick and you all get sick at the same time, I'm thinking you ate or ingested or exposed to something. If I get the flu, you're not going to get it. We live together. I get the flu. You're not going to get it right away. It's going to take time to incubate. So I get sick and I start feeling better. Oh, you start to get sick. Oh, you're going to get it. And then our kid gets it. Right? And it kind of moves on like that. So everybody gets it at the same time. They ingested it or got exposed at the same time. And I'd be thinking, all right, what have you eaten in the last couple of days? Oh, we had this party and we had a cookout and we had all this potato macaroni salad and we've been nunching on that for a few days. Was that left out? Did it have mayonnaise? Oh, yeah, it was out all day, but we figured it was okay. We brought it home. Ding, ding, ding. Chinese food's another common one. Oh, we had a party the other night. We had Chinese food. We finally put it away at 3 o'clock in the morning. We all decided to have Chinese food for breakfast. And at noontime, everybody's sitting on the toilet. That's what you get. So if you run into that, bring whatever you suspect to be to the hospital. Bring a sample of the food. They can test it and they can identify it. The more common cause of food poisoning is the ingestion of polypropyl toxins left over by the bacteria often in foods. Things like staphylococcus and streptococcus, when it digests this product, it leaves a residual waste and the waste is the toxic part of the bacteria. That's what's going to make you sick. Food that are left on refrigerators is a common vehicle. Again, potato salad, macaroni salad left out. Symptoms usually stop within two to three hours and can last as long as 24 hours. That's when those people say, I was violently sick for about 24 hours. I might feel better now. God, I was vomiting and diarrhea. Guess what? Probably had food poisoning and you didn't even know it. And the people, these are not necessarily life-threatening. What becomes life-threatening is because they're vomiting, they don't take fluids in. So vomiting and diarrhea are the number one cause of death worldwide. Hypovolemia is secondary to vomiting and diarrhea. So what happens is I'm taking it in. I'm not taking it in, but I'm getting rid of it. Sweating, vomiting, diarrhea, and you can lose tons of fluid very quickly. And if you don't take it back in as a patient, you need to go to the hospital and get IV fluid. And that's why children die, because they become hypovolemic very quickly. It only takes an infant two hours of vomiting and diarrhea to develop hypovolemia. Just two hours of vomiting and diarrhea and we don't take anything in. The most severe form of toxic ingestion is called botulism. I know some of you have heard of botulism. Anybody here ever heard of Botox? You get the shot and it takes away all your wrinkles and you look like this. Hey, I look so young. That's actually botulinum toxin that's actually medically produced. It's medical grade. And they inject it. What's that? What do you mean? Oh, when you get an injection, it can stay on the nerve synapses. Yeah, it can happen. That's one of the warnings they say. That's the reason why if you go to Botox, it has to be given by a medical professional. You just can't go to some random Botox guy. It's got to be a nurse or a doctor that gives it. The reason we can do that is because there is an antidote. Botulism is actually a neurotoxin. It affects the nerves and it can produce paralysis and death. Patients with botulism toxin can end up on a ventilator. They can end up stopping breathing. Symptoms include blurred vision, weakness, difficulty speaking or breathing, loss of neurological function. Resulting from improperly canned foods, most often it is canned meat. When I was younger, I liked dindymo beef stew. Like a ham? Hams can do it or beef stew or anything. But the dindymo beef stew, you go and buy that at the scratch aisle. $0.50 dindymo, you get a big can for $0.50. That's lunch for $0.50, I'm all over that. The problem is you get a little crack in the can. Not enough where anything leaks out. You squeeze the can, you won't notice it. But it's microscopic and air gets in. The air activates the bacteria that's in there and it begins to grow and multiply and begins to digest the meat. And that produces the botulism. It might not even taste bad. You might not even notice it. But it can have a toxic effect. If you catch it and get the patient to the hospital, they can give them the antidote and it's fine. Try not to determine the specific cause of acute GI issues. Remember we talked about the acute abdomen. Don't try to identify what it is. You may not know. You may never know. So the idea is to gather as much information as you can, transport the patient to the hospital. If you suspect a food or a toxic substance, bring it with you to the hospital. Plant poisonings. Now I am not a botanist. A botanist is somebody who studies plants. I am not a botanist. But I do know some things. So there are tens of thousands of cases of plant poisoning annually. Both animals and human. Anybody know when the most common time of that is? Jingle bells, jingle bells. Christmas time. Polly, poinsettias, and mistletoe. It's all toxic. So you get animals that eat them and kids that eat them. Everything's edible. It's Christmas time. Oh, cookies and everything. What's this? And pop it in their mouth. So many household plants are poisoned if it's ingested. If you come across a child that has some form of toxic or you think toxic exposure, and you suspect it's a plant, bring one leaf from every plant at the height of the child. Look in the child's mouth. Maybe they're chewing on something or they have residual plant in their mouth. And you can identify. Take pictures. These are all the plants that are in the house stock. I don't know what it was that they ingested. Look for bite marks on the plants. So these are some of the common ones. You could see all of these in the woods. Or in your backyard. Things like rosary pea. Water hemlock or wild carrot. Autumn crocus. Poison hemlock. Lily of the valley. Jimson weed. We talked about that. Dumb cane. Diphenbacchia. This is those big green leaves, the green and whitish leaves, the huge leaves. I used to have a plastic one at home. And if anybody that had any medical knowledge was coming over to say hi, I would just put it next to me and start chewing on it. Oh my God, oh my God. And then they'd realize it's plastic. But that causes respiratory depression. Digitalis purpurea. Foxglove. I recognize that name. Digitalis. Wait a minute. We take digitalis for atrial fibrillation. It's an antidysrhythmic. It comes from foxglove. So if you eat foxglove, you can affect cardiac function. Oleander or rose laurel. Tree tobacco. Mistletoe. Oakweed. Rhubarb. The rhubarb root you can eat. The rhubarb plant is toxic. Rhododendron or azaleas. Those are the thick, long, thin green leaves. Castor bean. This is an interesting one. Castor oil in the 40s, in the late 40s, early 50s and the 30s. They used to say take a teaspoon of castor oil. It's good for your hair and skin. Or if you were bad, they used to give you a tablespoon of castor oil because it was really bitter. It's like soap in the mouth back in the 30s and 40s. So if I process castor bean, if I make a mash and I process it one way, I make castor oil, which is very common. If I process it another way, I make ricin. Ricin is one of the most potent neurotoxins on the planet. It's used by terrorists. Nightshade and death camas. Is it possible to memorize every plant or poison, let alone their effects? Well, my job is not to know what it is. My job is to know what potentially it is. We call that the differential diagnosis. But I have to treat the airway, vital signs, notify the hospital, not poison control, take anything you suspect that may be the toxic item to the hospital. And these are some of the toxins here. This is that diphenbacchia, which is also called the dumb cane right there. And then this is mistletoe. Mistletoe. There's the castor bean right there. That's nightshade, foxglove, and rhododendron. And there's those long green leaves. Do you see these? Do you see these? Pay attention. Walk into the woods. You'll see these, even in New England. Maybe not now, because it's October. You'll also see there's ginseng weed, the death camas right there, poison ivy, poison oak, poison sumac. Some people definitely allergic to it. This is your pokeweed, rosary pea, and that one down there is poison sumac. So they say that 75 to 80% of all organic growing things on the planet are edible. These are not. So which of the following questions is of least pertinence for the ENT to ask a patient who intentionally overdosed on a medication? Why? Why? Why? Unless you suspect suicidal attempt, suicidal ideation, then I might ask, but it's not important to my treatments, per se. A 30-year-old male who's just an unloaded substance begins to vomit. You should... Probably pee, then see. Are you going to suction for 30 seconds? 15, so that's not it. Am I going to analyze the vomitus to try to identify the poison? Do I have time for that? Do I have chemicals to analyze it? Is he showing signs of respiratory... He's vomiting, do I want to bag him? So what do I want to do? Collect the vomitus... Of the four, I really want to suction, but less than 30 seconds, so that wouldn't be right. Of the four, the best answer is A. I thought you don't bring it unless you see something in it. I thought you don't bring it unless you see something in it. Nurses don't want it unless there's something in it. Yeah. There's book and there's street. Okay. And believe me, if you have a patient vomiting in front of you, they're going to do it again. Yeah. When caring for a patient with a surface contact poison, it's important to remember... B. Avoid contaminating yourself and others. Very good. Scene safety, B.S.I. That's always that. Most poisons occur via... Ingestion. B. 80%. And what is the number one age group? One to six. One to six, because everything's about the pile. How much activated charcoal would you administer to a 55-pound child who swallowed a bottle of aspirin? I don't know, KJ. One gram per kilogram. 55 pounds. How many kilograms is that? A. I don't even know. Divide by two and subtract 10%. No. Still, I didn't graduate from that. A. 25. Which one? B. B. 25. Divide by two and subtract 10%. After taking Vicodin for two years for chronic pain, a 40-year-old woman finds that her usual dose is no longer effective and she goes without for a higher dose. Example of? C. Tolerance. Very good. Which of the following effects does drinking alcohol not produce? D. You think it does. Oh, fine. I think it's right. M. A 21-year-old male was found unconscious in a valley. In an alley. Or a valley. Whichever one. Your initial assessment reveals that his respirations are slow and shallow, his pulses slow and weak. Further assessment reveals pupils are bilaterally constricted. Very small. What is he most consistent with? O. E. O. E. O. E. I hear B. Everybody agree with B? I said B. That's an opiate overdose. Constricted pupils. Pinpoint pupils. Constricted. What are we going to treat him with? Narcan. What's the first thing we're going to do, though? Bag him. Bag him. And then Narcan. Very good. The pneumonic dumbbells is used to recall the signs and symptoms of a cholinergenic poisoning. E. E. E. Or? M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M. M.