1. © 2011 National Safety Council 14-1 POISONING LESSON 14

2. © 2011 National Safety Council 14-2 Introduction Poison: any substance that enters or touches body with injurious or life-threatening effects Poisons enter body by being swallowed, injected, inhaled or absorbed Over 2 million poisoning incidents occur in United States every year About 29,000 deaths from accidental poisoning Some take a poison intentionally in suicide attempt or to experience substance’s effects This chapter includes overdose of alcohol and drugs, and venomous bites and stings

3. © 2011 National Safety Council 14-3 Swallowed Poisons Most cases of poisoning involve swallowed substances Effects may be immediate or delayed Give emergency care as soon as possible Patient may be unresponsive, confused and disoriented Most important thing is recognition

4. © 2011 National Safety Council 14-4 Assess the Situation Look for containers nearby or clue of substance or product use Ask others at scene what happened Try to find out how much person may have swallowed and how long ago

5. © 2011 National Safety Council 14-5 Signs and Symptoms of Swallowed Poisons Specific signs and symptoms vary May look and feel ill Abdominal pain Nausea, vomiting, diarrhea Altered mental status, unresponsive Burns, stains or odors around mouth Dilated or constricted pupils Abnormal breathing

6. © 2011 National Safety Council 14-6 Emergency Care for Swallowed Poison Perform standard patient care Condition may change rapidly Emergency care depends on patient’s condition Follow local protocol for oxygen For unresponsive patient: -Ensure EMS has been activated -Check breathing and provide BLS -Put breathing, unresponsive patient in recovery position (preferably on left side) -Monitor breathing and vital signs

7. © 2011 National Safety Council 14-7 Emergency Care for Swallowed Poison (continued) For responsive patient: -If mouth or lips burned by corrosive chemical, rinse with cold water (without swallowing) -Follow local protocol to call Poison Control Center (PCC) or medical direction – follow their directions

8. © 2011 National Safety Council 14-8 Emergency Care for Swallowed Poison (continued) For responsive patient: -Don’t give food or drink unless instructed by PCC or medical direction -Don’t attempt to induce vomiting -Don’t follow instructions on household product labels

9. © 2011 National Safety Council 14-9 Poison Control Centers Provide information and treatment advice for all types of poisonings Can be reached at 1-800-222-1222 Has more accurate information Follow local protocol for calling PCC, medical direction or waiting for EMS PCC also can advise on poisoning prevention

10. © 2011 National Safety Council 14-10 Inhaled Poisons Gases and fumes at home and work Examples: -Paints -Thinners -Chemicals

11. © 2011 National Safety Council 14-11 Inhaled Poisons (continued) Include gases that may escape from pipelines or transport tanks If you smell gas or there’s evidence of a leak, stay away Allow hazardous materials team to handle

12. © 2011 National Safety Council 14-12 Carbon Monoxide Invisible, odorless and tasteless May be present from: -Exhaust -Faulty furnace -Kerosene heater -Industrial equipment -Fireplace -Wood stove -Fire Exposure to large amounts can be lethal Results in more fatal unintentional poisonings in United States than any other poison

13. © 2011 National Safety Council 14-13 Assessing Inhaled Poisoning Perform standard assessment Do not enter scene without protection

14. © 2011 National Safety Council 14-14 Signs and Symptoms of Inhaled Poison Breathing difficulty Headache Dizziness, lightheadedness, confusion, weakness Nausea, vomiting Chest pain Convulsions Changing levels of responsiveness

15. © 2011 National Safety Council 14-15 Emergency Care for Inhaled Poisoning Perform standard patient care Immediately move patient to fresh air Monitor breathing and vital signs, give BLS as needed Put unresponsive patient in recovery position Loosen tight clothing around neck or chest Administer O 2

16. © 2011 National Safety Council 14-16 Alcohol and Drug Emergencies

17. © 2011 National Safety Council 14-17 Drugs Illicit drugs and prescription drugs cause a wide variety of behaviors and effects You do not need to know the drug taken to provide emergency care Consider possibility of drug abuse or overdose when behavior or signs and symptoms cannot be explained

18. © 2011 National Safety Council 14-18 Assessing Alcohol and Drug Emergencies Perform standard assessment Question patient and others at scene; give information to arriving EMS Assess for injuries or illness; don’t assume alcohol or drug is only factor involved

19. © 2011 National Safety Council 14-19 Signs and Symptoms of Alcohol Poisoning Smell of alcohol about person Flushed, moist face Vomiting Slurred speech, staggering Fast heart rate Impaired judgment and motor skills Agitated or combative behavior Changing levels of responsiveness, coma

20. © 2011 National Safety Council 14-20 Signs and Symptoms of Drug Abuse or Overdose Similar to alcohol poisoning Dilated or constricted pupils Stumbling, clumsiness, drowsiness, incoherent speech Difficulty breathing (very slow or fast) Changing levels of responsiveness Unusual or erratic behavior Agitated or combative behavior Presence of drug paraphernalia

21. © 2011 National Safety Council 14-21 Emergency Care for Alcohol and Drug Emergencies Perform standard patient care For responsive patient: -Protect patient from injury -Don’t let patient lie on back -Care for any injuries -Follow local protocol to call PCC and follow instructions

22. © 2011 National Safety Council 14-22 For unresponsive patient: -Position patient in recovery position (preferably on left side) -Be prepared for vomiting -Give BLS if needed -Keep patient warm in cold environments Emergency Care for Alcohol and Drug Emergencies (continued)

23. © 2011 National Safety Council 14-23 Emergency Care for Alcohol and Drug Emergencies (continued) For injured intoxicated patient: -Don’t rely on patient’s perception of injury -Give care as for unresponsive patient -If possible spinal injury, don’t move patient

24. © 2011 National Safety Council 14-24 Emergency Care for Alcohol and Drug Emergencies (continued) Provide care for any condition that occurs (seizures, shock, cardiac arrest, etc.) Keep patient from harming self or others Do not try to induce vomiting If patient is hostile or violent, stay away and call law enforcement When illegal drugs are involved, this is also a crime scene

25. © 2011 National Safety Council 14-25 Alcohol Withdrawal Withdrawal from alcohol dependence may cause delirium tremens: -Confusion, disorientation, agitation -Altered perception such as hallucinations or illusions Other signs and symptoms include: -Hand trembling, head shaking -Nausea, vomiting -Seizures Give same emergency care as for intoxicated patient

26. © 2011 National Safety Council 14-26 Poisonous Bites and Stings

27. © 2011 National Safety Council 14-27 Snake Bites Poisonous snakes include: Rattlesnakes Copperheads Water moccasins (cottonmouths) Coral snakes

28. © 2011 National Safety Council 14-28 Poisonous Bites and Stings Spiders  Black widow  Brown recluse Some scorpion species Portuguese man-of-war and some jellyfish Stings from bees, wasps, etc. can be life-threatening in patients with severe allergies

29. © 2011 National Safety Council 14-29 Assessing Bites and Stings Perform standard assessment Try to identify biting or stinging creature, but do not capture it Check skin for signs of bite or sting

30. © 2011 National Safety Council 14-30 Signs and Symptoms of Many Bites and Stings Pain or burning, redness and swelling at site Depending on species: -Difficulty breathing -Numbness or muscle paralysis

31. © 2011 National Safety Council 14-31 Signs and Symptoms of Many Bites and Stings (continued) Depending on species: -Nausea and vomiting -Blurred vision -Drowsiness or confusion, weakness -Signs of shock Possible allergic reaction

32. © 2011 National Safety Council 14-32 Emergency Care for Bites and Stings Perform standard patient care Have patient lie down and stay calm Wash wound with water with or without soap Remove jewelry and tight clothing before swelling begins Don’t use tourniquet

33. © 2011 National Safety Council 14-33 Emergency Care for Bites and Stings (continued) Don’t cut wound or suck venom With bee or wasp sting, remove stinger and venom sac by scraping it away gently Put cold pack on sting site For spider bite, keep bite area below level of heart With snake bite on extremity, wrap extremity with snug, but not tight, elastic bandage

34. © 2011 National Safety Council 14-34 Emergency Care for Bites and Stings (continued) 1.Watch for allergic reaction, treat for shock 2.Follow local protocol to assist with patient’s medication (EpiPen) 3.Place unresponsive patient in recovery position 4.Monitor breathing and vital signs 5.Give BLS as needed

35. © 2011 National Safety Council 14-35 Jellyfish or Portuguese Man-of-War Sting Wash sting area with vinegar as soon as possible to inactivate venom Remove any remaining tentacles To reduce pain, immerse area in water as hot as can be tolerated as long as pain is felt If hot water is unavailable, use a dry hot pack preferably, or a dry cold pack to reduce pain