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POISONING, DRUG & MEDICATION ABUSE
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Types of Poisoning Ingested Poisons Inhaled Poisons Injected Poisons
Orally (swallowed) Inhaled Poisons Respiratory system (breathed in) Most common cases - carbon monoxide poisoning Injected Poisons Break in the skin Absorption (Surface Contact) Poisons Through the skin, often with no visible sign of entry
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Danger of Further Injury
Poison may enter your body the same way it entered your patient's body Especially true in cases of absorption or inhalation poisoning Always attempt to establish the nature of the poisoning agent before taking action that could endanger yourself or others
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Common Examples Pesticides Herbicides Gaseous compounds Medicines
Household cleaning products Plants Paints Burning plastics Specific poisons Perfumes Food
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Signs and Symptoms Nausea Vomiting Abdominal pain
Constriction or dilation of pupils, Excessive salivation Excessive sweating Abnormal respirations or pulse Loss of consciousness Convulsions
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Poison Control Centre What is the poisoning agent? How much was taken?
The mechanism of poisoning? The patient’s vital signs? Was the poison: ingested, inhaled, injected, or absorbed through the skin? How long ago was the poison taken? What is the present status of the patient? Your greatest asset in treating a patient who has been poisoned is the ready access to the resources of a Poison Control Centre.
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Poison Control Centre - 911
Alberta British Columbia Manitoba 911 New Brunswick 911 Newfoundland (709) Northwest Territories (867) Nova Scotia Ontario PEI Quebec Saskatchewan Yukon (867)
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General Treatment - Unresponsive
Do not give fluids or induce vomiting Check vital signs If vitals signs are normal or stable Determine the poisoning agent Call the Poison Control Centre Monitor the vital signs frequently Transport as a Load and Go If ABC are compromised Perform AR or CPR (with appropriate barrier device) Collect any vomitus and any containers that may have held the suspected poisoning agent with the patient
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General Treatment - Responsive
Check vital signs Determine the poisoning agent Call the Poison Control Centre If directed, induce vomiting Monitor the vital signs frequently Transport as a Load & Go Collect any vomitus and any containers that may have held the suspected poisoning agent with the patient
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Ingested Poison Induce vomiting only if directed by the Poison Control Centre Do not induce vomiting if: The patient is unresponsive or convulsing The poison is a known corrosive agent such as: acid, lye, drain cleaner, or if it has caused burns to the lips, mouth or throat. a poison that contains petroleum distillates Ingested poisons are poisons introduced into the body orally (swallowed)
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Inhaled Poisons Additional signs and symptoms: Respiratory distress
Coughing Pain and burning in the throat Pain in the chest Cyanosis Inhaled poisons are poisons introduced into the body through the respiratory system (breathed in). The most common cases are those of carbon monoxide poisoning.
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Treatment Remove the patient from the contaminated atmosphere
Check and monitor vital signs Ensure that the airway, breathing and circulation are maintained Initiate AR/CPR as necessary Administer oxygen, if available Identify the poisoning agent Contact the Poison Control Centre and follow their instructions Transport to medical aid If the environment is unsafe, do not intervene, call the EMS and inform them of the situation
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Injected Poisons Signs and symptoms Confusion Disorientation Delusions
Pain Tenderness/swelling at the site of entry Unresponsive Diminished function or failure of the respiratory or circulatory systems Injected poisons are poisons introduced into the body via a break in the skin
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Treatment If swelling is apparent, remove all rings, watches and jewellery from the affected limbs Apply a constriction band Check, maintain and monitor vital signs Identify the poisoning agent Call the Poison Control Centre and follow the directions Transport the patient to medical aid
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Pressure Immobilization Bandage
is a tourniquet-like (venous tourniquet) device applied proximally (closer to the heart) to the injured or poisoned region of an extremity.
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Pressure Immobilization Bandage
A pressure immobilization bandage must: completely encircle the extremity be narrow enough to impede circulation be wide enough that the skin is not damaged Impedes circulation sufficiently to impede venous return to the heart, but not to completely eliminate arterial supply Peripheral pulse should still be palpable
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Absorbed Poison Common absorption poisons include: Pesticides
Herbicides Corrosives Acids Alkalis Some petroleum distillates Absorption poisons are introduced into the body through the skin, often with no visible sign of entry
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Signs and Symptoms Nausea Sweating Skin irritation Burns
Abdominal and substernal tightness Abdominal cramps Profuse salivation Respiratory distress Muscle twitching Seizures Paralysis
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Treatment Protect yourself from skin contamination
Remove the agent from continued skin contact by: Removing any contaminated clothing from the patient If substance is not reactive to water, wash the area including directing a stream of water If the poison is solid or in granular form, remove as much of it as possible by brushing before washing with water Identify the poison Call the Poison Control Centre and follow the directions given Transport the patient to medical aid Always check if the substance could react to water
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Insect Stings Stings from insects such as bees, wasps, and hornets are prevalent particularly during the warmer months and are more common among children The body reacts to insect stings on two different levels, local and systemic Systemic is a common anaphylactic shock situation and may require use of epipen.
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Reaction to stings Local Pain Redness Itching Swelling Systemic
Breathing difficulty Swelling around throat Skin welts or hives General itching Weakness Headache Abdominal pain Anxiety Restlessness In approximately 5% of the population, a generalized systemic reaction occurs with insect stings, particularly bee stings. The patient in these cases displays an acute allergic reaction to the venom, known as anaphylaxis In anaphylaxis, death can occur within as little as five minutes from the time of the sting. These people may have their medication with them and may require assistance
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Treatment Local For bee stings: scrape surface to remove stinger and venom sack Apply ice Systemic Monitor and be prepared to provide critical intervention Scrape surface to remove stinger and venom sack Apply ice to the area If possible, collect insect for identification Transport to next level of EMS
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Snake Bite North American poisonous snakes :
Coral Snakes Rattlesnakes Copperheads Water Moccasins The venom of rattlesnakes, copperheads and water moccasins alters normal characteristics of blood, particularly its ability to clot Coral snake's venom affects the nervous system In Canada, the most serious threat is from rattlesnakes
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Signs and Symptoms Bleeding under the skin and purplish discolouration after several hours Blood blisters Sweating Vomiting Rapid pulse Limb numbness Weakness Faintness Low blood pressure Severe burning pain and immediate swelling at the bite site, increasing over the next six-to-eight hours If no swelling has occurred after one hour, injection of venom is unlikely to have occurred
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Treatment Calm and reassure the patient
Have them lie down and keep them quiet throughout transportation to hospital Do not give them any alcohol Rings, watches and constricting clothing should be removed Clean the bite site with soap and water or an antiseptic solution, if available
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Treatment Locate the fang marks and place a pressure immobilization bandage around the entire length of the bitten extremity Immobilize the extremity in a splint to reduce circulation in the limb Check and monitor vital signs Ensure that the ABCs are maintained
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Treatment Under no circumstances should an ice pack or cold pack be applied to the area. Some types of snake venom are activated by cold Transport to medical aid If possible, advise the medical facility prior to the patient's arrival in order that anti-venom may be awaiting them
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Drug Abuse Drug Drug use Drug abuse
any chemical that modifies the function of living tissues resulting in physiological or behavioural changes Drug use usage of therapeutic or non-therapeutic substances to produce a desired effect with minimum hazard Drug abuse whenever drugs are taken or administered under circumstances and at doses that significantly increase their hazard potential
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Commonly Abused Drugs Tranquilizers Antidepressants Analgesics Alcohol
Prescription medication Solvents
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Alcohol - Signs and Symptoms
Breath odour Nausea Vomiting Lack of coordination Slurred of speech Emotional instability Loss of inhibitions Aggressive, violent behaviour and abusive language Deep respiration Facial flushing Dilated pupils
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Solvents - Signs and Symptoms
Characteristic strong odour of glue or of other chemicals Symptoms of intoxication similar to alcohol Euphoria Uncoordinated gait Slurred speech
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Barbiturates - Signs and Symptoms
Decreased blood pressure Decreased respiration rate Slurred speech Involuntary horizontal eye movement Lack of physical coordination Absence of alcohol odour Nembutal®, Seconal®, Amytal®, “Yellow Jackets”, “Goofballs” “Reds”, “Downers”, and “Blue Heavens”.
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Narcotics-Signs and Symptoms
Nausea Vomiting Constricted pupils Constipation Decreased respiration rate Unresponsiveness to pain Lethargy Numerous injection sites along veins of the arms or legs Codeine, Morphine, Heroin, Demerol®, and Percodan®.
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Stimulants - Signs and Symptoms
Dilated pupils Loss of appetite Over- or hyperactivity Rapid speech Belligerence Suspiciousness Confusion Rapid and strong pulse Shallow respiration Dry mouth Profuse perspiration Methedrine, Dexedrine, Benzedrine®, Ritalin®, caffeine, and Cocaine
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Cannabis - Signs and Symptoms
Intoxication and euphoria without drastic change in judgement or gait Reddening of the eyes Increased pulse rate Unusual hilarity Increased appetite marijuana hashish
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Hallucinogens - Signs and Symptoms
Markedly-dilated pupils Unusual hilarity Emotional swings Suspiciousness Bizarre behaviour Nausea and vomiting Increased pulse rate and blood pressure, Sweating Anxiety LSD 25 Psilocybine DMT DET Mescaline DOM STP Ectasy
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Treatment - Conscious Introduce yourself; attempt to carry on a conversation Attempt to establish their current state of mind If possible, attempt to "talk them down" and place them in a quiet, dimly lit room Try to establish the causative drug for the patient's current state Be aware of sudden changes in personality or behaviour Transport to medical aid
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Treatment - Unconscious
Establish the presence of vital signs Maintain and monitor vital signs Question bystanders and/or search the surroundings to establish the patient's past medical and drug history Transport the patient to medical aid Transport any findings to hospital with the person
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Assume the Worst Never assume that any altered level of consciousness or personality changes are the result of drug ingestion Treat as per any other casualty with an altered level of consciousness While poisoning is not a commonly encountered problem in winter first aid, drug abuse problems are unfortunately surprisingly common. Anaphylactic reactions can occur in any setting and at any time of the year. Treat these conditions appropriately and aggressively, and do not fall into the trap of thinking that someone with an altered level of consciousness, and alcohol odor to the breath, just needs to “sleep it off”. Unfortunately, many of these people will not survive.
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Remember Further danger Protect yourself and others from the poison
Use barrier devices Control / avoid the source of the poison When dealing with poisons, the first consideration is that of your safety. That includes making sure that the air is free of poisonous gases, and that inhaled, ingested, or skin contact poisons cannot harm you. Of special concern are strong poisons that could be on the lips of the patient, in any vomitus, or exhaled from the lungs. In such cases your own protection is vital. You should use barrier devices such as pocket masks or disposable filters.
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