2Types of Poisoning Ingested Poisons Inhaled Poisons Injected Poisons Orally (swallowed)Inhaled PoisonsRespiratory system (breathed in)Most common cases - carbon monoxide poisoningInjected PoisonsBreak in the skinAbsorption (Surface Contact) PoisonsThrough the skin, often with no visible sign of entry
3Danger of Further Injury Poison may enter your body the same way it entered your patient's bodyEspecially true in cases of absorption or inhalation poisoningAlways attempt to establish the nature of the poisoning agent before taking action that could endanger yourself or others
5Signs and Symptoms Nausea Vomiting Abdominal pain Constriction or dilation of pupils,Excessive salivationExcessive sweatingAbnormal respirations or pulseLoss of consciousnessConvulsions
6Poison 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.
7Poison Control Centre - 911 AlbertaBritish ColumbiaManitoba 911New Brunswick 911Newfoundland (709)Northwest Territories (867)Nova ScotiaOntarioPEIQuebecSaskatchewanYukon (867)
8General Treatment - Unresponsive Do not give fluids or induce vomitingCheck vital signsIf vitals signs are normal or stableDetermine the poisoning agentCall the Poison Control CentreMonitor the vital signs frequentlyTransport as a Load and GoIf ABC are compromisedPerform AR or CPR (with appropriate barrier device)Collect any vomitus and any containers that may have held the suspected poisoning agent with the patient
9General Treatment - Responsive Check vital signsDetermine the poisoning agentCall the Poison Control CentreIf directed, induce vomitingMonitor the vital signs frequentlyTransport as a Load & GoCollect any vomitus and any containers that may have held the suspected poisoning agent with the patient
10Ingested PoisonInduce vomiting only if directed by the Poison Control CentreDo not induce vomiting if:The patient is unresponsive or convulsingThe 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 distillatesIngested poisons are poisons introduced into the body orally (swallowed)
11Inhaled Poisons Additional signs and symptoms: Respiratory distress CoughingPain and burning in the throatPain in the chestCyanosisInhaled poisons are poisons introduced into the body through the respiratory system (breathed in). The most common cases are those of carbon monoxide poisoning.
12Treatment Remove the patient from the contaminated atmosphere Check and monitor vital signsEnsure that the airway, breathing and circulation are maintainedInitiate AR/CPR as necessaryAdminister oxygen, if availableIdentify the poisoning agentContact the Poison Control Centre and follow their instructionsTransport to medical aidIf the environment is unsafe, do not intervene, call the EMS and inform them of the situation
13Injected Poisons Signs and symptoms Confusion Disorientation Delusions PainTenderness/swelling at the site of entryUnresponsiveDiminished function or failure of the respiratory or circulatory systemsInjected poisons are poisons introduced into the body via a break in the skin
14TreatmentIf swelling is apparent, remove all rings, watches and jewellery from the affected limbsApply a constriction bandCheck, maintain and monitor vital signsIdentify the poisoning agentCall the Poison Control Centre and follow the directionsTransport the patient to medical aid
15Pressure Immobilization Bandage is a tourniquet-like (venous tourniquet) deviceapplied proximally (closer to the heart) to the injured or poisoned region of an extremity.
16Pressure Immobilization Bandage A pressure immobilization bandage must:completely encircle the extremitybe narrow enough to impede circulationbe wide enough that the skin is not damagedImpedes circulation sufficiently to impede venous return to the heart, but not to completely eliminate arterial supplyPeripheral pulse should still be palpable
17Absorbed Poison Common absorption poisons include: Pesticides HerbicidesCorrosivesAcidsAlkalisSome petroleum distillatesAbsorption poisons are introduced into the body through the skin, often with no visible sign of entry
18Signs and Symptoms Nausea Sweating Skin irritation Burns Abdominal and substernal tightnessAbdominal crampsProfuse salivationRespiratory distressMuscle twitchingSeizuresParalysis
19Treatment Protect yourself from skin contamination Remove the agent from continued skin contact by:Removing any contaminated clothing from the patientIf substance is not reactive to water, wash the area including directing a stream of waterIf the poison is solid or in granular form, remove as much of it as possible by brushing before washing with waterIdentify the poisonCall the Poison Control Centre and follow the directions givenTransport the patient to medical aidAlways check if the substance could react to water
20Insect StingsStings from insects such as bees, wasps, and hornets are prevalent particularly during the warmer months and are more common among childrenThe body reacts to insect stings on two different levels, local and systemicSystemic is a common anaphylactic shock situation and may require use of epipen.
21Reaction to stings Local Pain Redness Itching Swelling Systemic Breathing difficultySwelling around throatSkin welts or hivesGeneral itchingWeaknessHeadacheAbdominal painAnxietyRestlessnessIn 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 anaphylaxisIn 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
22TreatmentLocalFor bee stings: scrape surface to remove stinger and venom sackApply iceSystemicMonitor and be prepared to provide critical interventionScrape surface to remove stinger and venom sackApply ice to the areaIf possible, collect insect for identificationTransport to next level of EMS
23Snake Bite North American poisonous snakes : Coral SnakesRattlesnakesCopperheadsWater MoccasinsThe venom of rattlesnakes, copperheads and water moccasins alters normal characteristics of blood, particularly its ability to clotCoral snake's venom affects the nervous systemIn Canada, the most serious threat is from rattlesnakes
24Signs and SymptomsBleeding under the skin and purplish discolouration after several hoursBlood blistersSweatingVomitingRapid pulseLimb numbnessWeaknessFaintnessLow blood pressureSevere burning pain and immediate swelling at the bite site, increasing over the next six-to-eight hoursIf no swelling has occurred after one hour, injection of venom is unlikely to have occurred
25Treatment Calm and reassure the patient Have them lie down and keep them quiet throughout transportation to hospitalDo not give them any alcoholRings, watches and constricting clothing should be removedClean the bite site with soap and water or an antiseptic solution, if available
26TreatmentLocate the fang marks and place a pressure immobilization bandage around the entire length of the bitten extremityImmobilize the extremity in a splint to reduce circulation in the limbCheck and monitor vital signsEnsure that the ABCs are maintained
27TreatmentUnder no circumstances should an ice pack or cold pack be applied to the area. Some types of snake venom are activated by coldTransport to medical aidIf possible, advise the medical facility prior to the patient's arrival in order that anti-venom may be awaiting them
28Drug Abuse Drug Drug use Drug abuse any chemical that modifies the function of living tissues resulting in physiological or behavioural changesDrug useusage of therapeutic or non-therapeutic substances to produce a desired effect with minimum hazardDrug abusewhenever drugs are taken or administered under circumstances and at doses that significantly increase their hazard potential
30Alcohol - Signs and Symptoms Breath odourNauseaVomitingLack of coordinationSlurred of speechEmotional instabilityLoss of inhibitionsAggressive, violent behaviour and abusive languageDeep respirationFacial flushingDilated pupils
31Solvents - Signs and Symptoms Characteristic strong odour of glue or of other chemicalsSymptoms of intoxication similar to alcoholEuphoriaUncoordinated gaitSlurred speech
32Barbiturates - Signs and Symptoms Decreased blood pressureDecreased respiration rateSlurred speechInvoluntary horizontal eye movementLack of physical coordinationAbsence of alcohol odourNembutal®,Seconal®,Amytal®,“Yellow Jackets”,“Goofballs”“Reds”,“Downers”, and“Blue Heavens”.
33Narcotics-Signs and Symptoms NauseaVomitingConstricted pupilsConstipationDecreased respiration rateUnresponsiveness to painLethargyNumerous injection sites along veins of the arms or legsCodeine,Morphine,Heroin,Demerol®, andPercodan®.
34Stimulants - Signs and Symptoms Dilated pupilsLoss of appetiteOver- or hyperactivityRapid speechBelligerenceSuspiciousnessConfusionRapid and strong pulseShallow respirationDry mouthProfuse perspirationMethedrine,Dexedrine,Benzedrine®,Ritalin®,caffeine, andCocaine
35Cannabis - Signs and Symptoms Intoxication and euphoria without drastic change in judgement or gaitReddening of the eyesIncreased pulse rateUnusual hilarityIncreased appetitemarijuanahashish
36Hallucinogens - Signs and Symptoms Markedly-dilated pupilsUnusual hilarityEmotional swingsSuspiciousnessBizarre behaviourNausea and vomitingIncreased pulse rate and blood pressure,SweatingAnxietyLSD 25PsilocybineDMTDETMescalineDOMSTPEctasy
37Treatment - ConsciousIntroduce yourself; attempt to carry on a conversationAttempt to establish their current state of mindIf possible, attempt to "talk them down" and place them in a quiet, dimly lit roomTry to establish the causative drug for the patient's current stateBe aware of sudden changes in personality or behaviourTransport to medical aid
38Treatment - Unconscious Establish the presence of vital signsMaintain and monitor vital signsQuestion bystanders and/or search the surroundings to establish the patient's past medical and drug historyTransport the patient to medical aidTransport any findings to hospital with the person
39Assume the WorstNever assume that any altered level of consciousness or personality changes are the result of drug ingestionTreat as per any other casualty with an altered level of consciousnessWhile 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.
40Remember Further danger Protect yourself and others from the poison Use barrier devicesControl / avoid the source of the poisonWhen 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 disposablefilters.