1. Poisoning

2. You Are the Emergency Medical Responder
Lesson 24: Poisoning
You Are the Emergency Medical Responder
Your police unit is summoned to a residence on a report of an unconscious person. When you arrive and size-up the scene, you discover parents with their 2-year-old child. The mother is distraught and says she found her toddler on the kitchen floor very drowsy. She noticed that the under-the-sink cabinet door was open, and there was a bottle of liquid kitchen cleaner lying next to the child. She called because he was not responding when she tried to wake him up.

3. Poison
Any substance that causes injury, illness or death if it enters the body
Toxins are poisonous substances produced by microorganisms that can cause certain diseases but also are capable of stimulating neutralizing antibodies or antitoxins
Every person will/can react to poisons differently

4. Poison Control Centers
Specialized health care centers that provide information on poisons and suspected poisoning emergencies
24-Hour Poison Help Hotline:
U of U
Pharmacists, physicians, nurses, toxicologists
70% of poison exposure cases can be managed over the phone

5. Poison Control Centers
Poison Control Information
Name, phone number, county, and zip code
Victim's age and weight
Any symptoms the victim has related to the poisoning
Time the poisoning took place
Name of the substance or poison
Amount of the substance or poison
Current health problems of the victim
Medicines the victim is taking

6. How Poisons Enter the Body
Absorption
Skin / Mucus membranes
Injection
Bites, stings needles
Ingestion
Swallowed
Inhalation
Breathes
Poison oak
© Shutterstock.com/Dwight Smith
Poison Ivy.
© Shutterstock.com/Tim Mainiero
Poison sumac
Courtesy of

7. Ingested Poisons Young children and elderly higher risk
Foods are the most common
Bacterial food poisoning (Salmonella or E. coli)
Chemical food poisoning (containers lined with zinc, cadmium, copper, lead or mercury)
Drugs or medications
Household items

8. Signs and Symptoms of Ingested Poisons
Nausea, vomiting
Chest, abdominal pain
Difficulty breathing
Sweating
LOC
Seizures
Headache, dizziness
Weakness
Irregular pupils
Burning/tearing eyes
Abnormal skin color
Burn injuries
Lips
Around mouth

9. Providing Care for Ingested Poisons
Call more advanced medical personnel / PCC
Do not give anything to eat/drink unless told to do so
If patient vomits, save some in plastic bag
Induce vomiting only if instructed to do so
Unconscious
Corrosive substance
Pregnant (last trimester)

10. Ingested Poisons Ipecac
Action
Local irritant & vomit center stimulation
Onset of action
20-30 minutes in 97% people
Advantages
Easy to use
Was over-the-counter
Disadvantages
Poison can pass into small intestine during minute wait for vomiting
Delays additional care, can’t be mixed with activated charcoal
Only 30% - 50% stomach contents recovered = leaves 50% - 70% poison
Complications
Aspiration, esophageal rupture, death
Karen Carpenter

11. Inhaled Poisons Carbon monoxide Carbon dioxide Chlorine gas Ammonia
Sulfur dioxide
Nitrous oxide
Chloroform
Dry cleaning solvents
Fire extinguisher gases
Industrial gases
Hydrogen sulfide

12. Signs and Symptoms of Inhaled Poisons
Difficulty breathing
Chest pain
Nausea or vomiting
Headache, dizziness
Altered mental status
Seizures
Cyanosis

13. Providing Care for Inhaled Poisons
Follow appropriate safety precautions to ensure you do not inhale the substance and become poisoned as well
Remove patient from source without endangering yourself
Call more advanced medical personnel / PCC
Administer oxygen as soon as possible
Toxic fumes - may have to call hazard material team

14. Absorbed Poison
Enters the body through skin or mucus membranes of the eyes, mouth, and nose
Plants
Poison ivy
Poison oak
Poison sumac
Dry chemicals
Wet chemicals
Topical medications

15. Signs and Symptoms of Absorbed Poisons
Traces of the liquid, powder or chemical on the patient’s skin
Skin that looks burned, irritated, red, or swollen
Blisters that ooze fluid or a rash
Itchy skin

16. Providing Care for Absorbed Poisons
Follow appropriate safety precautions to ensure you do not come into contact with the substance and become poisoned as well - BSI
Brush / flush with water at least 20 minutes
Eyes, do not rinse into good eye!
Call more advanced medical personnel / PCC

17. Activity
You arrive at a local nursery in response to a call that an employee was splashed in the face and on the neck with a liquid chemical to kill weeds. The employee is conscious and is complaining that his skin and eyes feel “like they are on fire.”

18. Injected Poison
Bites or stings of insects, spiders, aquatic life, animals or snakes
Drugs or misused medications injected with a hypodermic needle

19. Signs and Symptoms of Injected Poisons
Bite or sting mark at point of entry
Stinger, tentacle or venom sac near entry site
Redness, pain, tenderness around entry site
Signs of allergic reaction
Itching, hives, rash
Weakness, nausea, dizziness
Severe allergic reactions
Anaphylaxis

20. Providing Care for Injected Poisons
Scene size-up / standard precautions
Primary assessment – provide care for conditions found
Apply ice/cold pack if appropriate
Provide specific care – chapter 16
Call more advanced medical personnel / PCC

21. You Are the Emergency Medical Responder
You complete your assessment and find that the toddler is unresponsive and his respiratory and pulse rates are extremely slow. He also has some redness around his mouth and lips, and there is a strong odor of bleach. Based on your findings, you suspect poisoning.

22. Enrichment Carbon Monoxide & Cyanide Poisoning
Carbon Monoxide (CO) and Cyanide result from fires, industrial accidents, and Weapons of Mass Destruction (WMD)
CO is the leading cause of poisoning deaths in the US
It is colorless, odorless, and tasteless
CO is a byproduct of combustion, therefore at-risk individuals include:
Boats, Bar-B-Que inside a closed garage
Sleeping inside a running car
Faulty furnace, wood stove, or water heater

23. Carbon Monoxide Poisoning Signs and Symptoms
Dull throbbing headache
Nausea or vomiting
Bluish skin color
Chest pain
Confusion
Convulsions
Dizziness
Drowsiness
Fainting
Hyperactivity
Impaired judgment
Irritability
Loss of consciousness
Low blood pressure
Muscle weakness
Rapid or abnormal heart beat
Shock
Shortness of breath

24. Cyanide Poisoning Signs and Symptoms
Ingestion or absorption
Dizziness
Headache
Nausea and vomiting
Rapid breathing
Rapid heart rate
Restlessness
Weakness
Large, concentrated/intense exposure
Convulsions
Loss of consciousness
Low blood pressure
Lung injury
Respiratory failure leading to death
Slow heart rate

25. Care for Carbon Monoxide Poisoning
Ensure that EMRs are properly outfitted for safety
Remove the patient from the situation as quickly as possible
Alert ER staff and physicians about the suspicion of CO poisoning
Inform the patient that he or she may have a blood test to confirm diagnosis
Monitor and treat everyone in the area
Administer emergency oxygen
Home CO detector

26. Care for Cyanide Poisoning
Observe for signs and symptoms of cyanide poisoning
Seek medical attention immediately
Seek fresh air or rest in a half-upright position
Administer emergency oxygen
Wear protective clothing
Rinse eyes with plenty of water
Read CO and cyanide Enrichment pages

27. Enrichment Administering Activated Charcoal
Give within 1 hour of ingestion (ideally) only if directed by medical control or the PCC and the patient is fully conscious and alert
Not for patients who have overdosed on cyanide or swallowed acids or alkalis
Mix it thoroughly with water and give through a straw or use an opaque container
Dosage:
1 g per kilogram of patient’s weight
30 to 100 g for adult
12 to 25 g for child or infant