Ch. 14-Poisoning Emergencies

Poisons may enter the body in four ways 1. Swallowing (ingesting) substances such as medications, household cleaners, or chemicals 2. Inhaling noxious dusts, gases, fumes, or mists 3. Penetrating the skin, such as by injection with hypodermic needles or by animal, snake, or insect bites 4. Absorbing through the skin (as with poisonous liquids) or touching the skin (as with poisonous plants) 2

14.1 Ingested Poisons Poison Control Centers The Importance of Taking a History Signs and Symptoms Varying levels of unconsciousness, from drowsiness to unconsciousness Abdominal pain, tenderness, bloating, and/or cramps Burns or stains around the mouth, pain in the mouth or throat, and/or pain during swallowing (corrosive poisons may corrode, burn, or destroy the tissues of the mouth, throat, and stomach) Unusual breath or body odors; characteristic chemical odors (such as turpentine) on the breath Excessive salivation Nausea, vomiting, and diarrhea If you have even slight suspicion that a person has been poisoned, give first aid care 3

First Aid Care 1. Maintain the airway and monitor the victim’s airway, breathing, circulation, and disabilities (ABCDs). 2. If the poison was a corrosive (acid) or caustic (alkali), immediately give the victim one or two 8-ounce glasses of cold water or milk to dilute the poison as instructed by Poison Control. Cold water or milk absorbs heat better than room-temperature or warm liquids. Do not give water or milk in any other case unless you are told to do so by the Poison Control Center. Water or milk may cause a dry poison (such as a tablet) to dissolve, and fills up the stomach, forcing stomach contents more quickly into the small intestine, where most of the absorption of poison into the bloodstream takes place. 3. Place the victim on his or her left side so that gravity will delay the poison from entering the small intestine, where most substances are absorbed into the bloodstream. Positioning the victim on his or her left side can delay movement of the poison into the small intestine by as long as two hours. 4. Call Poison Control; an estimated three-fourths of all ingested poison emergencies can be successfully handled with instructions given over the phone. 5. With the exception of an acid or alkali poisoning, never give a poisoning victim anything to eat or drink unless you are told to do so by Poison Control or by a medical professional. 6. Never induce vomiting. 7. Send suspected poisons, containers, plant parts, or other specimens with the victim to the receiving facility 4

5

Syrup of Ipecac Beginning in 1965 and until recently, the Poison Control Center and physicians advised first-aiders to induce vomiting if a victim swallowed poison – and the recommended way to induce vomiting was with syrup of ipecac. However, in November 2003, the American Academy of Pediatrics (AAP) advised that syrup of ipecac no longer be used to induce vomiting, and advised that people discard any syrup of ipecac they had on hand. 6

PROGRESS CHECK 1. One of the most common agents involved in poisoning by ingestion is ____________. (Tabasco sauce/motor oil/aspirin) 2. While the signs and symptoms of ingestion poisoning vary, it often causes ____________. (nausea/cyanosis/paralysis) 3. The top priority in managing ingestion poisoning is maintaining the ____________. (airway/circulation/level of consciousness) 4. Syrup of ipecac _______________________. (should only be used in children/should be used immediately regardless of the poison/should not be used) 7

14.2 Activated Charcoal Dosage Administration 1. Shake the container of activated charcoal thoroughly; if it is too thick to shake well, remove the cap and stir it until well mixed. The activated charcoal settles to the bottom of the bottle, and needs to be evenly distributed. 2. Activated charcoal looks like mud. Don’t mix the activated charcoal with anything else in an effort to make it more acceptable to the victim; you could make it less absorbent. 3. If the victim takes a long time to drink the activated charcoal, it will settle. Make sure you shake or stir it again before letting the victim finish the dose. 4. Record the time the victim took the activated charcoal and the specifics about the dose. 5. If the victim vomits, repeat the dose once. Once you have given a victim activated charcoal, don’t let the victim have milk, ice cream, or sherbet; all decrease the effectiveness of the activated charcoal. 8

PROGRESS CHECK 1. Activated charcoal absorbs poison because of its ____________. (chemical composition/additives/porous surface) 2. Activated charcoal works by ____________ poisons. (absorbing/binding/neutralizing) 3. You should not use activated charcoal for a victim who ingested ____________. (morning glory/detergent/gasoline) 4. Don’t give activated charcoal to someone who is not fully ____________. (alert/compromised/able to consent) 5. Use the ____________ form of activated charcoal whenever possible. (powdered/premixed/premeasured) 9

Vocabulary Ingesting- taking a substance into the body through the mouth Activated charcoal- A special steam-distilled charcoal that can absorb many times its weight in contaminants because of its porous Inhalation- The act of breathing in (inspiration), or the drawing of air or other gases into the lungs Carbon monoxide- An odorless, tasteless, colorless toxic gas that results from incomplete combustion Urushiol- The toxic element of poison ivy, which can be carried on animal fur, tools, clothing, and, when the plant is burned, in the air Absorption- Taking a substance into the body through the skin 10

14.3 Inhaled Poisons Difficulty breathing or shortness of breath Chest pain or tightness; a burning sensation in the chest or throat Nausea and vomiting Visual changes (blurred or double vision) Muscle weakness Cough, harsh vibrating sound when breathing, wheezing, or other abnormal breathing sounds Hoarseness Dizziness Headache, often severe Ringing in the ears (tinnitus) Seizures Altered mental status or confusion Signs of respiratory tract burns, such as singed nasal hairs, soot in the saliva, or soot in the throat 11

First Aid Care 1. Immediately move the victim into fresh air. Protect yourself—a trained First Aider should remove the victim from the poisonous environment. 2. Monitor the victim’s airway, breathing, circulation, and disability (ABCDs) 3. If there are no contraindicating injuries and the victim is conscious, have the victim lie down with head elevated; loosen all tight-fitting clothing, especially around the neck and over the chest. If the victim is unresponsive, place the victim on his or her left side. 3. If the victim is not breathing, start artificial ventilation immediately; do not interrupt it for any reason. Continue until the victim is breathing spontaneously or you are relieved by emergency personnel. All victims of carbon monoxide poisoning must receive medical care 12

PROGRESS CHECK 1. Most cases of toxic inhalation occur as a result of ____________. (automobile exhaust/carbon monoxide/fire) 2. The most common gas that causes poisoning is ____________. (sulphur dioxide/nitrous oxide/carbon monoxide) 3. Carbon monoxide is difficult to detect because it is completely colorless and ____________. (pervasive/odorless/combustible) 4. Carbon monoxide poisoning causes symptoms similar to ____________ symptoms. (flu/emphysema/respiratory arrest) 5. ____________ victims of carbon monoxide poisoning need medical care, even if they seem to have recovered. (No/About half/All) 13

14.4 Injected Poisons Signs and symptoms include: Dizziness Weakness Chills and fever Nausea and/or vomiting First Aid Care Activate the EMS system immediately, then: 1. Maintain the victim’s airway. 2. Be alert for vomiting; keep the victim sitting if possible to prevent the victim from inhaling vomit. 3. In the case of an animal or insect bite or sting, protect yourself from injury and protect the victim from repeated injection. Bees can sting only once, then lose their stinger, but wasps, hornets, and yellow jackets can sting repeatedly. 4. If the victim was bitten or stung, identify the insect, reptile, or animal that caused the injury, if possible; if you killed it, send it to the receiving facility with the victim. 14

PROGRESS CHECK 1. The most common source of injected poison is ____________. (illicit drugs/marine animals/insect stings) 2. Injected poisons cause a reaction at the injection site followed by a delayed ____________ reaction. (systemic/respiratory/circulatory) 3. The greatest danger from insect stings is ____________. (systemic poisoning/lack of antitoxins/anaphylactic shock) 4. The highest priority in caring for a victim of injected poison is ____________. (removing the stinger/protecting the airway/placement of a constricting band) 15

Exposure to a poisonous substance 14.5 Absorbed Poisons Signs and Symptoms of absorbed poison include : Exposure to a poisonous substance Traces of liquid or powder on the skin Burns Itching and/or irritation Redness 16

Signs and symptoms of contact with a poisonous plant include: Fluid-filled, oozing blisters Itching and burning Swelling Possible pain A rash lasting from 1 to 3 weeks Secondary infections from an irritated rash 17

First Aid Care 1. Protecting your hands with gloves, move the victim from the source of the poison and remove the victim’s contaminated clothing and jewelry. 2. Brush any dry chemicals or solid poisons from the skin, taking extreme care not to scrape the skin. 3. Irrigate the affected area with clean water for at least 20 minutes or until medical help arrives. 4. If the victim has been in contact with a poisonous plant, decontaminate the skin immediately by washing it with soap and water or by rinsing it with liberal amounts of rubbing alcohol. 5. If any reaction is severe, activate the EMS system or transport the victim to a medical facility. 18

PROGRESS CHECK 1. Absorbed poisons enter the body through the ___________. (alveoli/skin/small intestine) 2. The poisonous element in poison ____________ can be breathed in from smoke or carried on an animal’s fur. (oak/ivy/sumac) 3. If there is a liquid poison on the victim’s skin, ____________ for at least 20 minutes. (keep the victim quiet/irrigate with running water/monitor the victim’s status) 19