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Ch. 14-Poisoning EmergenciesCh. 14-Poisoning Emergencies

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Poisons may enter the body in Poisons may enter the body in four waysfour ways

1. Swallowing (ingesting) substances such as 1. Swallowing (ingesting) substances such as medications, household cleaners, or medications, household cleaners, or chemicalschemicals

2. Inhaling noxious dusts, gases, fumes, or 2. Inhaling noxious dusts, gases, fumes, or mistsmists

3. Penetrating the skin, such as by injection 3. Penetrating the skin, such as by injection with hypodermic needles or by animal, with hypodermic needles or by animal, snake, or insect bitessnake, or insect bites

4. Absorbing through the skin (as with 4. Absorbing through the skin (as with poisonous liquids) or touching the skin (as poisonous liquids) or touching the skin (as with poisonous plants)with poisonous plants)

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14.1 Ingested Poisons14.1 Ingested Poisons

Poison Control CentersPoison Control Centers The Importance of Taking a HistoryThe Importance of Taking a History Signs and SymptomsSigns and Symptoms

Varying levels of unconsciousness, from drowsiness Varying levels of unconsciousness, from drowsiness to unconsciousnessto unconsciousness

Abdominal pain, tenderness, bloating, and/or crampsAbdominal pain, tenderness, bloating, and/or cramps Burns or stains around the mouth, pain in the mouth Burns or stains around the mouth, pain in the mouth

or throat, and/or pain during swallowing (corrosive or throat, and/or pain during swallowing (corrosive poisons may corrode, burn, or destroy the tissues of poisons may corrode, burn, or destroy the tissues of the mouth, throat, and stomach)the mouth, throat, and stomach)

Unusual breath or body odors; characteristic Unusual breath or body odors; characteristic chemical odors (such as turpentine) on the breathchemical odors (such as turpentine) on the breath

Excessive salivation Excessive salivation Nausea, vomiting, and diarrheaNausea, vomiting, and diarrhea If you have even slight suspicion that a person has If you have even slight suspicion that a person has

been poisoned, give first aid care been poisoned, give first aid care

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First Aid CareFirst Aid Care

1. Maintain the airway and monitor the victim’s airway, breathing, circulation, 1. Maintain the airway and monitor the victim’s airway, breathing, circulation, and disabilities (ABCDs). and disabilities (ABCDs).

2. If the poison was a corrosive (acid) or caustic (alkali), immediately give the 2. If the poison was a corrosive (acid) or caustic (alkali), immediately give the victim one or two 8-ounce glasses of victim one or two 8-ounce glasses of cold cold water or milk to dilute the poison water or milk to dilute the poison as instructed by Poison Control. Cold water or milk absorbs heat better 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 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 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 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 the stomach, forcing stomach contents more quickly into the small intestine, where most of the absorption of poison into the bloodstream intestine, where most of the absorption of poison into the bloodstream takes place. takes place.

3. Place the victim on his or her left side so that gravity will delay the poison 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 from entering the small intestine, where most substances are absorbed into the bloodstream. Positioning the victim on his or her left side can delay 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. 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 4. Call Poison Control; an estimated three-fourths of all ingested poison emergencies can be successfully handled with instructions given over the emergencies can be successfully handled with instructions given over the phone. phone.

5. 5. With the exception of an acid or alkali poisoning, never give a poisoning 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 victim anything to eat or drink unless you are told to do so by Poison Control or by a medical professional. Control or by a medical professional.

6. 6. Never induce vomiting.Never induce vomiting.7. Send suspected poisons, containers, plant parts, or other specimens with 7. Send suspected poisons, containers, plant parts, or other specimens with

the victim to the receiving facility the victim to the receiving facility

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Syrup of IpecacSyrup of Ipecac

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

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PROGRESS CHECKPROGRESS CHECK

1. One of the most common agents involved in 1. One of the most common agents involved in poisoning by ingestion is ____________.poisoning by ingestion is ____________.

(Tabasco sauce/motor oil/aspirin)(Tabasco sauce/motor oil/aspirin)2. While the signs and symptoms of ingestion 2. While the signs and symptoms of ingestion

poisoning vary, it often causes ____________. poisoning vary, it often causes ____________. (nausea/cyanosis/paralysis)(nausea/cyanosis/paralysis)

3. The top priority in managing ingestion poisoning 3. The top priority in managing ingestion poisoning is maintaining the ____________.is maintaining the ____________.

(airway/circulation/level of consciousness)(airway/circulation/level of consciousness)4. Syrup of ipecac _______________________. 4. Syrup of ipecac _______________________. (should (should

only be used in children/should be used only be used in children/should be used immediately regardless of the poison/should immediately regardless of the poison/should not be used) not be used)

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14.2 Activated Charcoal14.2 Activated Charcoal

DosageDosage AdministrationAdministration

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

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PROGRESS CHECKPROGRESS CHECK

1. Activated charcoal absorbs poison because of its 1. Activated charcoal absorbs poison because of its ____________. ____________. (chemical composition/additives/porous (chemical composition/additives/porous surface)surface)

2. Activated charcoal works by ____________ poisons.2. Activated charcoal works by ____________ poisons.(absorbing/binding/neutralizing)(absorbing/binding/neutralizing)3. You should not use activated charcoal for a victim 3. You should not use activated charcoal for a victim

who ingested ____________. who ingested ____________. (morning (morning glory/detergent/gasoline)glory/detergent/gasoline)

4. Don’t give activated charcoal to someone who is not 4. Don’t give activated charcoal to someone who is not fully ____________. fully ____________. (alert/compromised/able to (alert/compromised/able to consent)consent)

5. Use the ____________ form of activated charcoal 5. Use the ____________ form of activated charcoal whenever possible. whenever possible. (powdered/premixed/premeasured)(powdered/premixed/premeasured)

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VocabularyVocabulary

IngestingIngesting- taking a substance into the body through - taking a substance into the body through the mouththe mouth

Activated charcoal- Activated charcoal- A special steam-distilled A special steam-distilled charcoal that can absorb many times its weight in charcoal that can absorb many times its weight in contaminants because of its porouscontaminants because of its porous

Inhalation- Inhalation- The act of breathing in (inspiration), or The act of breathing in (inspiration), or the drawing of air or other gases into the lungs the drawing of air or other gases into the lungs

Carbon monoxide- Carbon monoxide- An odorless, tasteless, colorless An odorless, tasteless, colorless toxic gas that results from incomplete combustiontoxic gas that results from incomplete combustion

Urushiol- Urushiol- The toxic element of poison ivy, which The toxic element of poison ivy, which can be carried on animal fur, tools, clothing, and, can be carried on animal fur, tools, clothing, and, when the plant is burned, in the airwhen the plant is burned, in the air

Absorption- Absorption- Taking a substance into the body Taking a substance into the body through the skin through the skin

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14.3 Inhaled Poisons14.3 Inhaled Poisons

Difficulty breathing or shortness of breathDifficulty breathing or shortness of breath Chest pain or tightness; a burning sensation in the chest Chest pain or tightness; a burning sensation in the chest

or throator throat Nausea and vomitingNausea and vomiting Visual changes (blurred or double vision)Visual changes (blurred or double vision) Muscle weaknessMuscle weakness Cough, harsh vibrating sound when breathing, wheezing, Cough, harsh vibrating sound when breathing, wheezing,

or other abnormal breathing soundsor other abnormal breathing sounds HoarsenessHoarseness DizzinessDizziness Headache, often severeHeadache, often severe Ringing in the ears (tinnitus)Ringing in the ears (tinnitus) SeizuresSeizures Altered mental status or confusionAltered mental status or confusion Signs of respiratory tract burns, such as singedSigns of respiratory tract burns, such as singed nasal hairs, soot in the saliva, or soot in the throatnasal hairs, soot in the saliva, or soot in the throat

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First Aid CareFirst Aid Care

1. Immediately move the victim into fresh air. Protect 1. Immediately move the victim into fresh air. Protect yourself—a trained First Aider should remove the victim yourself—a trained First Aider should remove the victim from the poisonous environment. from the poisonous environment.

2. Monitor the victim’s airway, breathing, circulation, and 2. Monitor the victim’s airway, breathing, circulation, and disability (ABCDs)disability (ABCDs)

3. If there are no contraindicating injuries and the victim is 3. If there are no contraindicating injuries and the victim is conscious, have the victim lie down with head elevated; conscious, have the victim lie down with head elevated; loosen all tight-fitting clothing, especially around the neck loosen all tight-fitting clothing, especially around the neck and over the chest. If the victim is unresponsive, place and over the chest. If the victim is unresponsive, place the victim on his or her left side.the victim on his or her left side.

3. If the victim is not breathing, start artificial ventilation 3. If the victim is not breathing, start artificial ventilation immediately; do not interrupt it for any reason. Continue immediately; do not interrupt it for any reason. Continue until the victim is breathing spontaneously or you are until the victim is breathing spontaneously or you are relieved by emergency personnel. relieved by emergency personnel.

All victims of carbon monoxide poisoning must All victims of carbon monoxide poisoning must receive medical carereceive medical care

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PROGRESS CHECKPROGRESS CHECK

1. Most cases of toxic inhalation occur as a result of 1. Most cases of toxic inhalation occur as a result of ____________.____________.

(automobile exhaust/carbon monoxide/fire)(automobile exhaust/carbon monoxide/fire)2. The most common gas that causes poisoning is 2. The most common gas that causes poisoning is

____________.____________.(sulphur dioxide/nitrous oxide/carbon monoxide)(sulphur dioxide/nitrous oxide/carbon monoxide)3. Carbon monoxide is difficult to detect because it is 3. Carbon monoxide is difficult to detect because it is

completely colorless and ____________. completely colorless and ____________. (pervasive/odorless/combustible)(pervasive/odorless/combustible)

4. Carbon monoxide poisoning causes symptoms similar to 4. Carbon monoxide poisoning causes symptoms similar to ____________ symptoms. ____________ symptoms. (flu/emphysema/respiratory (flu/emphysema/respiratory arrest)arrest)

5. ____________ victims of carbon monoxide poisoning need 5. ____________ victims of carbon monoxide poisoning need medical care, even if they seem to have recovered.medical care, even if they seem to have recovered.

(No/About half/All)(No/About half/All)

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14.4 Injected Poisons14.4 Injected Poisons

First Aid CareFirst Aid CareActivate the EMS system immediately, then:Activate the EMS system immediately, then:

1. Maintain the victim’s airway.1. Maintain the victim’s airway.2. Be alert for vomiting; keep the victim sitting 2. Be alert for vomiting; keep the victim sitting

if possible to prevent the victim from if possible to prevent the victim from inhaling vomit.inhaling vomit.

3. In the case of an animal or insect bite or 3. In the case of an animal or insect bite or sting, protect yourself from injury and sting, protect yourself from injury and protect the victim from repeated injection. protect the victim from repeated injection. Bees can sting only once, then lose their Bees can sting only once, then lose their stinger, but wasps, hornets, and yellow stinger, but wasps, hornets, and yellow jackets can sting repeatedly. jackets can sting repeatedly.

4. If the victim was bitten or stung, identify the 4. If the victim was bitten or stung, identify the insect, reptile, or animal that caused the insect, reptile, or animal that caused the injury, if possible; if you killed it, send injury, if possible; if you killed it, send it to the receiving facility with the it to the receiving facility with the victim.victim.

Signs and Signs and symptoms symptoms include:include:

Dizziness Dizziness WeaknessWeakness Chills and feverChills and fever Nausea and/or Nausea and/or

vomitingvomiting

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PROGRESS CHECKPROGRESS CHECK

1. The most common source of injected poison is1. The most common source of injected poison is____________. ____________. (illicit drugs/marine animals/insect stings)(illicit drugs/marine animals/insect stings)2. Injected poisons cause a reaction at the injection 2. Injected poisons cause a reaction at the injection

site followed by a delayed ____________ reaction. site followed by a delayed ____________ reaction. (systemic/respiratory/circulatory)(systemic/respiratory/circulatory)

3. The greatest danger from insect stings is 3. The greatest danger from insect stings is ____________.____________.

(systemic poisoning/lack of antitoxins/anaphylactic (systemic poisoning/lack of antitoxins/anaphylactic shock)shock)

4. The highest priority in caring for a victim of injected 4. The highest priority in caring for a victim of injected poison is ____________.poison is ____________.

(removing the stinger/protecting the airway/placement (removing the stinger/protecting the airway/placement of aof a

constricting band)constricting band)

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14.5 Absorbed Poisons14.5 Absorbed Poisons

Signs and Symptoms of absorbed poison Signs and Symptoms of absorbed poison includeinclude ::

Exposure to a poisonous substanceExposure to a poisonous substance Traces of liquid or powder on the skinTraces of liquid or powder on the skin BurnsBurns Itching and/or irritationItching and/or irritation RednessRedness

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Signs and symptoms of contact with a Signs and symptoms of contact with a poisonous plant include:poisonous plant include:

Fluid-filled, oozing blistersFluid-filled, oozing blisters Itching and burningItching and burning SwellingSwelling Possible painPossible pain A rash lasting from 1 to 3 weeksA rash lasting from 1 to 3 weeks Secondary infections from an irritated rashSecondary infections from an irritated rash

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First Aid CareFirst Aid Care

1. Protecting your hands with gloves, move the 1. Protecting your hands with gloves, move the victim from the source of the poison and remove victim from the source of the poison and remove the victim’s contaminated clothing and jewelry.the victim’s contaminated clothing and jewelry.

2. Brush any dry chemicals or solid poisons from the 2. Brush any dry chemicals or solid poisons from the skin, taking extreme care not to scrape the skin.skin, taking extreme care not to scrape the skin.

3. Irrigate the affected area with clean water for at 3. Irrigate the affected area with clean water for at least 20 minutes or until medical help arrives.least 20 minutes or until medical help arrives.

4. If the victim has been in contact with a poisonous 4. If the victim has been in contact with a poisonous plant, decontaminate the skin immediately by plant, decontaminate the skin immediately by washing it with soap and water or by rinsing it washing it with soap and water or by rinsing it with liberal amounts of rubbing alcohol.with liberal amounts of rubbing alcohol.

5. If any reaction is severe, activate the EMS 5. If any reaction is severe, activate the EMS system or transport the victim to a medical system or transport the victim to a medical facility.facility.

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PROGRESS CHECKPROGRESS CHECK

1. Absorbed poisons enter the body through the 1. Absorbed poisons enter the body through the ___________. ___________. (alveoli/skin/small intestine)(alveoli/skin/small intestine)

2. The poisonous element in poison ____________ can be 2. The poisonous element in poison ____________ can be breathed in from smoke or carried on an animal’s breathed in from smoke or carried on an animal’s fur. fur. (oak/ivy/sumac)(oak/ivy/sumac)

3. If there is a liquid poison on the victim’s skin, 3. If there is a liquid poison on the victim’s skin, ____________ for at least 20 minutes.____________ for at least 20 minutes.

(keep the victim quiet/irrigate with running (keep the victim quiet/irrigate with running water/monitor the victim’s status)water/monitor the victim’s status)