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Ingested (Swallowed) Poisons

Fortunately, most poisons ingested have low toxicity or are swallowed in amounts
so small that severe poisoning rarely occurs.
However, the potential for severe or fatal poisoning is always present.

What to Look For
. abdominal pain and cramping
. nausea or vomiting
. diarrhea
. burns, odor, stains around and in mouth
. drowsiness or unconsciousness
. poison containers nearby

What to Do
1. Determine critical information:
. Age and size of the victim?
. What was swallowed? (Read container label; save
vomit for analysis.)
. How much was swallowed (eg, a "taste," half a
bottle, a dozen tablets)?
. When was it swallowed?
2. If a corrosive or caustic (ie, acid or alkali) substance was swallowed,
immediately dilute it by having the victim drink at least one or two eight-ounce glasses of water or milk.
(Cold milk or water tends to absorb heat better than room-temperature or warmer liquids.)
3. For a responsive victim, call a poison control center immediately.
Some poisons do not cause harm until hours later, while others do damage immediately.
More than 75% of poisonings can be treated by following the instructions given over the telephone
from a poison control center. The center also will advise you if medical attention is needed.
Poison control centers routinely follow up calls to check whether additional symptoms or unexpected effects
are occurring. Call 911 and find out the number for local poison control centers.

Material Safety Data Sheets (MSDS)

For each hazardous chemical in the workplace, employer is required by law to maintain a copy of the MSDS.
An MSDS lists the hazardous Ingredients of a product, its physical and chemical characteristics (eg, flammability), its effects human health, the chemicals with which an adversely react, handling precautions, measures that can be used to control exposure, emergency and first aid procedures, and methods to contain a spill.

4. For an unresponsive victim, check ABCs and treat accordingly. Call 911 or the local emergency number. Monitor ABCs often.
5.Place the victim on his or her left side. This positions the end of the stomach where it enters the small intestine (pylorus) straight up. In this position, gravity will delay (by as much as two hours) the poison's advance into the small intestine, where absorption into victim's circulatory system is faster ("'Figure 1 ) The side position also helps prevent breathing for
materials into the lungs if vomiting begins. Induce vomiting only if a poison control center or a physician advises it.                                                          6 Inducing must be done within 30 minutes of swallowing.
If you are instructed by a poison control center or physician to induce vomiting, use syrup of ipecac.
It can be purchased without a prescription and is easily given. Follow the directions carefully. Ipecac will not work unless you also give sufficient water.
7. Give activated charcoal if a poison control center advise. ( _Figure 2 ).
The left-side position delays the poison from ing into the small intestine.

Place on left side

Activated charcoal

It is the single most effective agent for most swallowed poisons. Activated charcoal acts like a sponge to bind and keep the poison
in the digestive system, thus preventing its absorption into the blood.
Although activated charcoal may appear similar to burnt-toast scrapings and charcoal briquettes, they cannot be used for poisoning.
Not all chemicals, however, are absorbed well by activated charcoal, including acids and alkalis (eg, bleach, ammonia), potassium, iron, alcohol, methanol, kerosene, cyanide, malathion, and ferrous sulfate.
Major drawbacks of activated charcoal are its grittiness and its appearance. Trying to improve the taste or consistency by adding chocolate syrup, sher
bet, ice cream, milk, or other flavoring agents only decreases the charcoal's binding capacity. Place the charcoal mixture in an opaque container and have the victim sip it through a straw so it will be more
palatable. First aiders should give only the pre-mixed form. Some common names for the pre-mixed form are ActidoseTM, InstaCharTM, and LiquiCharTM
Although activated charcoal is an inexpensive, safe, and effective means for decreasing poison absorption, pharmacies do not routinely stock it.

8. Save poison containers, plants, and the victim's
vomit to help medical personnel identify the poison.

DO NOT give water or milk to dilute poisons unless instructed to do so by a poison control center. Fluids may dissolve a dry poison (eg, tablets or capsules) more rapidly and fill up the stomach, forcing stomach contents (ie, the poison) into the small intestine, where poisons are absorbed faster.

Alcohol and Other Drug Emergencies
Alcohol Intoxication

Helping an intoxicated person is often difficult since the individual may be belligerent and combative
Also, personal hygiene is sometimes less than optimal.
However, it is important that alcohol abusers be helped and not just labeled as "drunks:' Their condition may be quite serious, even life-threatening.

What to Look For

Although the following signs indicate alcohol intoxication, some may also mean illness or injury other than alcohol abuse, such as diabetes or heat injury:
. the odor of alcohol on a person's breath or clothing
. unsteady, staggering walking
. slurred speech and the inability to carry on a conversation
. nausea and vomiting
. flushed face

DO NOT let an intoxicated person sleep on his or her back.
DO NOT leave an intoxicated person alone.
DO NOT try to handle a hostile drunk by yourself. Find a safe place, then call the police for help.

What to Do

First aid for an intoxicated person includes these steps:

 1. Look for any injuries. Alcohol can mask pain.
2. Check ABCs and treat accordingly.
3. If the intoxicated person is lying down, place him or her in the recovery position. Rolling the victim onto the left side not only reduces the likelihood of vomiting and aspiration of vomit, but also delays absorption of alcohol into the bloodstream.
4. Call the poison control center for advice or the local
emergency number for help.
5. Provide emotional support, but if the victim becomes violent, leave the scene and find a safe place
until police arrive.
6. If the intoxicated victim has been exposed to the
cold, suspect hypothermia and move the person to a warm environment whenever possible. Remove wet clothing and cover the individual with warm blankets. Handle a hypothermic victim gently, because rough handling could induce a heart attack.

Drugs Other Than Alcohol What to Do
1. Check ABCs
2. Call the poison control center for advice or EMS help.                                3. Check for injuries.                                                                                     4. Keep the person on the left side to reduce the likelihood of vomiting and aspiration of vomit and to delay the absorption of drugs into the bloodstream 5. Provide reassurance and emotional support.                                              6. If the person becomes violent, find a safe place until the police arrive. Let law enforcement officers handle dangerous situations.

Carbon Monoxide Poisoning
Carbon monoxide (CO) victims are often unaware of presence. The gas is invisible, tasteless, odorless, and r irritating. It is produced by the incomplete burning 0f organic material such as gasoline, wood, paper, charcoal coal, and natural gas.

What to Look For

It is difficult to tell if a person is a CO victim. Sometimes a complaint of having the "flu" is really a symptom of ( poisoning. Although many symptoms of CO poisoning resemble those of the flu, there are differences. For example CO poisoning does not cause low-grade fever or generalized aching or involve the lymph nodes as the flu does..
The following conditions indicate possible CO poison;
. The symptoms come and go.
. The symptoms worsen or improve in certain places or at certain times of the day.
. People around the victim have similar symptom .                                      .Pets seem ill.

The signs and symptoms of CO poisoning are as follows:                                 . headache
. ringing in the ears (tinnitus)
. chest pain (angina)
. muscle weakness
. nausea and vomiting
. dizziness and visual changes (blurred or double vision)
What to Do

1. Get the victim out of the toxic environment and into fresh air immediately.
2. Call EMS personnel, who will be able to give the victim 100% oxygen, improving oxygenation.
3. Monitor ABCs.
4. Place an unresponsive victim in the recovery position.
5 Seek medical attention. All suspected CO victims should obtain a blood test to determine the level of CO.

Plant-Induced Dermatitis: Poison Dison Oak, and Poison Sumac

Most people cannot identify these irritating plants
Figure A helpful method of identifying these the "black-spot test."
When the sap is exposed to turns brown in a matter of minutes and by the is black.

Poison ivy, found in all 48 contiguous US states

Poison ivy dermatitis

1. Those who know they have been in contact with a poisonous plant should decontaminate the skin as soon as possible (within five minutes for sensitive
people, up to one hour for moderately sensitive individuals). Use soap and cold water to clean the skin of the oily resin or apply rubbing (isopropyl) alcohol liberally (not in swab-type dabs). If too little isopropyl alcohol is used, the oil will actually spread to another site and enlarge the injury. Other solvents (eg, paint thinner) can be used, but they are hard on the skin and may be flammable. Rinse with water to remove the solubilized material. Water removes the urushiol (plant resin) from the skin, oxidizes and inactivates it, and does not penetrate the skin as do solvents. Unfortunately, most victims do not know about their contact until several hours or days later, when the itching and rash begin.
2. If the reaction is mild, the person can soak in a lukewarm bath sprinkled with one to two cups of colloidal oatmeal, such as AveenoTM Colloidal oatmeal, which makes a tub slick, so take appropriate precautions, or apply any of the following:
. calamine lotion (calamine ointment if the skin
becomes dry and cracked) or zinc oxide
. baking soda paste: one teaspoon of water mixed
with three teaspoons of baking soda
3. If the reaction is mild to moderate, care for the skin as you would for a mild reaction and use a physician-prescribed corticosteroid ointment.
4. For a severe reaction, follow the same care guidelines for the skin and use a physician-prescribed oral corticosteroid (eg, prednisone). Apply a topical corticosteroid ointment or cream, cover it with
a transparent plastic wrap, and lightly bind the area with an elastic or self-adhering bandage.

DO NOT use nonprescription hydrocortisone creams, ointments, and sprays in strengths of less than 1 %. They offer little benefit.
DO NOT use over-the-counter anti-itch lotions like CaladrylTM because they may cause further skin irritation. Oral antihistamines such as BenadrylTM often are used in conjunction with prescription creams to help decrease itching.
DO NOT let the victim rub or scratch the rash
or itching skin.


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