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Poisoning
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
INGESTED (SWALLOWED) POISONS
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)
unconsciousness
.respiratory
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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