Poisoning

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 9-1-1 because he was not responding when she tried to wake him up.

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

Poison Control Centers Specialized health care centers that provide information on poisons and suspected poisoning emergencies 24-Hour Poison Help Hotline: 1-800-222-1222 U of U Pharmacists, physicians, nurses, toxicologists 70% of poison exposure cases can be managed over the phone

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

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 www.poison-ivy.org

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

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

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)

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 20-30 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

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

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

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

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

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

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

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.”

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

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

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

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.

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

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

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

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

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 368-371

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