Chapter 18

Poisoning

Types of Poisons• Ingested (swallowed)

• Through the mouth • Inhaled (breathed)

• Through the lungs• Absorbed (contact)

• Through the skin• Injected

• Through needlelike device

Ingested (Swallowed) Poisons

• Occurs when victim swallows toxic substance

• Most poisonings happen by ingestion.• Common among children• Some substances can block airway.• Analgesics are most common poisoning.• Most exposures to plants are minor.

Recognizing Ingested Poisons

• Abdominal pain, cramping• Nausea or vomiting• Diarrhea• Burns, stains, odor near or in mouth• Drowsiness or unresponsiveness• Poison containers nearby

Care for Ingested Poisons (1 of 3)

• Determine• Age and size of victim• What and how much poison ingested• When it was taken

• If corrosive or caustic, have victim sip cold water or milk.

• Responsive victim, call Poison Control Center at 800-222-1222• Can advise if medical care is needed

Care for Ingested Poisons (2 of 3)

• Unresponsive victim, call 9-1-1

• Place victim in recovery position.

• Do not induce vomiting.

• Give activated charcoal if advised.

Care for Ingested Poisons(3 of 3)

• Activated charcoal

• Black powder that binds to poison

• Does not absorb all drugs well

• Save containers, plants, and vomit

Alcohol Intoxication

• Alcohol is a depressant.• Most commonly abused drug in US.• Often implicated as cofactor in other

types of accidents• Can cause belligerent, combative

behavior• Can be life-threatening• Take condition seriously

Recognizing Alcohol Intoxication

• Odor of alcohol• Unsteadiness, staggering• Confusion• Slurred speech• Nausea and vomiting• Flushed face• Seizures can also result.

Care for Alcohol Intoxication• Look for injuries.• Monitor breathing.• Recovery position• Call poison control center at 800-222-1222.• If victim becomes violent, leave scene and

await police.• Provide emotional support.• If victim is unresponsive, await EMS.• Move person to a warm place.

Drug Emergencies

• Drug classifications:• Uppers (stimulants)—amphetamines,

cocaine, caffeine• Downers (sedative-hypnotic)—

barbiturates, tranquilizers, marijuana, narcotics

• Hallucinogens—LSD, mescaline, peyote, PCP

• Volatile chemicals—glue, cement, paint solvent, gasoline, spray paint, nail polish remover

Sympathomimetics

• Stimulants (“uppers”)• Produce excitement• Amphetamines, methamphetamines• Taken by mouth or injected• Cocaine• Crack

Recognizing Sympathomimetic Use

• Disorganized behavior• Hyperactivity• Restlessness• Anxiety or great fear• Paranoia• Delusions

Care for Sympathomimetic Users

• Check breathing.• Call poison center or 9-1-1.• Check for injuries.• Place in recovery position.• Give reassurance, emotional support• If violent, seek safety until police arrive.• Seek medical care.

Hallucinogens

• Produce changes in mood, sensory awareness

• Hear colors, see sounds

• Cause hallucinations, bizarre behavior

• Protect user from hurting self

Recognizing Hallucinogen Use

• Visual hallucinations

• Intensity of vision and hearing

Care for Hallucinogen Use• Check breathing.• Call poison center or 9-1-1.• Check for injuries.• Place in recovery position.• Give reassurance, emotional support• If violent, seek safety until police arrive.• Seek medical care.

Marijuana

• Flowering hemp plant

• Estimated 20 million people use marijuana daily in US

Recognizing Marijuana Overdose

• Euphoria, relaxation, drowsiness• Short-term memory loss• Impaired capacity for complex

thinking and work• Depression, confusion• Altered perception of time• Anxiety, panic• Hallucinations

Care for Marijuana Overdose

• Check breathing.• Call poison center or 9-1-1.• Check for injuries.• Place in the recovery position.• Give reassurance, emotional support• If violent, seek safety until police arrive.• Seek medical care.

Depressants

• Often prescribed as part of legitimate medicine

• People may solicit prescriptions from several physicians.

• Includes:• Opiates (narcotics)• Sedative hypnotics (barbiturates

and tranquilizers)

Recognizing Sedative-Hypnotic Drug Use

• Drowsiness, sleepiness

• Slurred speech

• Slow breathing rate

Opiates

• Pain relievers named for opium

• Heroin, codeine, morphine

• Frequently abused

• Addicts may start with appropriate prescription

Recognizing Opiate Overdose

• Reduced breathing rate

• Pinpoint pupils

• Sedated condition, unresponsiveness

Care for Depressant Overdose• Check breathing.

• Call poison center or 9-1-1.

• Check for injuries.

• Place recovery position.

• Give reassurance, emotional support

• If violent, seek safety until police arrive.

• Seek medical care.

Abused Inhalants

• Glue, gasoline, lighter fluid, nail polish

• Similar effects to alcohol

• Can die of suffocation

• Can change heart rhythm

• Can cause permanent brain damage

Recognizing Abused Inhalant

• Mild drowsiness, unresponsiveness

• Slurred speech, clumsiness

• Seizures

• Slow breathing rate

• Smell of solvents

Care for Abused Inhalant

• Check breathing.

• Call poison center or 9-1-1.

• Check for injuries.

• Place in recovery position.

• Give reassurance, emotional support

• If violent, seek safety until police arrive.

• Seek medical care.

Carbon Monoxide Poisoning • Leading cause of poisoning death in US each

year• Invisible, tasteless, odorless, colorless,

nonirritating gas• Can be unintentional poisoning or suicide• Can occur in older car, extended time in

running car, or from faulty furnaces, water heaters, kerosene heaters

• Causes hypoxia

Recognizing Carbon Monoxide Poisoning (1 of 2)

• Headache• Ringing in ears• Chest pain• Muscle weakness• Nausea and vomiting• Dizziness and visual changes• Unresponsiveness• Respiratory and cardiac arrest

Recognizing Carbon Monoxide Poisoning (2 of 2)

• Symptoms come and go.

• Symptoms worsen and improve in certain places and at certain times.

• Nearby people have similar complaints.

• Pets seem ill.

Care for Carbon Monoxide Poisoning

• Remove victim from environment immediately.

• Call 9-1-1.• EMS can give 100% oxygen for 30 or 40

minutes to reverse CO poisoning.• Monitor breathing.• Place unresponsive, breathing victim in

recovery position.• Seek medical care.

Plant-Induced Dermatitis(1 of 2)

• Poison ivy, poison oak, poison sumac

• 15-25% of exposed people will have incapacitating swelling, blisters

• Oil oozes out from plant when brushed.

Plant-Induced Dermatitis(2 of 2)

• Oil not visible on human skin• Spread by direct contact• Can stay active for months or years• Smoke from burning plants can cause

severe dermatitis• Difficult to identify plants• Leaves grow in groups of three

Recognizing Plant-Induced Dermatitis

• Rash• Itching• Redness• Blisters• Swelling• The greater the amount of skin affected,

the greater the need for medical care.• Onset usually occurs 1-2 days after

contact.

Care for Plant-Induced Dermatitis

• Clean skin with soap and cold water as soon as possible.

• Apply rubbing alcohol liberally, then remove with water.

• Lukewarm bath and colloidal oatmeal• Wet compresses with aluminum acetate• Calamine lotion or baking soda paste• Corticosteroid ointment and oral

corticosteroid

Stinging Nettle

• Plant with stinging hairs on stem and leaves

• Stinging hair is touched• Fine needlepoint penetrates skin• Injects chemical irritant

Recognizing Stinging Nettle Poisoning

• Can affect anyone• Effects limited to exposed area• Immediate response• Redness• Rapid, intense burning• Itching• Reaction lasts hours, not days

Care for Stinging Nettle Poisoning

• Wash exposed area with soap and water.

• Apply:

• Cold, wet pack

• Colloidal oatmeal, hydrocortisone cream, or calamine lotion

• Over-the-counter antihistamine