POISONS

A poison or a toxin is any substance that, when entering the body, or coming in contact with the skin, can harm the body.
More than one million a year - in US

Ingested - Inhaled - Absorbed - Injected

INGESTION - About 80% of poisoning is by mouth.
Major cause of infant and children poisoning.
Get clues from the scene - containers, vomitus,
clothes, pt. and bystanders. Try to determine how much was ingested.

Signs and Symptoms

• burns or stains around mouth
• odors
• abnormal pulse and/or resp
• sweating, tearing, salivating
• nausea, abdominal pain, vomiting
• signs of shock

Treatment - Call Poison Control

Generally Tx is activated charcoal or diluting with milk or water

Most ingested poisons are absorbed into the blood stream in the small intestine.
Some activated charcoal has a rapid acting laxative in it that speeds it along the intestinal tract.

Don't administer activated charcoal without medical (or poison control center) direction, and be very aware of the contraidications:

*Pt with AMS, is not fully alert, coughing violently, or is convulsing
*Pt who has ingested acids or alkalis. Mouth, throat, and esophagus may be already severely damaged and more swallowing may cause further damage.

Medication of first choice for ingested poisoning:

Activated Charcoal (commonly called Actidose, Liqui-Char, InstaChar, Super-Char, etc.) absorbs the poison.
Can be very messy. Side effects are black stools and vomiting
Average adult dose = 25 to 50 grams
Average dose for infants and children = 12.5 to 25 grams

Syrup of Ipacac, still suggested to parents by some poison control centers, is no longer taught in EMT curriculum. Result of Ipacac is ineffective vomiting which loses only about one-third of stomach contents, and it works too slow (20 minutes), chance of AMS changes in that time may lead to aspiration.

O2, transport, prepare to suction, treat enroute, lateral recumbent or sitting up (prepare for vomiting)

INHALED

Be sure scene is safe for you.
Some poisonous gases may be undetectable by the EMT.
Some inhaled poisons can also be absorbed through the skin.

Check scene for clues - containers, odors, fire or smoke, poor ventilation

S and S (inhaled poisons)

• Loss of consciousness, Altered Mental Status
• dyspnea
• hoarseness, throat tightness, burning, itching,
• headache, dizziness, nausea, vomiting

Treatment

fresh air, open airway, high flow O2
transport

ABSORBED

Thru the skin, or in the eye

S and S

• Itching, burning, raised skin temp
• Headache
• Altered VS
• Shock

Treatment

Brush off dry chemicals

Flood area with water, minimum of 20 minutes
No high pressure, no neutralizing acids or alkalis

Remove contaminated clothes and wash again

Transport

INJECTED

Spiders, snakes, bees ,wasps, hornet. needles and syringes

S and S

• puncture, blotchy, painful, itching, numbness, swelling at site
• Sweating and salivating
• Nausea and vomiting, headache, dizziness, weakness, muscle cramp
• Dyspnea, urticaria, and
• Anaphylactic shock -
  swelling of airway, lips and tongue, bronchospasm,
  wheezing, chest tightness and cough,
  anxiety, abdominal cramps,
  respiratory failure

Treatment

Treat for shock

Bee sting - barbed stinger remains, attached muscle continues to inject venom
for up to 20 minutes after sting. Scrape - don't pull - stinger off. No tweezers

Wash fang mark site with soap and water. Did envenomation occur(swelling and discoloration)

Constricting band above and below, but not on or across joint

Splint to immobilize

Have Pt admin med (epi kit) & antihistamines

Human bite - Contains an exceptionally wide range of virulent bacteria.
May be a combination of puncture. laceration, avulsion, and crush injury.
Dry dressing and immobilize
Transport for surgical cleansing and antiboiotic therapy.