chapter 14-17

POISONING

Introduction to Poisoning

A poison is a substance that causes injury, death, or impairment of an organism through chemical action (as opposed to the biological action of a bacteria or virus). The effects of exposure to poison can range from mild irritation to death. Poisons can exist in various forms including solid, liquid, or gas (fume).

Routes of Poison Entry

There are four primary routes through which a poison can enter the body:

  1. Ingestion - Swallowed through the digestive system.
  2. Inhalation - Breathed in through the lungs.
  3. Absorption - Entering through the skin or other membranes.
  4. Injection - Delivered through bites, stings, or hypodermic syringes.

Figure 14–1: Routes of Poison Entry

Types of Poisons

Ingested Poisons
  • Description: Ingested poisons enter the body through the digestive system.
  • Examples: Toxic mushrooms, contaminated shellfish, alcohol, aspirin (ASA), and commonly misused household chemicals (cleaning products, pesticides).
Inhaled Poisons
  • Description: Inhaled poisons are harmful gases or fumes breathed in.
  • Common Inhalants:
    • Carbon monoxide (from combustion).
    • Chlorine (found in swimming pools).
    • Household fumes (e.g., glue, paint).
  • Specific Poison: Hydrogen sulfide (H2S), frequently found in aerosol sprays.
Absorbed Poisons
  • Description: absorbed through the skin or mucous membranes in the mouth or nose.
  • Examples: Contact with poison ivy, pesticides, or certain drugs (e.g., cocaine).
Injected Poisons
  • Description: Enter the body via bites or stings from insects, spiders, or snakes, or through needle injections.

Poison Control Centres

Poison Control Centres are present across Canada to assist individuals coming into contact with suspected poisons. These centres provide:

  • Access to information on virtually all poisonous substances.
  • Guidance for necessary immediate action and treatment protocols.
  • Important to know the local Poison Control Centre’s number for emergencies.

Recognizing Poisoning

Indicators of Poisoning

The severity and presentation of the poisoning depend on:

  • Type and quantity of the poisonous substance.
  • Route of entry into the body.
  • Patient characteristics (height, weight, age).
  • Quick Acting Poisons: Act rapidly and have clear signs and symptoms.
  • Slow Acting Poisons: Can be harder to identify based on symptoms.
Signs and Symptoms

Common signs and symptoms indicative of poisoning include:

  • Sweating
  • Nausea
  • Vomiting
  • Diarrhea
  • Abdominal pain (chest or abdomen)
  • Dyspnea (difficulty breathing)
  • Altered level of responsiveness
  • Seizures
Initial Assessment Questions

If poisoning is suspected, obtain the following information:

  1. Type of poison.
  2. How exposure occurred (ingestion, inhalation, etc.).
  3. Time of occurrence.
  4. Amount of poison involved (if known).

General Care for Poisoning Emergencies

Steps to Take

Specific interventions vary based on the type of poison involved but general guidelines include:

  1. Protect yourself and limit exposure to the poison.
  2. Contact the Poison Control Centre.
  3. Follow directions provided.
  4. Refer to product labels or Safety Data Sheets (SDS) for first aid procedures.
  5. Oral Intake: Do not give anything orally unless directed by the Poison Control Centre.
  6. If the poison is unknown and vomiting occurs, save a sample part of it for testing—label with patient identification information.
  7. Manage any concurrent medical problems while monitoring the patient.
  8. Administer oxygen when indicated.

Ingested Poisons

Signs and Symptoms of Ingested Poisons
  • Open poison containers near the patient
  • Mouth burns or irritation
  • Unusual breath odours
  • Abnormal salivation (including colour)
  • Abdominal issues (cramps, vomiting, diarrhea)
  • Drowsiness or unresponsiveness
Food Poisoning

Food poisoning occurs when a person eats contaminated food. If multiple individuals exhibit the same symptoms after eating together, suspect food poisoning. Induction of vomiting may be advised by the Poison Control Centre under certain conditions.

Inducing Vomiting Criteria

Before inducing vomiting, ensure:

  • Patient is fully responsive and can follow instructions.
  • Patient is cooperative and has not previously vomited spontaneously.
  • No stability issues concerning heartbeat or respiratory level.
Medical Interventions

Depending on guidance from the Poison Control Centre, activated charcoal may be administered to neutralize poisons in the stomach. Some ingested poisons can be diluted with water to mitigate damage upon ingestion.

Inhaled Poisons

General Signs of Inhaled Poisons

Symptoms include:

  • Respiratory distress, irritation in the throat/nose.
  • Dizziness, seizures, or blue-tinged skin (cyanosis).
  • Unusual odours in the air or breath.

Management Guidelines

  • Ensure your safety before entering scenes of suspected inhalant poisoning.
  • Patients with inhaled poisoning should be quickly transported for medical evaluation.
Example: Carbon Monoxide Poisoning
  • Characteristics: Odourless and colourless gas found in fumes from combustion.
  • Effects: Replaces oxygen in blood. Symptoms include headaches, weak pulse, confusion, and respiratory distress.
  • Management: Immediate removal from exposure; further medical assessment.

Absorbed Poisons

Treatment for Absorbed Poisons
  1. Wash affected skin area immediately with cool water and dry.
  2. Maintain cleanliness and dryness of the area.
  3. Seek physician help if symptoms worsen.
Rash-Causing Plants
  • Examples: Poison ivy, poison sumac, and poison oak produce urushiol oil, which may cause severe skin irritation.
  • Signs include: itching, rashes, and swelling. Burning sensations may be felt in affected areas. Avoid exposure to smoke from burning these plants.
Treatment for Plant Poisoning
  • Use creams to reduce irritation.
  • Severe cases should seek immediate medical assessment.

Injected Poisons

Causes of Injected Poisons

Common sources are bites from animals or insects, injecting substances, and exposure from stings.

  • Animal bites can cause infections or transfer rabies (significant risk).
Management Strategies
  • Insect Bites: Check bite area and remove stingers. Monitor closely for signs of allergic reactions. Avoid pulling stinger out forcefully.
  • Spider Bites: Notably, bites from black widow and brown recluse spiders can be serious. Monitor closely for symptoms and treat accordingly with rapid transport if needed.
Rapid Transport Necessity

Any venomous bite or multiple animal stings must be treated as emergencies requiring immediate transport to medical facilities.

General Precautions and Considerations

  • Personal Safety: Always ensure that personal safety is maintained during exposure and treatment of potential poisoning.
  • Follow Protocols: Maintain diligence in following established emergency treatment protocols for suspected poisoning cases.

Conclusion of Poisoning Notes

This guide covers essential information about recognizing, managing, and understanding the nature of poisons and their effects on the human body. Awareness of symptoms, immediate care practices, and the utilization of Poison Control resources are vital in responding effectively to poisoning cases.

ENVIRONMENTAL ILLNESSES

Introduction

The human body regulates temperature to maintain homeostasis. However, when faced with extreme heat or cold, illness and injury can occur. This material covers various environmental illnesses, including heat-related conditions, cold exposure effects, drowning scenarios, and high-altitude sickness.

Key Elements of Temperature Homeostasis

The human body's core temperature should remain around 37°C (98.6°F). To maintain this, mechanisms such as vasodilation (expelling heat) or shivering (producing heat) activate depending on environmental circumstances.

Mechanisms of Heat Transfer
  1. Conduction - Direct contact with a solid or liquid that can warm/cool through bodily contact.
  2. Convection - Air or liquid flow transferring heat.
  3. Radiation - Heat loss or absorption through electromagnetic waves.
  4. Evaporation - Heat loss occurs when sweat evaporates from the skin. This is critical in hot environments.

Heat-Related Illness

Categories
  1. Heat Cramps: Painful muscle spasms as a result of exertion in hot weather.
  2. Heat Exhaustion: Generally occurs from extreme heat with symptoms including weakness, dizziness, and vomiting. Blood flow to skin increases, possibly leading to shock.
  3. Heat Stroke: Critical condition with deadly potential, often following ignored signs of heat exhaustion. Core temperature may exceed 40°C (104°F). Immediate action is necessary as perspiration ceases and cooling capability is lost.
Treatment for Heat Illnesses

  • Heat Cramps: Move to a cooler location, provide hydration, stretch muscles gently.

  • Heat Exhaustion: Remove from heat, hydrate, apply cool compresses to exposed skin or via immersion procedures.

  • Heat Stroke: Rapid cooling measures, fluid replacement, and immediate emergency response with transport. Observe for loss of consciousness and monitor vital signs.

Cold-Related Illness

Categories
  1. Hypothermia: Dangerous drop in core body temperature. Begins showing mild symptoms like shivering, ultimately leading to unconsciousness.
    • Treatment: Handle gently, insulate, avoid removing clothing, initiate warming protocols. Transport urgently.
  2. Frostbite: Localized freezing injury affecting extremities, potentially leading to long-term damage.
    • Treatment: Slow rewarming in warm water, monitor for blistering. Assist with recovery gently.

Drowning

Drowning is a suffocation episode resulting from immersion. Initial response includes removal from water, airway clearance, and initiating life support if necessary. Monitor closely for airway compromise post-rescue. Drowning patients should always be transported for assessment, possibly organizing a specialized rescue team if necessary.

High-Altitude Illness

Occurs due to decreased oxygen availability at high elevations. Symptoms include fatigue, dyspnea, headache. Immediate altitude reduction or providing oxygen therapy is crucial. Monitor for complications such as High Altitude Pulmonary Edema (HAPE) or High Altitude Cerebral Edema (HACE).

Crisis Intervention

Introduction

Crisis situations often arise unexpectedly. As a responder, handling emotional and psychological distress alongside physical ailments can be challenging. Effective communication and psychological support are as critical as physical care in these situations.

Types of Crises

Psychological Crises

Life-threatening situations can induce significant emotional responses in patients and their families. Possible crises include responses to:

  1. Suicide Attempts: Must be approached with care, documenting all details while providing emotional support.
  2. Assault: Responding effectively while ensuring personal safety is paramount during assault situations.
  3. Death and Dying: Professionalism is key in emotionally charged circumstances, maintaining compassion and sensitivity.
Mental Health Crises

Depending on the condition presented by the patient, utilizing active listening techniques is significant. Keep a calm demeanor while becoming familiar with the specifics of their emergency to provide effective support and intervention. Responders should refrain from diagnosing mental conditions but focus on immediate care needs.

Special Populations

Overview

Responders frequently encounter special populations with unique needs, including pediatric and geriatric patients, those with disabilities, and individuals in palliative care. Each group requires specific considerations in care and management, especially concerning their psychological and physiological states.

Note: Each section contains extensive definitions, explanations, and procedural steps to ensure comprehension of the material related to poisoning, environmental illnesses, crisis situations, and approaches to special populations. This information serves to educate responders about best practices in managing medical emergencies. Utilize appropriate protocols and seek assistance when necessary to ensure the safety and well-being of all involved.