Poisoning KNOWLEDGE OBJECTIVES SKILL OBJECTIVES. 1. List the four ways poisons enter the body.

Transcription

1 KNOWLEDGE OBJECTIVES Poisoning 1. List the four ways poisons enter the body. 2. List at least six signs and symptoms of poisoning. 3. Describe the role of a poison centre. 4. Identify the general principles of care for any poisoning emergency. 5. Describe the specific care for casualties of ingested, inhaled, and absorbed poisons. 6. Describe the specific care for injected poisons from an insect bite or sting, marine life sting, snakebite, animal bite, and tick bite. 7. Identify the three main categories of commonly abused or misused substances. 8. Identify ten signs and symptoms that may indicate substance abuse or misuse. 9. Describe the general care for someone suspected of misusing or abusing a substance. 10. Describe the signs and symptoms of anaphylaxis. 11. List seven ways to prevent poisoning. 12. Define the key terms for this chapter. SKILL OBJECTIVES After reading this chapter and completing the class activities, you should be able to 1. Make appropriate decisions about care when given an example of an emergency in which someone may have been poisoned. 249

2 OUTLINE Introduction 313 How Poisons Pester the Body 313 Poisoning Prevention 314 Signs and Symptoms Poisoning 315 Poison Centres 315 Care for Poisoning 315 Ingested Poisons 316 Inhaled Poisons 317 Absorbed Poisons 317 Injected Poisons 318 Substance Misuse and Abuse 324 Commonly Misused and Abused Substances 324 Signs and Symptoms of Substance Misuse or Abuse 327 Care for Substance Misuse or Abuse 327 Anaphylaxis 328 Signs and Symptoms of Anaphylaxis 328 Care for Anaphylaxis 328 KEY POINTS Poisoning Prevention Keep all medications and dangerous products well out of the reach of children. Use childproof safety caps on containers of medications and other potentially dangerous products. Keep products in their original containers with the labels in place. Use poison symbols to identify dangerous substances. Dispose of outdated products. Use potentially dangerous chemicals only in well-ventilated areas. Wear clothing for work that involves a poisonous substance that can prevent contact with the substance. Signs and Symptoms of Poisoning The Scene Odours. Flames/smoke. Open/empty/spilled/out-of-place containers. Overturned/damaged plants. The Casualty Nausea/vomiting. Chest/abdominal pain. Breathing difficulty. Altered consciousness. Seizures. Burns on/around mouth. 250

3 Severity depends on Type and amount of poison. How and when the poison entered body. Casualty's size, weight, and age. Types of Poisoning Ingested. Inhaled. Absorbed. Injected. Care for Poisoning Survey the scene to gather clues. Remove the casualty from source of poisoning. Do a primary survey. Care for life-threatening conditions. Contact the poison centre, and summon more advanced medical personnel. If casualty is conscious, do a secondary survey. Clear the casualty's airway, as needed. Withdraw if casualty becomes violent or threatening. Signs and Symptoms of Anaphylaxis Hives. Itching. Rash. Weakness. Nausea/vomiting. Dizziness. Trouble breathing. Care for Anaphylaxis Summon more advanced medical personnel. Position the casualty to aid breathing. Administer oxygen, if available. Monitor ABCs. Calm the casualty. Care for Substance Abuse and Misuse Survey the scene. Do a primary survey. Contact the poison centre, and summon more advanced medical personnel. Question the casualty and bystanders. Keep the casualty calm. Monitor casualty's ABCs, if casualty is conscious. Maintain normal body temperature. 251

4 LEARNING ACTIVITIES Matching Match each term with its definition. Write its letter on the line in front of the definition. Terms a. Activated charcoal b. Poison c. Syrup of ipecac d. Designer drug e. Drug abuse f. Hallucinogen g. Stimulant h. Anaphylaxis i. Overdose j. Substance 5. Deliberate, persistent, excessive use of a substance without regard to health concerns 6. A substance that affects the central nervous system to speed up physical and mental activity 7. A substance used to induce vomiting in poisoning cases 8. A situation in which a person takes enough of a substance that it has poisonous or fatal effects 9. A substance that causes injury or death when introduced into the body 10. A severe allergic reaction; a form of shock 11. Any substance other than food intended to affect the functions of the body k. Substance misuse Definitions 1. The use of a substance for unintended purposes, or for intended purposes but in improper amounts or doses 2. A substance that absorbs ingested poison 3. A substance that affects mood and thought, alters perceptions of time and space, and produces delusions 4. A medical substance that is chemically modified for street use 252

5 Short Answer Read each statement or question and write the correct answer or answers in the space provided. 1. List four things you should not do for a casualty of a snakebite What are three questions to ask regarding a suspected poisoning? With ingested poisoning, list at least three situations in which the poison centre would not induce the casualty to vomit? List at least four general guidelines to follow to prevent unintentional poisonings List the four ways in which a poison can enter the body List at least five signs and symptoms of anaphylaxis

6 CASE STUDIES Read the case studies and answer the questions that follow. Case 17.1 In the quarterfinals of a regional softball tournament, one of the players retrieves a foul ball and play continues. About 15 minutes later, the girl complains of pain in her abdomen and of being nauseated. She is perspiring heavily. As you examine her, you note a red area on her leg surrounding what might be a bite or a sting. 1. Which of the following could you immediately exclude as a possible cause of this girl's problem? a. Black widow spider b. Tick bite c. Scorpion d. Bee 2. Why would you exclude that possible offender? 3. As you care for this girl, her condition worsens. She begins to have difficulty breathing, and you hear wheezing. What condition do you suspect is developing? a. Rabies b. Tetanus 4. T F Part of your treatment for this casualty should be to administer oxygen, and summon more advanced medical personnel. 5. Which of the following medications might this girl carry or her parents have available that could ease her symptoms? a. Nitroglycerine b. Epinephrine c. Insulin d. Codeine Case 17.2 You are called late one evening to respond to a man lying in the doorway of a building. You find a middle-age man lying on the sidewalk. He is thin, flushed, and sweating profusely. He has recently vomited. He tries to push you away when you first attempt to touch him, and mutters something about getting "the rattlesnakes" away from him. When you try to speak with him or ask him questions, he simply moans or grunts. After a few moments, he becomes unresponsive. His pulse rate is 100, his respiration rate is 28, and breaths are shallow. 1. T F Proper emergency care for this casualty depends on your ability to determine whether this is a case of substance abuse or a medical condition not related to substance use. 2. T F This casualty's signs and symptoms are consistent with use of the designer drug Ecstasy. c. Anaphylaxis d. Lyme disease 254

7 3. Which of the following are included in the general principles you will use in treating this casualty? a. Summon more advanced medical personnel. b. Try to keep the casualty calm by minimizing movement. c. Attempt to find bystanders who are familiar with the casualty. d. All of the above. 4. What should you do if the casualty becomes violent or threatening? a. Try to physically restrain him. b. Ignore him and continue to provide care. c. Withdraw to a safe distance, and wait for more advanced personnel. d. Ask bystanders to help you. 255

8 SELF-ASSESSMENT Circle the letter of the best answer. 1. Which signs and symptoms are you likely to find in a casualty of anaphylaxis? a. Hives, rash, and itching b. Nausea and vomiting c. Coughing and wheezing d. All of the above 2. Which of the following is the typical first sign of an infection resulting from a deer tick bite? a. A red, raised rash b. Dry flaky patches c. Small blisters d. Numerous red, swollen areas 3. Which of the following signs and symptoms would help you distinguish a casualty of poisoning from a casualty of another medical emergency? a. Nausea, vomiting, and abdominal pain b. Breathing difficulty and faintness 4. Which of the following questions should you ask about a suspected poisoning to help you provide emergency care? a. How much was taken? b. When was the poison taken? c. Does the casualty have a history of drug use/abuse? d. a and b. 5. Which of the following can be the source of an injected poison? a. A housefly b. An aspirin c. A bathroom cleaner d. A dog 6. Which signs and symptoms are you likely to find in a person who has taken an overdose of depressants? a. Slurred speech, drowsiness, and confusion b. Paranoia, rapid pulse, and pinpoint pupils c. Sweating, chills, and rapid pulse d. Euphoria, dry skin, and flushed face c. Burns around the lips and tongue d. Seizures and loss of consciousness 256

9 7. Which of the following is likely to be helpful as a general guideline to help prevent poisonings? a. Keep all medications within reach. b. Place all prescription medication in marked bottles. c. Keep products in their original containers with their original labels in place. d. Do not dispose of outdated products. 10. Which of the following signs and symptoms would help you distinguish a casualty of poisoning from a casualty of another medical emergency? a. Nausea, vomiting, and abdominal pain. b. Breathing difficulty and faintness. c. Burns around the lips and tongue. d. Seizures and loss of consciousness. 8. Where would you be most likely to find a poison centre? a. In the emergency department of a large hospital b. In a city or county health department c. In a large police or fire department d. All of the above 11. Which of the following poisons should you eliminate from the body by inducing vomiting? a. Poisonous berries. b. Drain cleaner. c. Kerosene. d. Chlorine bleach. 9. What are the major categories of commonly abused or misused substances? a. Medications, alcohol, and cocaine b. Stimulants, hallucinogens, and depressants c. Inhalants, amphetamines, and narcotics d. Alcohol, cocaine, and heroin 12. Which of the following signs are you likely to see in a casualty in the early stages of carbon monoxide poisoning? a. Pale or bluish skin colour. b. Cherry-red skin colour. c. Profuse sweating. d. Hot, dry, red skin. 257

10 13. Which signs and symptoms are you likely to find in a person who has taken an overdose of depressants? a. Slurred speech, drowsiness, and confiision. b. Paranoia, rapid pulse, and pinpoint pupils. c. Sweating, chills, and rapid pulse. d. Euphoria, dry skin, and flushed face. 14. What should you do if a casualty of drug overdose becomes violent or threatening? a. Try to physically restrain the casualty. b. Ignore the casualty, and continue to provide care. c. Withdraw to a safe distance, and wait for more advanced personnel. d. Ask bystanders to help you. 16. Which of the following questions should you ask about a suspected poisoning to help you provide emergency care? a. How much was taken? b. When was the poison taken? c. Does the casualty have a history of drug use/abuse? d. a and b. 17. Which signs and symptoms are you likely to see in an individual who has taken an overdose of amphetamines? a. Slurred speech, drowsiness, confusion, and nausea. b. Profound depression, slow pulse, dilated pupils, and thirst. c. Sweating, chills, rapid pulse, and restlessness. d. Euphoria, dry skin, flushed face, and increased appetite. 15. Which substances are responsible for the largest percentage of unintentional poisonings? a. Cleaning products. b. Drugs and medications, c. Petroleum products. d. Foods. 258

11 Matching: 1. k 2. a 3. f 4. d 5. j 6. g 7. c 8. i 9. b 10. h 11. e. Answers to Exercises Unit 17-Poisoning substances, wear clothing that can prevent contact with the substance. Case Study 17.1: 1. b (and probably c); 2. Bites from a tick infected with a disease take several days or more to cause symptoms. (Answer c is unlikely because a scorpion sting is very unlikely in Canada.) 3. c 4. T 5. b. Short Answer: 1. Do not apply ice.; Do not cut the wound.; Do not apply a tourniquet.; Do not use electric shock. 2. What type of poison was taken? ; How much was taken?; When was it taken? 3. Injection; inhalation; ingestion; absorption. 4. Swelling and reddening skin; hives; itching; dizziness; weakness; vomiting; nausea; difficulty breathing; rash. 5. The casualty is unconscious; The casualty is having a seizure.; The casualty is pregnant.; The casualty has ingested a corrosive substance.; The casualty is known to have heart disease. 6. Keep all medications and dangerous products well out of the reach of children.; Use childproof safety caps on containers of medications and other potentially dangerous substances.; Keep products in their original containers with their labels in place.; Use poison symbols to identify dangerous substances.; Dispose of outdated products.; Use potentially dangerous chemicals only in well-ventilated areas.; When working with poisonous Case Study 17.2: 1. F 2. T 3. d 4. c. Self-Assessment: 1. d 2. a 3. c 4. d 5. d 6. a 7. c 8. a 9. b. 10. c. 11. a. 12. a. 14. a. 15. b 16. d 17. c 259

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