OBJECTIVES
Upon completion of this lesson, you will be able to:
- List the signs and symptoms of poisoning, and steps for pre-hospital treatment.
- List four specific signs and symptoms of ingested poisons.
- List four specific signs and symptoms of inhaled poisons.
- List four specific signs and symptoms of absorbed poisons.
- List the signs and symptoms of injected poisons, including snakebites, and the steps for pre-hospital treatment.
- List the signs and symptoms for alcohol abuse and the steps for pre-hospital treatment.
- List the signs and symptoms for drug abuse and the steps for pre-hospital treatment.
1. Poisons
Definition:
Any substance that can impair or cause death of cell structure or function.
A poison can enter the body four ways:
• Inhalation
• Ingestion
• Absorption through the skin
• Injection
Scene Assessment
- Always perform a scene assessment – safety first. Protect yourself, your crew, and others from the poison.
- Use universal precautions. Try to identify the source or substance involved. Get as much information as you can, as quickly as possible.
- Perform the initial assessment and obtain the patient’s history.
- Signs and symptoms of poisoning will vary depending on the type of poison.
Write down the telephone number of your local Poison Control Centre:
………………………………………………………………
General signs and symptoms of poisoning
• Nausea and vomiting
• Abdominal pain
• Diarrhea
• Difficulty breathing
• Dizziness or confusion
• Altered level of consciousness
• Seizures
• Burns or redness around the mouth or skin
• Excessive salivation or sweating
• Unusual odors on the breath or clothing
Pre-hospital treatment for poisoning
Use universal precautions and secure the scene. Use special protective equipment when necessary.
Move the patient away from the source of the poisoning, especially in inhalation and absorbed poisoning.
For absorbed poisons:
• Remove the patient’s contaminated clothing.
• Blot the poison from the skin with a clean cloth or towel. If the poison is a dry powder, brush it off.
• Flood the affected area with copious amounts of water until EMS arrives.
Maintain airway patency. Administer oxygen per local protocol.
Perform initial assessment. Do not perform mouth-to-mouth resuscitation in inhaled or ingested poison cases. Use the BVM.
Call your local poison control centre, if available.
Perform physical exam.
For ingested poisons:
• Give the patient one or two glasses of water to dilute the poison.
• Induced vomiting is contraindicated in poisoning with hydrocarbons, strong acids, alkalis, and corrosives.
• Per local protocol, give the patient activated charcoal – 2 or 3 spoonfuls in eight ounces of water.
Bring the suspected source, container, labels, or other evidence of the poison to the hospital.
Treat for shock.
Continually monitor the patient. Transport the patient
2. Ingested Poisons
An ingested poison is one that is introduced into the digestive tract by way of the mouth. In cases of ingested poison, all information should be obtained as quickly as possible while the initial assessment is performed. Look for signs of spilled liquids, tablets, capsules, poisonous substances or any container that can help you to identify the substance or source of poisoning.
Specific signs and symptoms of ingested poison
- Burns, swelling, or stains around the mouth
……………………………………………………………………………………………….. - Abnormal breathing
……………………………………………………………………………………………….. - Diaphoresis
……………………………………………………………………………………………….. - Excessive salivation or foaming at the mouth
………………………………………………………………………………………………..
Pre-hospital treatment for ingested poisons
- Call the poison control center or medical direction for instructions.
- Do not administer anything by mouth (e.g. water, milk, activated charcoal, syrup of ipecac) unless advised to do so by poison control center or with medical direction, because it may be harmful for the patient. Check local protocols and always call for medical direction before assisting a patient with medications. The poison control center or medical direction may tell you to have the patient consume the fluids in sips to prevent vomiting. If the patient is having convulsions or is gagging, do not give anything by mouth unless otherwise directed by a physician or the poison control center.
- Administer oxygen and assist ventilation, if necessary.
- In case of vomiting, position the patient so that no vomit will be aspirated. Put him on one side or in a semisitting position with the head turned to the side.
- Save all vomit for later analysis by hospital staff.
3. Inhaled Poisons
Poisoning caused by fumes and vapors can be swift. The body absorbs inhaled poisons very rapidly. The longer the exposure, the worse the prognosis. You may need to use special masks to gain access to the patient in a hazardous environment. Additional expert help may be required. Signs and symptoms of ingested poisoning are more related to the respiratory system.
Though it is important to give care immediately, do not enter the scene unless you are sure it is safe.
Scene Assessment
Assessment of inhaled poisons can be very dangerous. To ensure your safety, be wary of peculiar odors or visible vapors. If you are not properly equipped or trained, have trained personnel bring the patient to you. Do not enter the scene unless it is safe. Search for other victims. Try to get specific information on the poison and the patient’s medical information as soon as possible.
It is important to obtain the patient’s information or that of witnesses as soon as possible, to look for indications of inhaled poison.
- Type of poison or substance involved.
- Duration of exposure to the poison.
- Symptoms experienced by the patient.
- Any pre-existing medical conditions of the patient.
- Environmental conditions at the scene (e.g., confined space, chemical spills).
- Presence of unusual odors or fumes.
- Details of how the exposure occurred (accidental or intentional).
- Whether other individuals at the scene were also affected.
Common inhaled poisons
- Carbon monoxide
……………………………………………………………………………………………….. - Carbon dioxide from industrial sites, sewers, and wells
……………………………………………………………………………………………….. - Chlorine gas (common around swimming pools)
……………………………………………………………………………………………….. - Fumes from liquid chemicals and sprays
……………………………………………………………………………………………….. - Ammonia
……………………………………………………………………………………………….. - Sulphur dioxide (used to make ice)
……………………………………………………………………………………………….. - Anesthetic gases (ether, nitrous oxide, chloroform)
……………………………………………………………………………………………….. - Dry cleaning solvents, degreasing agents, or fire extinguishers
……………………………………………………………………………………………….. - Industrial gases
……………………………………………………………………………………………….. - Incomplete combustion of natural gas
……………………………………………………………………………………………….. - Hydrogen sulphide (sewer gas)
………………………………………………………………………………………………..
Specific signs and symptoms of inhaled poison
- History of exposure to toxic fumes
- Chest pain or chest tightness
- Burning sensation in chest or throat
- Coughing, wheezing, or rales
4. Absorbed Poisons
An absorbed poison is one that enters the body through contact with the skin. Examples of natural sources include poison ivy, poison sumac, and poison oak. Man-made sources include corrosives, insecticides, herbicides, and cleaning agents. Signs and symptoms of absorbed poisons are more related to skin involvement.
Specific signs and symptoms of absorbed poisons
- Redness, irritation, or rash on the skin
- Itching or burning sensation at the contact site
- Swelling or blistering of the skin
- Pain or tenderness in the affected area
5. Injected Poisons
Injection poisoning occurs when a poison enters the body through a break in the skin. The break can be caused by a needle (drugs), an insect bite or sting, or a puncture.
Scene Assessment
During scene assessment, look for clues such as syringes and drug paraphernalia. Inspect surroundings for animals, insects, or marine life. Conduct initial assessment, paying close attention to airway breathing. Monitor mental status and prioritize patients for transport. Obtain a focused history and perform a physical exam. Get information on the suspected poison or its origin.
Try to find answers to the following questions at yourself:
- Is there a history of drug abuse?
- Type of drug used, frequency, and method of administration (e.g., injection, oral, inhalation).
- Any history of allergic reaction to bites or stings?
- Specific allergens involved and severity of previous reactions (e.g., anaphylaxis, swelling, rash).
- How long from time of injection to onset of signs or symptoms?
- Exact or estimated time of exposure to the appearance of symptoms (e.g., pain, swelling, or systemic reactions).
Specific signs and symptoms of injected poisons
- Pain, swelling, or redness at the injection site
- History of allergic reactions or drug abuse
- Bite mark or stinger embedded in the skin
- Discoloration or swelling at the injury site after a few hours
- Other symptoms similar to ingested poisons, such as nausea, vomiting, or altered consciousness
Pre-hospital treatment for injected poisons
Use universal precautions and secure the scene.
- Maintain open airway.
……………………………………………………………………………………………….. - Administer oxygen. Be alert for possible patient vomiting.
……………………………………………………………………………………………….. - Protect yourself and the patient from repeated injections. Cut off the patient’s clothing to protect from possible repeated insect stings or bites.
……………………………………………………………………………………………….. - For bee stings, remove the stinger together with the poison sac. Use a plastic card and scrape the skin’s surface to keep the sac from breaking inside the patient’s skin. Place a bag of ice or cold pack on the sting.
……………………………………………………………………………………………….. - Bring all containers, labels, or other evidence of poisoning to the hospital.
……………………………………………………………………………………………….. - Conduct a physical exam.
……………………………………………………………………………………………….. - Treat for shock.
……………………………………………………………………………………………….. - Monitor the patient during transport.
………………………………………………………………………………………………..
Snake Bites
These are quite common in certain areas. Signs and symptoms may delay several hours before presenting. Death can occur quickly if the patient has an allergic reaction to the venom.
Treat all snakebites as poisonous.
Specific signs and symptoms for poisonous snake bites
- Nausea and vomiting
……………………………………………………………………………………………….. - Weakness, paralysis
……………………………………………………………………………………………….. - Seizures, decreased level of consciousness
……………………………………………………………………………………………….. - Puncture wound
……………………………………………………………………………………………….. - Pain and/or burning sensation around the bite mark
……………………………………………………………………………………………….. - Blood oozing from the bite mark
……………………………………………………………………………………………….. - Discoloration and swelling
………………………………………………………………………………………………..
Pre-hospital treatment for snake bites
Use universal precautions and secure the scene.
- Ensure the scene is safe for you and the patient.
……………………………………………………………………………………………….. - Perform a primary assessment and ensure that breathing is adequate.
……………………………………………………………………………………………….. - Locate the fang marks and clean this site with water and soap.
………………………………………………………………………………………………..
- Remove rings, bracelets, and any constricting items.
……………………………………………………………………………………………….. - Keep the extremity immobilized. Try to keep the bitten area at or below the level of the heart.
……………………………………………………………………………………………….. - Per local protocol, apply a pressure bandage (constricting bandage) to slow the spread of the venom (emphasize proper application).Do not make incisions around the bite marks, and do not suction the venom from the wound…………………………………………………………………………………………………
- Treat for shock and provide basic life support as needed.
……………………………………………………………………………………………….. - Do not give the patient any food or drink.
……………………………………………………………………………………………….. - If possible, capture the snake for species identification.
……………………………………………………………………………………………….. - Administer oxygen per local protocol.
……………………………………………………………………………………………….. - Continually monitor the patient during transport.
………………………………………………………………………………………………..
Only anti-venin works as an antidote for a poisonous snake bite.
Anti-venin serum must be administered on the basis of three criteria:
• Identification of the specific snake species involved.
• Severity of symptoms or progression of envenomation (e.g., systemic reactions, swelling, or neurological symptoms).
• Patient’s medical history, including allergies or contraindications to anti-venin.
6. Alcohol Abuse
Alcohol is a drug with general social acceptance when ingested moderately. Abuse of this drug leads to alcoholism and serious chronic intoxication with great physical and mental deterioration. A patient under the influence of alcohol can be dangerous to him/herself and to others.
If the patient allows it, conduct an initial assessment and physical exam including an interview; the assistance of friends and witnesses can be very helpful.
Specific signs and symptoms of alcohol abuse/poisoning
- The smell of alcohol on the breath and/or clothes.
- Slurred speech • Unsteady gait
- Confusion or disorientation • Vomiting
- Flushed skin • Decreased level of consciousness
Pre-hospital treatment for alcohol abuse/poisoning
Use universal precautions and secure the scene. Persons with alcohol poisoning can injure others or themselves.
- Verify whether it is strictly a case of alcohol abuse (determine if the patient is diabetic).
……………………………………………………………………………………………….. - Per local protocol, allow EMS to decide if police intervention is required.
……………………………………………………………………………………………….. - Monitor vital signs and stay alert for breathing problems. Be alert for vomiting and take steps to prevent aspiration.
……………………………………………………………………………………………….. - Protect the patient from injury without using restrictive means.
……………………………………………………………………………………………….. - Give oxygen per local protocol.
………………………………………………………………………………………………..
Transport the patient.
Signs and Symptoms of Alcohol Withdrawal (Delirium Tremens)
An alcoholic who suddenly stops drinking alcohol (abstinence) can suffer serious problems. Sudden abstinence often leads to delirium tremens (DT).
- Tremors or shaking
- Hallucinations
- Seizures
- Agitation or confusion
7. Drug Abuse
It is not necessary for the rescuer to know the specific names and the effects of each one of the drugs, but the medical first responder should have the ability to identify a possible case of drug abuse. The five types of frequently abused drugs are:
- Stimulants: These stimulate the central nervous system, causing the user to become excited. This group of drugs includes amphetamines, cocaine, caffeine, asthmatic drugs, and vasoconstrictive drugs.
……………………………………………………………………………………………….. - Depressants: These depress the central nervous system and include non-barbiturate sedatives, diazepam, bromazepam, lorazepam, methaqualone, paraldehyde, barbiturates (pentobarbital, phenobarbital, secobarbital), and anticonvulsants. These reduce pulse and breathing, cause drowsiness, and slow the reflexes.
……………………………………………………………………………………………….. - Analgesic narcotics (opium-derivatives): Their use produces an intense state of relaxation. Some are easily obtainable, such as codeine found in cough syrups. Morphine, heroin, and Demerol belong to this group of drugs. These drugs reduce body temperature, slow the pulse and breathing, relax the muscles, and cause pupil contraction, drowsiness, and sluggishness.
- Hallucinogens: These drugs alter personality and distort perception. They include LSD, PCP, STP, mescaline, peyote, and psilocybin. Marijuana also has some hallucinogenic properties. Patients often imagine hearing unusual sounds and seeing strange colors. Persons using hallucinogens can become aggressive and pose a threat to you, others, and themselves.
………………………………………………………………………………………………..
- Volatile chemicals: The vapors of certain chemical substances cause excitement, euphoria, or the sensation of flying. In general, these chemicals are solvents, cleaning fluids, glues, and gasoline. The effects are temporary loss of reality, loss of the sense of smell, accelerated pulse and breathing, and possible coma.
………………………………………………………………………………………………..
Signs and symptoms of drug abuse
The following list is a combination of the various signs and symptoms for the different drugs described above.
- Excitability or hyperactivity
- Sluggish and slow movements or reflexes
- Reduced pulse and breathing
- Accelerated pulse and breathing
- Relaxed muscles
- Constricted or dilated pupils
- Distorted perception
- Aggressive behavior
- Euphoria
- Possible coma
Pre-hospital treatment for drug abuse
- Ensure the patient has a clear airway and assist breathing as necessary.
Induce vomiting if the patient is conscious and if the overdose was taken orally within the last 30 minutes.
- Only do so if directed by medical personnel or poison control.
If the patient is hyperactive, apply restraints to prevent self-injury and injury to others.
- Use restraints as a last resort and ensure they are safe and humane.
Speak with the patient to win his/her trust and to monitor level of consciousness.
- Keep the patient calm and cooperative.
Monitor the patient’s breathing carefully because sedatives can cause respiratory depression and lead to possible respiratory arrest.
- Be prepared to provide assisted ventilation if necessary.
Comfort the patient and provide emotional support.
- Reassure the patient to reduce anxiety and agitation.
Watch for adverse reactions.
- Be alert for worsening symptoms or complications.
Keep all evidence of drug abuse.
- Collect containers, paraphernalia, or other items for analysis.
Call your local poison control centre, if available.
- Provide them with as much information as possible about the drug and the patient’s condition.
Administer oxygen as per local protocol.
- Ensure the patient receives adequate oxygen to prevent hypoxia.
Transport the patient.
Conclusion:
Recognizing the signs and symptoms of poisoning and responding promptly can save lives. Whether dealing with ingested, inhaled, absorbed, or injected poisons, understanding the specific indicators and administering appropriate pre-hospital treatment is critical.
Always prioritize scene safety, use universal precautions, and seek guidance from medical professionals or poison control centers. Awareness of alcohol and drug abuse signs, as well as managing complications like delirium tremens, is equally vital.
Preparedness, knowledge, and swift action are the foundation of effective response, ensuring the best outcomes for individuals affected by toxic exposures or substance-related emergencies
Emma Lee, an expert in fire safety with years of firefighting and Rescuer experience, writes to educate on arescuer.com, sharing life-saving tips and insights.