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  » First Aid  »  Poisoning
More than 1.5 million calls are made each year to regional poison control centers to report accidental poisonings and more than three-fourths of these incidents involve children under the age of 5. Most poisonings are accidental, but a substantial number are the result of suicide attempts. Although the widespread use of child-proof tops for drug containers sold in this country has reduced poisonings dramatically, children remain the most frequent poisoning victims. The aged are the second most commonly affected group. Failing eyesight, the use of multiple drugs, and confusion or difficulty in remembering whether a medication was taken are among the causes of accidental poisoning in older people. Other sources of poisonings are drug overdoses among drug abusers—increasingly common incidents, affecting all classes and age groups. Mixing drugs and alcohol or the unwitting use of drugs that interact with each other are yet other sources of accidental poisonings. This section focuses primarily on ingested poisons; inhalation and chemical spills are discussed elsewhere.


HANDLING POISONING EMERGENCIES

Proper management of poisoning requires expert guidance. The most important single resource in handling poisoning emergencies is the local poison control center. A directory of centers appears in appendix C. Your local center is listed in the telephone book white pages or may be obtained from Directory Assistance. Affix this number to all telephones or post it in a conspicuous place, such as a bulletin board next to a telephone. All family members as well as baby-sitters should know when and how to call this number. When calling the poison control center:
  • Be prepared to give as much information as possible. The person answering the phone will want to know your name, location, and telephone number so he can call back in case you are disconnected, or can summon help if needed.
  • Give the name of the substance ingested and, if possible, the amount and time of ingestion. If the bottle or package is available, give the trade name and ingredients if they are listed.
  • Describe the state of the poisoning victim. Is the victim conscious? Are there any symptoms? What is the person's general appearance, skin color, respiration, breathing difficulties, mental status (alert, sleepy, unusual behavior)? Vomiting? Convulsions?
Using this information, the poison center specialist can give specific first-aid instructions. The majority of the cases called into poison control centers can be handled at home if instructions are followed promptly and correctly. All households, especially those with children, should have on hand syrup of ipecac to induce vomiting (which is recommended in only certain cases of poisoning). Activated charcoal, when taken by mouth, prevents the intestinal absorption of a large number of ingested substances and is often given by health professionals to treat poisoning. Currently it is recommended for use only by medical personnel. There is no such thing as a universal antidote. First aid for a poisoning emergency follows the same general guidelines applicable for any injury:
  • Check first for vital signs-breathing and pulse-and, if they are absent, then perform CPR.
  • If there are obvious symptoms of serious poisoning, call the rescue squad.
  • If the person is having convulsions, treat as outlined in the section on convulsions in this chapter.
  • If the person is conscious, call the poison control center and follow whatever instructions are given.
  • If you are unable to reach a poison control center or a local hospital emergency department for advice, transport the victim to the nearest emergency service.
If you are far from medical assistance (greater than 30 minutes), the following general guidelines should be applied in the absence of specific instructions from a poison control center or other reliable source:
  • Determine the nature of the ingested substance. If there are no visible bottles or other clues, examine the mouth for signs of burns, which would indicate an acid or alkali. Smell the breath for a petroleum-like odor.
  • Diluting the poison by administering water or milk is advised for most substances. Water is recommended for acid and alkali ingestion if the person can swallow.
  • If the substance that has been swallowed is a medication, poisonous plant, pesticide, or other product with significant systemic toxicity and has been ingested within the previous hour, induce vomiting. Give 1 or 2 tablespoons of ipecac syrup followed by 1/2 glass to 2 glasses of water. If the first dose does not induce vomiting, this may be repeated in 20 minutes. Vomiting can also be induced by inserting a spoon or finger at the back of the throat to produce a gag reflex. Collect a specimen of the vomitus for analysis by medical personnel.
Do not induce vomiting if:
  1. The nature of the substance is unknown.
  2. A corrosive substance (house cleaner, lye, bleach, or other acid or alkali product) is suspected.
  3. A petroleum product (benzene, kerosene, gasoline, turpentine, paint thinner, other hydrocarbon) is suspected. Vomiting a petroleum product carries the danger of inhaling it into the lungs, causing chemical pneumonia.
  4. The person is having seizures, is unconscious or appears to be losing consciousness.
  5. The victim is less than 1 year of age.
Take the poisoning victim, along with the bottle or container of whatever was ingested, and any vomitus to the nearest hospital emergency department for further treatment.
ACIDS AND ALKALIS

Household cleaners frequently contain caustic acids and alkalis. They are found in lye, bleaches, and toilet bowl or drain and oven cleaners, and such preparations as hair straighteners. Each year, because of the accessibility of these chemicals, many young children are rushed to emergency rooms after drinking one of these harmful products. Parents and grandparents do not perceive these substances as dangerous since their container labels are almost always marked "poisonous if ingested," and they appear unappetizing to adults. But to young children, their colorful bottles and cans suggest something good to eat or drink. Many poisonings have also occurred after these chemicals were poured and stored in beverage containers such as milk or soft-drink bottles. (So never keep harmful substances in containers that are meant for potables!) Always make sure these types of chemicals are stored in places inaccessible to children. Ingestions of these poisons are serious incidents. If they occur:
  • Take the victim immediately to a hospital emergency service.
  • Do not induce vomiting.
  • For acid or alkali ingestion, have the victim take water or milk and swallow if possible, or swish it in the mouth once and spit it out. Do not make the person vomit.
POTENTIALLY HARMFUL SUBSTANCES COMMONLY FOUND ABOUT THE HOUSE
AcetaminophenDrain cleanerIodinePermanent-wave solutions
AmmoniaFabric softenerIonic detergentsRat poison
AspirinFloor waxLaxativesRoom deodorizer
BleachFurniture polishLighter fluidRubbing alcohol
Carpet cleanerHairsprayLiquorShampoo
Cement and glueHair straightenersMetal polishShoe polish
Contraceptive pillsHeadache remediesNail varnishSleeping pills/sleep aids
DeodorantsHeart medicinesOven cleanerTranquilizers
DepilatoriesHouseplantsPaintTurpentine
Diet pillsIbuprofenPaint thinnerVitamins
DiureticsInsecticidesPerfumeWindow cleaning fluid

PETROLEUM PRODUCTS

Poisonous petroleum products include gasoline, kerosene, benzene, mineral spirits, furniture polishes, paint thinners, and other solvents. In recent years, inhaling or sniffing some of these products has become popular among young people, especially drug users, because the fumes can produce a "high." This can be a deadly practice as evidenced by the number of young people who have died from cardiorespiratory problems or suffered severe liver damage from sniffing correction fluid, glue, carbon tetrachloride, and other petroleum-based chemicals. Household petroleum products should always be stored out of the reach of children. If accidental ingestion occurs:
  • Call your local poison control center for specific instructions. Serious pulmonary problems may accompany certain types of poisoning.
  • Do not induce vomiting unless specifically instructed to do so.  

PESTICIDES

Common examples of pesticide poisoning include accidental ingestion of rodent pellets; ant, roach, and other bug poisons; garden sprays; and farm chemicals. Skin contact with these liquid or powdered products may also produce toxicity. Prevention of pesticide poisoning:
  • Avoid the use of pesticides in households where there are young children. Never have pesticide containers lying around where children can reach them.
  • If a pesticide must be used, do so when children will be away and make sure that it is a type that does not leave a harmful residue.
  • As with all poisonous products, pesticides should be stored in their original containers in a child-proof place.
If ingestion occurs, call your poison control center immediately for instructions or take the child to a hospital emergency service. There are specific antidotes for this type of serious poisoning.

INDUSTRIAL POISONS

Increasing attention and concern are being focused on the fact that industrial poisons are wending their way into food and water supplies. In most instances, the health effects are apt to be delayed. But occasionally the toxic effects are displayed relatively rapidly and may cause irreversible damage or death. Poisonings from lead, mercury, and other heavy metals are graphic examples. A few years ago, mercury poisoning in rural Japan was traced to eating fish taken from waters contaminated by industrial waste. Similarly, lead poisoning among children remains a serious problem in the United States, not only from the practice of eating flaking paint chips that contain lead but also from many other sources, including drinking water contaminated by lead from pipes and brass fixtures. Industrial wastes near factories where lead is used are another source of lead poisoning.

Avoiding exposure is often difficult, since individuals have little or no control over release of these chemicals into the environment. If lead or other such poisoning is suspected, especially in a child, medical consultation should be sought for evaluation and treatment and the local department of health should be notified. In cases of suspected environmental contamination, the Environmental Protection Agency should be notified.

MEDICATIONS AS POISONS

Almost any medication taken in a large enough quantity can have a toxic effect. Aspirin remains one of the leading causes of accidental poisoning in young children, although this danger has diminished because of child-proof containers. Iron pills, or multivitamin pills containing iron, are also a major source of childhood poisoning. Acetaminophen (Tylenol, Anacin-3, etc.) is an increasingly frequent source of acute poisoning. Other over-the-counter drugs, including cold preparations, sleep aids, and antihistamines, can be toxic as well. With some drugs, the margin between therapeutic and toxic doses is relatively small; taking a few extra sleeping pills, for example, may be sufficient to cause a coma. Altered metabolism of medications in the elderly may narrow the therapeutic margin. Take these preventive steps to guard against poisonings with medications.
  • Follow label or physician's instructions in taking any medication. Discard leftover prescription drugs unless they are medications taken for chronic or recurring conditions.
  • Do not share prescriptions.
  • Great caution should be exercised in taking more than one drug at a time, including over-the-counter medications, birth control pills, and vitamin preparations. When taken simultaneously, these substances may have harmful effects. When telling your pharmacist or doctors about your medications, pills, and capsules, list all of them, including nutrient supplements.
  • Many accidental poisonings in children involve drugs, usually those taken by their parents. Use containers with childproof tops. As emphasized elsewhere, all medications should be stored in a safe place where children cannot get them. People often overlook the drugs left on a nightstand, in a pocketbook, refrigerator, or other unlikely places, but young children have been victims of poisoning from taking medications left in such spots.
  • The elderly or people with failing memories or eyesight may need extra help in keeping track of and in taking prescribed medication. Color-keyed labels, a large-print medication calendar, or a preset alarm may be helpful, but often the best solution is to have a family member, neighbor, visiting nurse, or other reliable person supervise the medication ingestion.
  • Patronize a pharmacy capable of properly filling and tracking your prescription medication use as well as identifying unusual side effects or interactions of your prescribed medications.

POISONOUS PLANTS

There are more than 700 plant species in the United States that can cause poisoning if a part of them is swallowed. Depending on the plant, the type and degree of toxicity vary from simple local irritation to serious systemic (widespread) reactions. In some cases, the entire plant is poisonous. In others, there are edible parts attached to segments that are poisonous: Occasionally, it may be the bulb (e.g., daffodils or narcissus) that is hazardous; in other plants, the berries or seeds (mistletoe berries, apple, or apricot seeds) should not be eaten; and in still others, the flower (jasmine), leaves (tomatoes or rhubarb), or roots are toxic. In addition, cooking may alter the toxicity of some plants. Surveys have found that plants are second only to medicines as the cause of serious poisoning in children under 5. The problem is increasing, according to poison control centers, because of the growing popularity of houseplants, and also the number of families who make foraging for wild food a hobby. Wild mushrooms are particularly notorious. Although only about 100 of the 5,000 species of mushrooms found in the United States are poisonous, some of these, such as the amanitas, are particularly deadly. To prevent plant poisonings:
  • Do not buy houseplants that are poisonous to either humans or pets. Cats and dogs frequently like to chew on plant leaves, and although most will avoid poisonous plants, kittens and puppies may not be so wise.
  • Avoid decorative plants (like the Jerusalem cherry) that have an appetizing appearance but highly poisonous fruits or berries.
  • In foraging for food during a hiking or camping trip, don't eat anything that you are unsure about.
  • Don't let children nibble on anything that grows wild, including berries you know are safe. Many wild berries look alike and you can't expect a child to make such distinctions when you are not around. Consult the list in the box above for some of the more common poisonous plants.
If someone ingests a poisonous plant:
  • Contact a poison control center for information and instructions.
  • If you are not sure of the species of plant that has been ingested, bring it and the victim with you to an emergency facility.
  • As a general rule, in suspected toxic plant ingestion, if professional advice is unavailable and the victim is fully conscious, the stomach should be emptied by inducing vomiting.
A CAUTION ON HERBS AND HERB MEDICINE

Herbs are mankind's oldest remedies, and many are still used as the basis for modern medicine. But many herbs are also deadly; others are not particularly harmful, but neither do they possess any great healing or curative powers. A medicinal herb should be treated like any medication: Do not take it unless you are completely familiar with its effects or you have checked with your doctor. Be wary of herbalists and home herbal remedies and never try brewing your own. Many plants look alike, and a deadly poison can easily be mistaken for one that is harmless. For example, one bite of water hemlock, which looks very much like parsley, chervil, or coriander (all harmless), can be fatal. Above is a list compiled by the Food and Drug Administration of toxic plants.

COMMON POISONOUS PLANTS
There are hundreds of poisonous plants in the United States. Following are some of the more common ones that are grown in gardens, used as houseplants, or grow in the wild.DaphneMistletoe (berries)
Deadly nightshadeMonkshood
DelphiniumMountain laurel
Dieffenbachia (also called dumbcane)Mushroom
English ivyOleander
FoxglovePhilodendron
Grass pea vinePoinsettia
Autumn crocusHolly (berries)Potato (sprouts, roots, and vines; only the tuber is edible)
AzaleaHorse chestnutsRhododendron
BelladonnaHyacinth (bulbs)Rhubarb (leaf and roots; only the stalk is edible)
Bird-of-paradise (seed pod)HydrangeaPoison hemlock
ButtercupsIrisPokeberry
CassavaJack-in-the-pulpitPurple locoweed
Castor beanJasmine (flowers)Rapeweed
ChinaberryJerusalem cherrySkunk cabbage
Chinese evergreenJimsonweed (also called thornapple) Sweet pea
Christmas pepperLantanaTomato plant leaves
CorncockleLarkspurWater hemlock
Daffodil (bulb)Lily-of-the-valleyWisteria (seeds)
 ManchineelYew (needles, bark, seeds, and berries)