Poisons

Introduction to poisons

A poison - also called a toxin - is a substance which, if taken into the body in sufficient quantity, may cause temporary or permanent damage.

Poisons can be swallowed, absorbed through the skin, inhaled, splashed into the eyes, or injected. Once in the body, they may enter the bloodstream and be carried swiftly to all organs and tissues. Recognition features vary with the poison - they may develop quickly or over a number of days.

See the individual tips for recognition features and treatment of specific poisions.

1. Swallowed poisons

Introduction

Chemicals that are swallowed may harm the digestive tract, or cause more widespread damage if they enter the bloodstream and are transported to other parts of the body.

Hazardous chemicals include common household substances. For example, bleach, dishwasher detergent, and paint stripper are poisonous or corrosive if swallowed. Drugs, whether they are prescribed or bought over the counter, are also potentially harmful if they are taken in overdose. The effects of poisoning depend on the substance that has been swallowed.

Recognition features

Depends on the poison, but there may be:

• Vomiting, sometimes bloodstained.
• Impaired consciousness.
• Pain or burning sensation.
• Empty containers in the vicinity.
• History of ingestion/exposure.

Treatment

Your aims:

• To maintain the airway, breathing, and circulation.
• To remove any contaminated clothing.
• To identify the poison.
• To arrange urgent removal to hospital.

If the casualty is conscious:

• Ask them what they have swallowed.
• Try to reassure them.
• Dial 999 for an ambulance
• Give as much information as possible about the swallowed poison. This information will assist doctors to give appropriate treatment once the casualty reaches hospital.

If the casualty becomes unconscious:

• Open the airway and check breathing
• Be prepared to give chest compressions and rescue breaths if necessary.
• Place them into the recovery position if the casualty is unconscious but breathing normally.
• Use a face shield or pocket mask for rescue breathing if there are any chemicals on the casualty's mouth

2. Alcohol poisoning

Introduction

Alcohol (chemical name, ethanol) is a drug that depresses the activity of the central nervous system - in particular, the brain.

Prolonged or excessive intake can severely impair all physical and mental functions, and the person may sink into deep unconsciousness.

There are several risks to the casualty from alcohol poisoning:

• An unconscious casualty risks inhaling and choking on vomit.
• Alcohol widens (dilates) the blood vessels. This means that the person loses heat, and hypothermia may develop.
• A casualty who smells of alcohol may be misdiagnosed and not receive appropriate treatment for an underlying cause of unconsciousness, such as a head injury, stroke, or heart attack.

Recognition features

There may be:

• A strong smell of alcohol.
• Empty bottles or cans.
• Impaired consciousness: the casualty may respond if roused, but will quickly relapse.
• Flushed and moist face.
• Deep, noisy breathing.
• Full, bounding pulse.
• Unconsciousness.

In the later stages of unconsciousness:

• Dry, bloated appearance to the face.
• Shallow breathing.
• Weak, rapid pulse.
• Dilated pupils that react poorly to light.

Treatment

Your aims:

• To maintain an open airway.
• To assess for other conditions.
• To seek medical help if necessary

If the casualty is conscious:

• Cover a casualty with a coat or blanket to protect them from the cold.
• Assess the casualty for any injuries, especially head injuries, or other medical conditions.
• Monitor and record vital signs - level of response, pulse and breathing - until the casualty recovers or is placed in the care of a responsible person.

If the casualty becomes unconscious:

• Open the airway and check breathing.
• Be prepared to give chest compressions and rescue breaths if necessary.
• Place them into the recovery position if the casualty is unconscious but breathing normally.
• Dial 999 for an ambulance.

DO NOT induce vomiting.

3. Drug poisoning

Introduction

Poisoning can result from an overdose of either prescribed drugs or drugs that are bought over the counter. It can also be caused by drug abuse or drug interaction.

The effects vary depending on the type of drug and how it is taken (see table below). When you call the emergency services, give as much information as possible. While waiting for help to arrive, look for containers that might help you to identify the drug.

Recognition features

Category	Drug	Effects of poisioning
Painkillers	Asprin (swallowed)	Upper abdominal pain. Nausea & vomiting. Ringing in the ears. "Sighing" when breathing. Confusion and delirium. Dizziness.
	Paracetamol (swallowed)	Little effect at first, but abdominal pain, nausea and vomiting may develop. Irreversible liver damage may occur within 3 days (malnourishment and alcohol increase the risk).
Nervous system depressants and tranquillisers	Barbiturates and benzodiazepines (swallowed)	Lethargy and sleepiness, leading to unconsciousness. Shallow breathing. Weak, irregular, or abnormally slow or fast pulse.
Stimulants and hallucinogens	Amphetamines (including Ectasy) and LSD (swallowed); cocaine (inhaled)	Excitable, hyperactive behaviour, wildness and frenzy. Sweating. Tremor of the hands. Hallucinations.
Narcotics	Morphine, heroin (commonly injected)	Small pupils. Sluggishness and confusion, possibly leading to unconsciousness. Slow, shallow breathing which may stop altogether. Needle marks, which may be infected.
Solvents	Glue, lighter fuel (inhaled)	Nausea and vomiting. Headaches. Hallucinations. Possibly, unconsciousness. Rarely, cardiac arrest.

Treatment

Your aims:

• To maintain breathing and circulation.
• To arrange removal to hospital.

If the casualty is conscious:

• Help them into a comfortable position.
• Ask them what they have taken.
• Reassure them while you talk to them.
• Dial 999 for an ambulance.
• Monitor and record vital signs - level of response, pulse and breathing - until medical help arrives.
• Look for evidence that might help to identify the drug, such as empty containers. Give these samples and containers to the paramedic or ambulance crew.

If the casualty becomes unconscious:

• Open the airway and check breathing.
• Be prepared to give chest compressions and rescue breaths if necessary.
• Place them into the recovery position if the casualty is unconscious but breathing normally.
• Dial 999 for an ambulance.

DO NOT induce vomiting.

4. Food poisoning

Introduction

Food poisoning is usually caused by consuming food or drink that is contaminated with bacteria or viruses. Some food poisoning is caused by poisons (toxins) from bacteria already in the food. The salmonella or E. coli group of bacteria, which are found mainly in meat, are common causes of food poisoning.

Symptoms may develop rapidly (within hours), or they may not occur until a day or so after eating contaminated food.

Toxic food poisoning is frequently caused by poisons produced by the staphylococcus group of bacteria. Symptoms usually develop rapidly, possibly with 2-6 hours of eating the affected food.

One of the dangers of food poisoning is loss of body fluids. The dehydration that results from this fluid loss can be serious if the fluids are not replaced quickly enough. Dehydration is especially serious in the very young and the very old, and, in some cases, treatment may be required in hospital.

Recognition features

There may be:

• Nausea and vomiting.
• Cramping abdominal pains.
• Diarrhoea (possibly bloodstained).
• Headache or fever.
• Features of shock.
• Impaired consciousness.

Your aims

• To encourage the casualty to rest.
• To give the casualty plenty of bland fluids to drink.
• To seek medical help if necessary .

Treatment

• Advise the casualty to lie down and rest. Help them if necessary.
• Give the casualty plenty of bland fluids to drink and a bowl to use if they vomit.
• Call a doctor for advice.

If the casualty's condition worsens:

• Dial 999 for an ambulance.

5. Poisonous plants and fungi

Introduction

Many young children eat plant leaves or brightly coloured berries, but serious poisoning as a result rarely occurs.

However, ingesting even small amounts of foxglove or wild arum can cause nausea, vomiting, and stomach cramps; and large amounts are potentially fatal. Seizures may occur after ingesting laburnum seeds.

Serious poisoning as a result of eating mushrooms is also rare. Mushrooms found in the garden may cause nausea, vomiting, and occasionally, hallucinations. Death cap mushrooms cause vomiting and severe watery diarrhoea between 6 and 12 hours after ingestion and can be fatal.

Recognition features

There may be:

• Nausea and vomiting.
• Cramping abdominal pains.
• Diarrhoea.
• Seizures.
• Impaired consciousness.

Treatment

Your Aims:

• To identify the poisonous plant, if available.
• To manage any seizures.
• To seek medical aid if necessary.

If the casualty is conscious:

• Ask them what they have eaten and reasure them.
• Try to identify the poisonous plant, and find out which part of it has been eaten.
• Get medical advice at once so that the appropriate treatment can be given.
• Keep any small pieces of the palnt that you have found to show to the doctor or send with the casualty to hospital.

If the casualty becomes unconscious:

• Open the airway and check breathing
• Be prepared to give chest compressions and rescue breaths if necessary.
• Place them into the recovery position if the casualty is unconscious but breathing normally.
• Dial 999 for an ambulance.

Do not induce vomiting.

6. Insect stings

Introduction

Usually a sting from a bee, wasp, hornet are not serious and are more painful than dangerous. But with any insect bite or sting it is important to look for signs of an allergic reaction.

Aims

• Relieve any swelling and pain.
• Arrange any medical treatment, if necessary.

Treatment

• You need to reassure and calm the casualty down.
• There will be pain and possibly some redness and swelling around the site of the sting.
• If the sting is visible, brush or scrape it off. You could use the blunt edge of a knife or a credit card for instance. Please don’t use tweezers are you risk squeezing more poison into the wound.
• Apply an ice pack or cold compress for at least 10 minutes, and if possible raise the effected part.
• If swelling and pain persist advise the casualty to see their doctor.
• Stings to the mouth and throat can be dangerous. There is a risk of the tissues in the mouth and throat swelling which could cause the airway to become blocked.
• Sucking on an ice cube, or an ice cream or lolly for instance for children ,or sipping cold water will prevent any swelling.
• However, if the swelling starts to develop and breathing becomes difficult then arrange for medical help immediately.
• Some people suffer severe allergic reactions to insect bites and stings, if the casualty shows any sign of impaired breathing or swelling to the face, neck, tongue, mouth or lips or shows a wide spread rash then dial 999 or 112 for an ambulance.