First Aid Help For Different Types of Poisoning

Introduction

Every year, many people seek medical help for poisoning that might have taken place one way or the other. A majority of these people seem to be children under the age of 5. Approximately 25, 000 children under the age of 5 are taken to the A&E departments in the UK each year after being suspected of accidental poisoning [1] [2]. One in five of these will lead to admissions in the hospital for further observation and/or treatment [1].

Although poisoning can have potentially fatal effects; being aware of how to prevent such occurrences, acting quickly and responsibly in the case of suspicion of poisoning, and administration of first aid measures and procedures, can reduce these effects and perhaps eliminate serious damage.

This project will discuss what is considered as a poison, the different types of poisoning that can occur, the symptoms to watch out for in each type of poisoning and how to administer first aid in each case.

Report

A poison is any substance (a solid, a liquid or a gas) which can cause temporary or permanent damage to the body if it enters in sufficient amounts. The poison is able to affect the normal functions and processes of the body. [2][3]

There are four main ways in which a poison can enter the body:

1. By ingestion (via eating or drinking)
2. By inhalation (via nose and mouth)
3. By injection (via body tissues or bloodstream)
4. By absorption (through the skin)

Poisoning by ingestion can occur due to the following reasons:

• Accidentally or intentionally overdosing on over-the-counter, prescription or illegal drugs – leads to drug poisoning.
• Household cleaners (e. g. bleach), chemicals and medications being left within the reach of young children who are unaware.
• Original labels of containers being left on them, which are now used to store the poisonous substances.
• Food that has been stored improperly – could lead to food poisoning when the contaminated food is consumed.
• Consuming plants, fungi or berries that are poisonous. Examples of poisonous plants are foxgloves, wild arum and some types of mushrooms. Consuming laburnum seeds can cause seizures. [3]

Poisoning by ingestion may be presented with the following signs and symptoms:

• Nausea, vomiting or diarrhoea (sometimes may be blood-stained)
• Severe abdominal pains and/or cramps
• Changes in breathing and pulse rates, partial loss of responsiveness or seizures
• Corroded or burned tissues of the mouth or even a burning sensation
• Unusual odours in the breath (e. g. after drinking chemicals etc)
• Stains around the mouth

What you should do if swallowed poisons are suspected:

• If the person is conscious, ask them what they have swallowed, how much and when. Look for any clues, like plants, berries or empty packaging and containers. Sometimes it is a good idea, if you can, to collect the berries and the leaves of the plant from which the berries were taken, as these can be used to identify what exactly was consumed.
• Call 999 or 112 for medical help or the poison control centre and tell them as much information as possible.
• Keep checking their breathing, pulse and level of response.
• If they become unresponsive, open their airway and check their breathing. Follow the instructions for treating someone who is unresponsive.
• Never try to make the person vomit, but if they vomit naturally then put some of their vomit into a bag or container and give it to the ambulance. This may help them identify the poison.
• Sometimes the medical services may instruct you to give the person some milk or water to dilute the substance, but don’t do this unless told to.

Alcohol Poisoning (Comes Under Poisoning by Ingestion)

Drinking an excessive amount of alcohol in a short space of time leads to alcohol poisoning. Too much alcohol prevents the proper functioning of the nervous system, in particular, the brain. This leads to the severe weakening of both the mental and physical functioning of the body and affects sight, speech, coordination and memory. There is also the possibility of the affected person entering deep unresponsiveness, and in the worst cases, it can slow or stop their breathing, which can be fatal and lead to death.

Key symptoms to check for, if alcohol poisoning is suspected [3]:

• A strong smell of alcohol and there might be empty bottles or cans that you can see
• Confusion and slurred speech
• Vomiting
• Reddened or moist face
• Deep, noisy breathing
• A strong and pounding pulse
• Unresponsiveness

If the person is unresponsive, check for the following as well:

• Shallow breathing
• Weak, rapid pulse
• Widened eye pupils that react poorly to light

What you need to do:

• Reassure them and cover them with a coat or blanket to keep them warm and prevent heat loss from the body.
• Check them over for any injuries, especially head injuries in case they might have fallen over, and for any other medical conditions.
• If the person is breathing normally but is not fully responsive, place them into the recovery position.
• Make sure that you keep checking their breathing, level of response and pulse.
• Do not try to make them be sick as this could block their airway and stop them from breathing.
• If you are unsure about how serious their condition is, then call the local emergency number for medical help e. g. 999 (UK) or 112.
• If they become unresponsive at any point, open their airway, check their breathing and prepare to treat someone who has become unresponsive.

Drug Poisoning

Additional symptoms (as well as the above mentioned for ingested poisons) to check if drug poisoning is suspected:

1. Confusion or excitable hyperactive behaviour
2. Sweating and shaking hands
3. Hallucinations – they may claim that they can ‘hear voices’ or ‘see things’
4. Unusually small or large eye pupils
5. Needle marks which may be infected

Poisoning by Inhalation

This type of poisoning can occur when a person encounters certain toxic gases. These gases can affect breathing by a direct effect or by preventing the proper transport of oxygen by the red blood cells. Examples of these gases are sulphur dioxide, the oxides of nitrogen, ammonia, hydrogen sulphide, hydrogen cyanide and carbon monoxide.

The signs and symptoms to look out for poisoning by inhalation are:

• Shortness of breath
• Coughing
• Cyanosis (bluish colour/tint to the skin)
• Cherry red colour if its carbon monoxide poisoning

First aid for poisoning by inhalation:

• Call the emergency services on 999 or 112 and tell them that you suspect inhalation of fumes.
• If necessary, get them away from the source of the fumes into an environment with fresh air. Do not enter the fume-filled area yourself. If the casualty is in a closed space filled with exhaust fumes, open the doors letting the fumes escape before you enter.
• Support the casualty in a comfortable position and encourage the casualty to breathe normally. Reassure them. Stay with them until the emergency services arrive. Ensure that the person’s airway is open and it is maintained.
• Treat any burns or other injuries.
• Monitor the casualty by keeping an eye on their breathing, response and pulse. If the casualty is unresponsive, open the airway, check for breathing and if necessary, perform CPR and provide artificial ventilation.

Carbon Monoxide Poisoning

Inhaling or breathing in large volumes of smoke or gas can be dangerous, and if this occurs, then a casualty needs immediate medical attention as it is possible that they have low levels of oxygen in their blood and tissues. Carbon monoxide is a poisonous gas and it is often called the silent killer since it is difficult to detect as it has no taste or smell. This gas directly stops the red blood cells from carrying oxygen to all the necessary body tissues and organs, which will critically affect the functioning of all the essential processes of the body system. It can easily become fatal if large amounts are inhaled e. g. from vehicle exhaust fumes or smoke within a confined space, or even in small amounts from perhaps a leakage of fumes from a faulty boiler or heater at home. Sometimes it is possible that people who have carbon monoxide poisoning are unaware that they are affected, and they may even blame any symptoms on other causes. The young and elderly are at an increased risk. As always, it is better to reduce any risk by making sure that gas appliances are checked and serviced regularly and to fit an approved carbon monoxide detector in your home.

If the casualty has had exposure to low levels of carbon monoxide for prolonged periods of time, they may complain of:

• Headaches
• Confusion
• Feeling aggressive
• Nausea and vomiting
• Diarrhoea

Severe symptoms may include:

• Grey-blue skin colouration in lips and earlobes
• Bright, cherry red colour
• Rapid, difficult breathing
• Impaired level of response, leading to unresponsiveness
• The first symptoms of asphyxia appear when a 30% blood saturation level has been reached.
• Proceed with the first aid as for any other inhalation poisoning (mentioned above).

Poisoning by Absorption

Some substances can cause poisoning or irritation of the skin when they come into contact – for example in the form of gases, fumes, mists, liquids and dust. The underlying tissues, hair follicles, sweat glands and oil glands may be also affected. Irritation and inflammation can occur when the natural structure is altered due to the poisonous substance. Severe immediate effects are rare, and usually, inflammation happens with prolonged exposure. Significant changes in skin colour or texture should be noted and medical help should be sought.

Early first-aid care that can prevent any discomfort:

• Remove any contaminated clothing
• Flood the contaminated area with plenty of water
• If it’s a dry poison, brush off as much as you can before washing the area with plenty of water.
• Clean the surrounding area e. g. if the poisonous substance is on the floor, or carpet/mat or there has been a spillage.
• Monitor for any signs of shock or changes in breathing.

Poisoning by Injection

This type of poisoning occurs when the poison enters the skin via injections or bites from animals, poisonous snakes and insects. In some cases, it is possible for some people to have a severe allergic reaction to a non-poisonous bite or drug, which could result in an anaphylactic shock. First-aid in this type of poisoning aims to reduce the amount of poison that travels to the heart to as low a level as possible.

General first-aid for poisoning by injection:

• Try to keep the person as calm, quiet and at rest as possible
• All jewellery (bracelets, rings, watches, anklets etc) should be removed from the bitten area, in case swelling occurs.
• Apply a constricting bandage above and below the bite at the edge of swelling, loosely enough to just slide a finger under the bandage. The pulse should be checked periodically below the bite; bandages are only to be used for constriction, not as a tourniquet. [4]
• Take the person to a medical facility, whilst keeping them as still and calm as possible or call 112 for an ambulance.

Snakebites

All snakebites should be treated the same, as it is difficult to determine whether the snakebite is from a poisonous snake or not. Bites from a snake can cause a severe allergic reaction (anaphylaxis) to some people. There are 2 venomous types of snakes in Bulgaria – the Common Viper (known as the Adder in the UK) and the Nose-Horned Viper [6].

Different types of snakebites

• Dry bite: when the snake strikes but no venom is released. This type of bite will be painful and can cause swelling and redness around the area where the snake has bitten.
• Venomous bite: when the snake strikes and releases venom (poison) into the wound. The constituents of snake venom are essentially designed to stun, numb or kill other animals.

Since you can’t tell the difference between a dry bite and a venomous bite, you should always assume that venom has been injected and manage the bite as a medical emergency.

Symptoms of a venomous bite include:

• severe pain around the bite, this might come on later
• swelling, bruising or bleeding from the bite, or blood oozing from the site or gums
• bite marks on the skin (these might be obvious puncture wounds or almost invisible small scratches)
• swollen and tender glands in the armpit or groin of the limb that has been bitten
• tingling, stinging, burning or abnormal feelings of the skin
• feeling anxious or confusion
• nausea (feeling sick) or vomiting (being sick)
• blurred vision
• headache or dizziness
• breathing difficulties or irregular heartbeat
• problems swallowing
• stomach pain
• muscle weakness
• collapse, paralysis, coma or death (in the most severe cases)

First Aid for snakebites:

• Provide emergency care including cardiopulmonary resuscitation (CPR) if needed.
• Call 112 for an ambulance and medical help.
• Keep the person lying down and quiet with the injured part immobile and lower than the rest of the body.
• Remove all items of jewellery from the injured area
• Apply a pressure immobilisation bandage. It should be tight enough to slow down surface circulation, but not so tight to cut off the arterial flow.
• Avoid washing the bite area because any venom left on the skin can help identify the snake.
• DO NOT apply a tourniquet, cut the wound or attempt to suck the venom out.

Pressure Immobilisation Technique

A pressure immobilisation bandage is recommended for anyone bitten by a snake. This involves firmly bandaging the area of the body involved, such as the arm or leg, and keeping the person calm and still until medical help arrives.

Follow these steps to apply a pressure immobilisation bandage:

• First, put a pressure bandage over the bite itself. It should be tight and you should not be able to easily slide a finger between the bandage and the skin.
• Then use a heavy crepe or elasticised roller bandage to immobilize the whole limb. Start just above the fingers or toes of the bitten limb, and move upwards on the limb as far as the body. Splint the limb including joints on either side of the bite.
• Keep the person and the limb completely at rest. If possible, mark the site of the bite on the bandage with a pen.

Conclusion

First aid is the immediate care given to someone who is injured or ill in some form, and without urgent attention and proper care being initiated, irreversible damage and even death can be caused. First aid doesn’t replace a doctor, but it makes sure that the victim is protected to a certain extent until medical assistance arrives. Being aware of situations in which first aid can be administered, the symptoms and signs to look out for and knowing the plan of action to take can save lives, especially when you may be the only person around.

Poisoning is an important community health problem and it is an important part of emergency service provision [14]. In most cases, poisoning occurs accidentally and knowing what to do if this occurs, or even better, if measures are taken to prevent such circumstances, then unnecessary fatalities can be avoided and will ensure increased safety, awareness and protection. In the case of poisoning, proper first-aid is lifesaving.

Always Remember

• Medications should always be stored out of reach of children and ideally be locked up.
• Cleaning chemicals, liquids, and detergents should always be kept in their original container and stored in a place out of reach from children. Under the sink is a bad place unless the area is always locked.
• Poison proofing a home includes getting rid of any chemicals that you do not need. This includes items in the kitchen, laundry room, garage, and the workshop.
• Never try to induce vomiting if poisoning is suspected unless told otherwise by the medical emergency services or poison control centre.