care for a poisoned patient

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Emergency guide

- Poisoning definition

The entry of any harmful substance  (natural or manufactured)  or pollutant into the body in a certain quantity, causing damage inside the body

Toxic substances enter a person's body in one of the following ways:

1.  Orally

2.  Inhalation

3.  Skin absorption

4.  Injection (in tissues or blood)

- Signs of poisoning

1- Food poisoning:

·  Nausea, vomiting, and diarrhea

·  Severe abdominal cramps and pain

·  Decreased breathing rate and blood circulation

2- Poisoning by inhalation:

-Shortness of breath, cough and cyanosis

- Possible cardiac arrest if breathing stops and is not corrected

3- Poisoning by absorption:

-  Irritation of the skin and mucous membranes with eye inflammation

4- Injection poisoning:

-  It can cause pain and swelling at the injection site, along with respiratory and circulatory failure

In addition to the above-mentioned symptoms, there are some sure signs such as burns to the lips, tongue and mouth when taking a caustic substance orally. As for liquid drugs, the color of the lips and mouth may change and give a certain smell to the breath

- First aid methods

1- Food poisoning:

In this case, it is preferable to get rid of the toxic substance and expel it through vomiting so that it does not remain for a long time in the stomach and intestines and be absorbed from them. However, there are some cases in which it is strictly forbidden to make the injured person vomit, which are:

·  If the injured person swallows a strong acidic or alkaline substance, this is because trying to bring it back up through vomiting increases the damage to the throat and esophagus

·  If the injured person swallows a petroleum product, this is because if it accidentally enters the lungs, it causes pneumonia

·  If the injured person is unconscious or semi-conscious, as he may inhale vomit into the respiratory system

·  If the injured person is in a state of convulsion

·  If the heart condition is serious and may be made worse by trying to vomit

To make the injured person vomit, do the following:

·  Dissolve some salt in warm water and let the injured person drink it

·  Inserting fingers into the throat or the tip of a spoon. In this case, the toxic substance must be diluted by giving a large amount of water or fluids

·  Keep the victim's head down as much as possible to prevent the possibility of some of the toxic substance escaping into the respiratory system

·  Collect the vomit and take it to the hospital with the patient for examination. Also, take the box or container that contained the toxic substance, if any.

2- Inhalation poisoning:

The injured person is taken away from the place of gas poisoning and placed in a place with fresh air. If the injured person cannot breathe, artificial respiration is also performed. If the heart muscle stops, the paramedic performs external massage of the heart muscle

3- Poisoning by absorption through the skin:

1- Remove clothing contaminated with the substance, including the injured person’s shoes, watch, rings, wedding  ring , etc

2- Expose the affected part to a stream of water for at least fifteen minutes

3- Do not apply any treatment to the skin at the site of the injury

4- Note breathing and circulation

Poisoning by injection:

Snake bite:

Signs and symptoms:

·  Prick mark: There are usually two prick marks at the site of the injury, or there may be only one mark if the muscle is in one of the fingers or toes

·  Severe pain and burning with spreading swelling - nausea and vomiting - shortness of breath - shock

How to provide first aid to the injured:

·  Do not move the injured person at all, because any movement will increase blood circulation and thus speed up the delivery of the poison to the heart. Remove the watch or jewelry that is in the place of the injury

·  Tie the top and bottom of the injury site so as to prevent the unoxygenated blood from reaching the injury site and the poison with it to the heart. As for the arterial blood, it should not be affected by this tie. To make sure of this, feel the pulse in this artery below the injury site. If it is not felt, reduce the intensity of the tie a little so that you can feel it under your fingers

·  If the bite has not been more than half an hour, make a small, shallow incision in the bite site to remove the venom, taking care to stay away from any large blood vessel in this area

·  The paramedic sucks the poison from the place if he does not find anyone to help him do so. He sucks it out with his mouth, taking care that there is no wound anywhere in his mouth or lips

·  A piece of ice can be placed directly over the bite site

·  The injured person should not be given any alcoholic beverages at all

·  The injured person should be taken to the hospital as quickly as possible

5- Drug poisoning:

Medicines that cause poisoning if taken orally, inhaled, or injected are divided into six types, which are:

* Sedative or hypnotic drug * Stimulant drug * Volatile chemicals

Drugs (hashish)  * *Hallucinogenic drugs * Sleeping and narcotic drugs

Signs of poisoning with a sedative or  hypnotic  drug:

·  The patient is very similar to someone who has been poisoned by alcohol, except that there is no alcoholic smell from the mouth. Drug poisoning affects the central nervous system

·  The affected person speaks in an unclear manner with inconsistent body movements, which may be followed by mental and sensory disability

·  The patient may also fall into a deep sleep or fall into a coma depending on the amount of medication he took, and it may lead to death, especially if the person took alcohol with it

Signs of stimulant drug poisoning:

·  It affects the central nervous system and causes excitement or irritation to the person, resulting in loss of appetite, increased energy and activity in the body

·  The ability to move without sleeping for long periods of time, and is usually used by drivers, football players, and others, which may cause some accidents

·  The person also suffers from nervousness, hand tremors, dilated pupils, dry mouth, profuse sweating, and talks a lot. He may also have hallucinations

Signs of poisoning by volatile chemicals:

·  The central nervous system is affected, swelling of the nose and throat occurs, with temporary blood disorders such as anemia. Some substances lead to liver and kidney damage and interfere with bone marrow functions

·  A feeling of numbness in the head, slowness and lack of clarity in speech, and an irregular way of walking may lead to a coma

Drugs  (hashish):

The affected person becomes very talkative and unstable in his cheerful state, followed by psychological depression and dizziness with confusion in the person's sense of time, place and vision with a change in voice, irregularity in the way he walks, a false sense of courage which may cause serious problems

hallucinogenic drug:

Disorientation with hallucinations and delusions

Sleeping drug:

It reduces blood circulation, breathing, blood pressure and metabolic rate with dangerous dehydration. It also causes loss of appetite and dangerous weight loss. The pupil of the eye becomes constricted, like the head of a pin, and may dilate as a result of the lack of oxygen reaching the brain afterwards

First aid in case of drug poisoning:

·  Check breathing and circulation

·  Help the injured person vomit to get  rid of the medication

·  Give oxygen if available

·  Protect the injured person from harming himself or others by tying him up, for example

·  Quickly transfer the injured person to the hospital 

6- Alcohol poisoning:

Its symptoms:

- Sweating - Tremors and shaking - Anxiety and tension

- Dizziness - Hallucinations - Distinctive mouth odor

Unusual  violent behavior

First aid:

All the paramedic can do is put the injured person in a separate room and not leave him alone, while taking into account the calmness around him, and the room being lit up 

7- Asthma:

·  It is an allergy to a certain substance that can enter the body either through inhalation, swallowing or injection

·  For example, it occurs as a result of a person being exposed to dust or air polluted with a certain substance. It also occurs with some types of food in some people. Asthma affects the normal breathing of the person as a result of a change in the size of the lungs

·  In the case of normal breathing for a normal person, the chest muscles and diaphragm make the chest cavity expand by expanding, and consequently the lungs, which are spongy, expand, and thus a large amount of air enters them. When the chest muscles and diaphragm begin to relax, the exact opposite happens

·  In the case of  asthma , the bronchial tubes and the smaller bronchioles are in a state of contraction, which results in narrowing of all the tubes of the airways, with congestion and swelling of the mucous membranes lining them, and secretions increase, thus disrupting the breathing process

8- crops tablet:

The  crops  tablet  consists of an aluminium phosphide compound and is used to preserve crops from pests that cause decay. These discs are stored in tightly sealed containers away from moisture

How to be exposed and how to cause poisoning

1.  Inhalation of phosphine gas inside the storage chamber

2.  Swallowing for suicidal or negligent purposes within the reach of children

When the tablet is exposed to stomach acid, phosphine gas is released, which is a toxic compound for cells that inhibits vital cellular enzymes, causes direct tissue erosion, and causes the collapse of blood circulation, which leads to a direct effect on the heart muscle, in addition to fluid loss and damage to the adrenal gland

How to deal with a patient poisoned :

1.  Administer coconut oil or paraffin oil (2-5 bottles of 50 ml) to the patient:

o   If the patient can swallow, give it orally.

o   If the patient cannot swallow, administer it through a nasogastric tube.

o   The oil remains in the stomach, encapsulating the substance and preventing the release of phosphine gas by maintaining the bond between aluminum and phosphide, which protects the heart muscle from damage.

2.  Administer sodium bicarbonate (1-2 ampoules intravenously) as an initial dose before test results appear to neutralize the resulting acidity.

o   Note: There is no specific antidote for treatment. Do not administer activated charcoal as it has no role in this case.

3.  Transfer the patient to the intensive care unit (ICU) for necessary supportive measures:

o   Conduct blood gas analysis and correct blood bicarbonate levels until they reach 20.

4.  Perform an ECG and cardiac enzyme tests to assess the heart's efficiency:

o   Do not administer intravenous fluids, as they may overload the heart.

o   In case of heart failure, administer norepinephrine via an infusion pump at a rate of 5-20 micrograms per minute. This is preferred over dopamine as the patient may experience arrhythmia.

5.  Administer an antispasmodic and injections to reduce absorption.

6.  Place the patient on oxygen therapy.

7.  Administer acetylcysteine intravenously in the following doses:

o   First dose: 150 mg/kg in 200 ml of 5% dextrose over 30 minutes.

o   Second dose: 50 mg/kg in 500 ml of 5% dextrose over 4 hours.

o   Third dose: 100 mg/kg in 1 liter of 5% glucose over 12 hours.

9- clostridium botulinum:

A serious disease caused by a toxin secreted by a bacterium called Clostridium botulinum, which is an anaerobic bacterium that causes botulism food poisoning and has the ability to cause an epidemic

Botulism toxins and their effect and impact on humans are nullified if exposed to a temperature of 100 degrees Celsius for ten minutes, such as  (frying in oil)

How is the infection transmitted?

Botulism occurs when food is contaminated with botulinum toxin, in an anaerobic environment with low acidity. This may also be helped by the low salt and sugar content of preserved foods, such as salted fish . (Feseekh)  and canned foods

Using unhealthy fish that may be rotten and the salting period is not sufficient (ten days or more)

Botulinum toxin injections  (Botox)  are used in physical and cosmetic treatment

Symptoms:

Symptoms start to appear after 12 to 36 hours  (with a minimum of 2 hours and a maximum of 10 days).

1-   Blurred vision and double vision

2-   dry throat

3-   Difficulty swallowing

4-   Muscle weakness or paralysis that begins in the upper limbs and spreads to the rest of the body  (the most dangerous of which is the respiratory muscles)

5-   Shortness of breath

6-   Respiratory failure that may lead to death

procedures

1-   Check symptoms

2-   Vital signs monitoring

3-   Airway and breathing monitoring

4-   Giving botulism serum

Place at 2-8°C and dilute with 0.9% saline solution

- How to perform gastric lavage in case of poisoning

Definition:

It involves removing the contents of the stomach and washing them using a gastric tube. Gastric lavage is not performed in the case of poisoning with acidic or alkaline substances, or if the injured person loses consciousness, or if the person has consumed a petroleum substance, or if he has consumed caustic potash.

the goal:

1-   Rapid elimination of the toxic substance to reduce its absorption through the blood

2-   To empty the stomach contents before performing a gastroscopy

3-   To diagnose and stop stomach bleeding

Tools used:

1.  Wide-opening gastric tube

2.  Large syringe with a regulator (50 ml)

3.  Large plastic funnel with a regulator compatible with the gastric tube

4.  Water-soluble lubricant

5.  Water from a tap or an alternative substance (milk, saline solution, sodium bicarbonate, fruit juice, activated charcoal)

6.  Container to collect stomach contents

7.  Mouth gag and endotracheal tube

8.  Container for the sample to be analyzed

Steps:

- General nursing care for patients with gastrointestinal poisoning

1.  Ensure the airway is clear and sufficient oxygen reaches all parts of the body by:

The goal is to improve the oxygen supply to the brain and heart muscles and accelerate the elimination of carbon monoxide by: