POISONING, BITES, DIABETIC EMERGENCIES FN Brno, October 2011 POISONING Poisoning • Unintentional: result from exposure to or ingestion of toxic substances, including drugs and alcohol, chemicals, contaminated food • Intentional: in cases attempted suicide Poisoning • The effect depends on the type and amount of substance absorbed • A poison (toxin) may cause temporary or permanent damage • Poisons can be swallowed, absorbed through the skin, inhaled, splashed into the eyes or injected Poisoning • A poison, after entering to the body, may enter the bloodstream and be carried to all organs and tissues • Signs and symptoms: vary with the poison (develops quickly or over a number of days) : local signs : systemic signs Swallowed poisons Drugs and alcohol, cleaning and gardening products, plant poisons, bacterial and viral (food) poisons Effects: nausea, vomiting, abdominal pain, seizure, irregular, fast or slow heartbeat, impaired consciousness Inhaled Industrial poisons, fumes from fires, chlorine Effects: headache, confusion, difficulty breathing, cyanosis Absorbed through the skin Cleaning and gardening products, plant poisons Effects: pain, swelling, rash, redness, itching Splashed in the eyes Effects: pain and watering of the eye, blurred vision, inability to open the injured eye Injected through the skin Venom from stings and bites, drugs Effects: pain, redness and swelling at injection site, nausea, vomiting, difficulty breathing, seizures, anaphylactic shock Poisoning first aid • Identify the poison • Monitor victim • Seek medical help • Resuscitate if necessary • Help victim into fresh air • Remove contaminated clothing, wash area for at least 10 minutes (absorption through the skin) • Irrigate the eye DO NOT INDUCE VOMITING ! Alcohol poisoning • Depresses the activity of the central nervous system • Impairs all physical and mental functions • Risks from alcohol poisoning: ▫ inhaling and choking on vomit ▫ loosing heat, hypothermia ▫ underlying condition often misdiagnosed Alcohol poisoning • First aid: - cover the person with a coat to protect from the cold - asses the person for any injuries - monitor and record vital signs (level of response, pulse, breathing) - if unconsciouss – recovery position Methanol poisoning • Over 50 death casualties over last year in CR • Accidental poisoning • Inability to recognize methanol while drinking it and distinguish it from ethanol and so avoid drinking greater amount of it • Antifreeze, windshield wipe fluid • Methanol – contaminated alcohol Methanol poisoning confusion abdominal pain headache inarticulate speaking visual impairment, seizures, coma Methanol poisoning • Prognosis ▫ 4 ml can cause blindness ▫ 30 ml death • First aid ▫ Drink 150-200 ml strong 40 % alc. volume liquor – known origin ▫ Call EMS • Hospital management ▫ Gastric irrigation, Antidote – ethanol or fomepizole, supportive treatment Drug poisoning • Prescribed • Over the counter • Drug abuse Drug poisoning – NS depressants • Unconsciousness, shallow breathing, weak or abnormally slow or fast pulse, meiosis • Illicit drugs : morphine, heroin Drug poisoning- Stimulants and hallucinogens • Stimulants and hallucinogens (amphetamines - Ectasy , LSD, cocaine): • Excitable, hyperactive behavior, wildness, sweating, tremor of the hands, hallucinations Food and fungi poisoning Food and fungi poisoning • Common • Symptoms may develop rapidly (within 2-6 hours): nausea, vomiting, abdominal pains, headache, fever mushrooms: vomiting, severe watery diarrhea, hallucinations, poisoning may be fatal • Danger: dehydration liver failure Poisoning – hospital management • Supportive therapy: ABC • Slow absorbtion of the poison : ▫ Orogastric lavage ▫ Activated charcoal • Promote removal from body ▫ Forsed diuresis, hemodialysis • Special antidotes BITES AND STINGS Insect sting Insect sting Sting from a bee, wasp or hornet Recognition: pain at the site of sting, swelling, redness Sting in the mouth or throat – swelling can obstruct the airway Serious reaction - anaphylactic shock First aid : raise the affected part apply an ice pack or cold compress Bites Bites • Bites from certain species of scorpions and spiders, snakes (vipers, exotic snakes), sea creatures • Bites in the mouth or throat are dangerous because swelling can obstruct the airway • Be alert to an allergic reaction • Can cause serious illness and may be fatal (spiders, snakes) Bites – First aid • Raise the affected part • Apply an ice pack or cold compress • Wash the wound, compression bandage above the wound • Immobilize • Note the snakes appearance Anaphylactic shock • Severe allergic reaction • Contact with trigger factor • Develop within seconds or minutes • Triggers: skin or airborne contact with particular material the injection of drug the sting of insect food (shrimps, peanuts) Anaphylactic shock • Chemicals are released to blood • Dilatation of blood vessels • Constriction of air passages (bronchoconstriction) • Swelling of tongue, throat Treatment: adrenalin (auto-injector) DIABETIC EMERGENCIES Diabetic emergences • Hypoglycemia – low blood sugar • Hyperglycemia – high blood sugar Hypoglycemia • Develops quickly – over few hours • Weakness, hunger/nausea • Swaeting, cold, clummy • Strange behaviour • FA : sugary drink, sweet food Hyperglycemia • Develops slowly – over days • Weakness • Warm, dry skin • Drowsiness • FA :transport to hospital If in doubt- give sugary drink – little harm in hyperglycemia Questions ?