Poisoning and Initial Measures to Treat the Individual Inflicted with It

Any material that causes interference and disorders in the individual’s well being or causes death while entering the body (through eating, breathing or injection) is called poison.

According to WebDa, on the basis of the announcement of Food and Drug Administration of Mashhad University of Medical Sciences, poisoning includes any disorders, interference and damages exerted to different systems in the body, which can either be accidental, as to lack of adequate care and attention or, in some cases, is intentionally done with a poisonous material.

It should be mentioned that in addition to the materials that are generally considered as a poison, some other materials which are not normally categorized as poisons can also be poisonous and damaging; for example, those drugs that their excess or improper consumption changes them into damaging poisonous materials. Contact with poisons can be sudden with clear and immediate symptoms and side effects, or gradual with delayed poisoning. In some cases, the poisoning signs and side effects appear long after contact with poisoning factor.

In general, the way through which the poison can enter the body are: through eating, breathing, skin absorption, and injection.

Most household poisoning cases are either through eating or breathing. We will shortly elaborate these poisoning types and necessary first aid measures.

Gastrointestinal Poisoning (through Eating)

The most prevalent kinds of poisonings are gastrointestinal ones which mostly occur accidentally by keeping poisonous materials and chemicals in improper containers or bottles of drinkable products. In these types of poisonings, the material enters the body though the mouth. After a while, the individual notices some symptoms which vary depending on the type of poison, its strength, the amount consumed, the body mass of the person, and the time that has passed since the poison is consumed.

Poisoning through eating may appear through any of the following factors:

1. Poisoning caused by eating contaminated food: to prevent these, the correct condition of preserving and cooking foods must be observed. All convenient foods must be boiled completely before consumption. Canned foods must be boiled in water for 20 minutes before the can is opened.


2. Poisoning caused by caustic chemicals: including household detergents like bleaches, Hydrochloride (HCl) and anti-germ materials. In case of this type of poisoning, mouth, esophagus and throat will burn. If vomiting happens, the risk would be multi-fold.


3. Poisoning with drugs and medicine: this type of poisoning mostly happens in kids as to repetitive dosage given to them by parents, or when curious toddlers put the drug in their mouth.


4. Poisoning with oil-products: vomiting after poisoning with oil and petrol products causes the material to return to respiratory tracts and lungs and lead to respiratory infections. Therefore, vomiting must be prevented in the person who is injured.


5. Poisoning with poisonous plants: some plants are poisonous; for example, Acacia, Narcissus bulbs, flower tubers of Hollyhock, Buttercup, Oleander, Dieffenbachia, Azalea, Spurge and Croton plant are poisonous. Their contact with the skin, and the contact of oral mucosa with the latex of the broken or cut leaves can created severe burn and inflammation in the mouth and throat.


6. Poisoning with pesticides: including insecticides, rat poison, Organophosphates and Organo-chlorinated poisons consumed in agriculture and Aluminum Phosphide known as rice tablet. Some pesticides have antidotes that must be injected immediately.

It must be mentioned that:

The most prevalent cases of household poisoning are caused by consuming the existing drugs or oil/petrol products at home. Therefore, more care and attention must be paid in keeping these items.

Signs and Symptoms of Gastrointestinal Poisonings:

A sign of burnt area or the color of the poison that is consumed around the mouth and lips, abnormal odor in the mouth or breath of the injured person, abnormal breathing, abnormal pulse or palpitation of the heart, perspiration, narrowed or dilated pupils, seizure, belly pain, foaming in the mouth or excess drooling or secretion of saliva, nausea, diarrhea and vomiting.

First Aids in Gastrointestinal Poisonings:

The first step is diluting the poison. To do so, in case s/he is conscious, the patient must be forced to drink water or milk. Another measure is to prevent the absorption of the poison by the body and then helping its excretion from the body. In those cases that you are sure that the poisoning is not caused by strong aci, base (Alkali) or a petrol/oil product, the following measures can be undertaken:

1.  Have the patient drink water or milk in order to dilute the poison.


2.  In case activated carbon or charcoal is available, use it to absorb the poison. The molecules of this charcoal stick to the poison molecules in the stomach and intestine and prevent their absorption. That’s why, you can give the patient, the powder of activated charcoal mixed into the water.


3. Transfer the patient to a hospital or medical center as soon as possible.


4. Prevent vomiting in the patient.

In the treatment of poisoning with caustic materials (acid and base):

Prevent vomiting in the patient. There is no need to give them activated charcoal. If the patient is completely conscious, and there is no seizure, immediately give him/her a lot of water or milk to drink.

A Second Notice: in case the poisoning is caused by a strong acid (Hydrochloric acid), a strong base (anti-germ materials), oil or gas, the person who is injured must not be forced to vomit.

The signs or cases indicating that you must avoid forcing the patient to vomit are:

• Burnt areas around the mouth and lips,


•  The odor of oil or gas from the patients’ mouth,


• Unconsciousness,


•  Pregnant women and


• Those patients who have had severe heart strokes.

When the injured person vomits, hold him/her on the sides or on stomach in a position where the head is in a lower position than the back.

In the cases that forcing the patient to vomit is prohibited, avoid forcing him/her to drink a lot of liquids, as the increase in the stomach content increases the risk of vomiting in the injured person.

Respiratory Poisonings

In this case, the poisonous material enters the body through the respiratory system while breathing. Taking in various chemical gases like Chlorine,  Ammonia, Carbon Monoxide, Carbon Dioxide, gases created by convector heaters and water heater, or the car exhaust, insecticide sprays or agricultural pesticides.

The vapor emitted from the mixture of HCL and whitening materials is so dangerous, especially for the eyes, skin and lungs. Therefore, it is suggested to wear a mask or cover the nose and mouth with a wet piece of cloth while using them. Avoid using them in places with inadequate ventilation.

The Best Measures to Treat Respiratory Poisoning:

1. Immediately take the injured person out of the poisoning source and the enclosed space to an open space to get fresh air


2. Control one’s breathing and attempt to breathe


3. Untighten the clothes of the injured person


4. Call the emergency or transfer the patient to treatment centers to receive oxygen and necessary drugs

Skin Poisonings

The poisons that can be absorbed by the skin usually irritate or damage the place they are absorbed through. Though in some cases the poison can be absorbed by the skin with minor damages or no damage at all, these cases are so rare. In order to determine the type of poison, get help from the patient himself, or search on the existing belongings and things around the patient to figure out the type of the poison. In case you face these types of poisonings:

1. Keep the patient away from the source


2. Wash the place of contact with a lot of water


3. Take out the contaminated clothing of the injured person and transfer the patient to treatment center after fully washing the skin with a lot of water

Signs and Symptoms of Skin Contact Poisonings:

1. The inflammation or redness of the skin


2. Chemical burn


3. Shock


4. Skin rashes


5. Accumulation of water under the skin and blisters appearing


6. Feeling itchy


7. Nausea


8. Vomiting

Injection Poisonings

There are four major factor for these types of poisonings including: medical injection, animal biting, snake biting and insect biting.

Poisoning Through Medical Injection

The injection of some medicine in various ways, no matter Intra Venous (IV), Intra Muscular (IM), Sub Cutaneous (SC) or Intra Dermal (ID) can cause allergic symptoms and reactions. Moreover, some people are allergic to specific diseases. The major signs and symptoms appear as allergic or anaphylactic shock.

Major signs and symptoms of Anaphylactic shock caused by drug injection are feeling itchy all through the body, inflammation, general weakness, unconsciousness, irregular pulse and respiration.

First aid measures in injection poisoning are similar to that of Anaphylactic shock, i.e. the patient must be taken to the hospital immediately.

Poisoning Through Animal Biting

Human or animal biting causes very severe skin laceration and inflation. The biting of animals such as fox, wolf, dog and raccoon can transfer Rabies virus and lead to death if no medical care is implemented. Human biting can also transfer a lot of microbes from mouth to skin as well as transferring Tetanus.

Major measures in animal biting:

Wash the wound with soap and warm water to minimize the risk of infection. Gently dry the wound and cover with sterile bandage or wound dressing. Take the injured person to treatment centers for the other stages of treatment measures.

In case the wound is deep and bleeding, control the bleeding by exerting direct pressure and lifting the damaged area. Tightly cover the wound with sterile dressing and bandage to control bleeding and prepare the condition to transfer the injured person to treatment centers. The patient’s history of tetanus vaccination must be asked from him or her.

Poisoning Through Snake Biting

There are two major types of snakes: non-poisonous and poisonous. Poisonous snakes are found in central Iran and desert areas. Some are very dangerous, as their poison is lethal.

Poisonous snakes have the following characteristics:

1. Triangle head shape or flat head that is wider than the neck


2. Long narrow pupils (like cats)


3. Colorful heat sensitive patches between the eyes and oral cavity


4. Shorter length


5. Various colors

Poisonous snakes use their fangs (biting teeth) to inject their poison.

Inside these fangs is empty like the tip of a needle, and the inner duct has a way to the venom bag which is on snake’s head and behind the inner ear. With the contraction and pressure exerted through biting, this venom bag is pressed, so the venom is injected to the body of the person through the inner duct of the fangs.

The signs and symptoms of snake biting (considering snake species) include:

• a sign of two holes, pain, redness, severe inflammation in the area which is bitten, nausea, vomiting, vision disorder, excess drooling or secretion in the mouth, perspiration, and difficulty in breathing. In severe cases, there is a possibility breathing failure in the patient.

First Aid and Measures to Treat Snake Biting

1. Try to calm down the injured person and help him/her to recline.


2. Gently wash the bitten area with soap and water and dry it with sterile gauze.


3. Essentially use limiting bandage 3 centimeters above the bitten area


4. Avoid movement in the damaged area.

The most influential treatment of snake biting is the injection of antidote in the hospital.

Notice: never use tourniquet or garo to tighten the wounded area, as arteries would also be closed, and the textures that are further away from the bitten area would also be damaged.

Poisoning Through Insect Biting

Insects have the highest population among animal species in the world; therefore, there is no limitation on the number of insects that bite humans.

The most important one of these insects are honey bees, red bees, fire ants, spiders, scorpion and Dracula insect. Opposed to snake biting, in insect biting, the biting area is just a single spot.

The signs and symptoms of honey bee, red bee, wasp, and fire ant biting are:

• Sudden surge of pain, redness, feeling itchy, hives, shortness of breath, change in skin color, faint, Anaphylactic shock

First Aid and Measures to Treat Insect Biting

Extract the insect’s sting which is left in the skin with a pair of sharp tongs. Cool compress the area. In case there is a shock, immediate treatments must be undertaken for the shock. In case of severe anaphylactic shock (especially in wasp and bee biting) immediately transfer the patient to the hospital. In case of Dracula insect biting, wash the poison-contaminated area with soap and water and sterilized with medical alcohol. Using anti-inflammatory ointments is also beneficial.

Scorpion

Most poisonous scorpions in Iran are found in areas close to deserts like Kashan, and around Ahwaz. The intensity of their biting depends on the amount of the poison injected. More than 90% of scorpion biting incidences have occurred on the hand. Kids are among most cases of scorpion biting.

Signs and Symptoms of Scorpion Biting

• Searing pain in biting area, increasing inflammation, change in color in the bitten area, nausea, vomiting, numb and tingling finger, uneasiness and anxiety, excessive mouth secretion or drooling, consciousness disorder, incontinence of urine and stool, seizure.

First Aid and Measures to Treat Scorpion Biting

Put the injured person in lying position on the back. Close the bitten area with limiting bandage up to 3 centimeters above. Cool compress the area with cold water bag. Never put ice on the skin. Transfer the patient to the hospital to get the antidote.