This chapter gives suggestions about the medicines and first aid equipment you might want to keep to deal with poisoning and the other problems described in this book.

A poisons centre will be able to tell you which antidotes and antivenoms you should keep, and how to get them. If there is no poisons centre in your region, ask the pharmacy of your district hospital.

The amount of medicines you keep will depend on how many people you serve and how far you have to go to get more supplies.

How to care for medicines and first aid equipment

Medicines

• Medicines that may be useful when poisons have been swallowed (see Chapter 9):
  • syrup of ipecacuanha to cause vomiting,
  • activated charcoal to bind poison,
  • magnesium sulfate (Epsom salts) to use as a laxative to make poisons move through the gut quickly; it can also be used as an antidote when hydrofluoric acid has been swallowed.
• Antidotes that can be given by a person without medical training, when there is no doctor:
• calcium gluconate gel, to put on the skin when hydrofluoric acid has been in contact with the skin,
• magnesium hydroxide, to be given by mouth when hydrofluoric acid has been swallowed,
• methionine tablets, to be given by mouth for paracetamol poisoning,
• naloxone, to be given by intramuscular injection, for opiate poisoning.


• Medicines to treat some of the effects of poisoning:
  • aspirin, 300 mg tablets, for fever or pain,
  • hydrocortisone cream, for itching rash caused by irritant plants,
  • paracetamol, 500 mg tablets for adults, and paracetamol elixir for children, for fever or pain,
  • rehydration drink, prepackaged mix, for dehydration,
  • tetanus antitoxin, for use after snake bite, spider bite or fish sting, when there is a danger of tetanus.

First aid equipment

The following will be useful for dealing with patients who have been exposed to a poison, bitten by a snake or stung by a spider, insect or fish:

• thermometers for taking temperature in the mouth,
• thermometers for taking temperature in the rectum,
• cotton wool and dressings,
• bandages and sticking plaster,
• cups and spoons to measure accurate doses of medicine: 1 litre, ´ litre, 5 ml,
• syringes and needles (if you are trained to give injections),
• soap, towels, nail brush,
• scissors,
• tweezers with pointed ends,
• sterile bottles for keeping samples of blood, urine or vomit,
• sterile bags,
• sterile gloves,
• notebook, pencils and pens.

Medicines and antidotes that can be given by doctors outside hospital

Antidotes

This is not a complete list of antidotes. It includes only those that can be given outside hospital.

Acetylcysteine: given by mouth in paracetamol poisoning and carbon tetrachloride poisoning. Acetylcysteine should be given by injection only in a hospital or medical centre where resuscitation can be given if the patient has an allergic reaction.

Ascorbic acid: given by mouth to treat methaemoglobinaemia from sodium chlorate poisoning.

Atropine: for injection in poisoning from carbamate or organophosphorus pesticides.

Calcium gluconate solution: for injection under the skin when hydrofluoric acid has been in contact with skin.

Deferoxamine (desferrioxamine): for injection in iron poisoning.

Dicobalt edetate, 1.5% solution: for injection in cyanide poisoning.

Dimercaprol (also called British anti-Lewisite (BAL) compound): for arsenic poisoning and lead poisoning.

4-Dimethylaminophenol (4-DMAP), 5% solution: for injection in cyanide poisoning.

DMPS (dimercaptopropanesulfonate): for arsenic poisoning and lead poisoning.

Hydroxocobalamin, 40% solution: for intravenous injection in cyanide poisoning.

Methylthioninium (methylene blue): for cyanosis caused by methaemoglobin in dapsone poisoning.

Obidoxime chloride: for poisoning from organophosphorus pesticides.

Penicillamine: for lead poisoning.

Phytomenadione (vitamin K): for injection in warfarin poisoning.

Potassium ferricyanoferrate (Prussian blue) or ferric ferrocyanide: for thallium poisoning.

Pralidoxime mesilate (P-2-S) or pralidoxime chloride (PAM2): for poisoning from organophosphorus pesticides.

Pyridoxine: for intravenous injection in isoniazid poisoning.

Sodium calcium edetate: for lead poisoning.

Sodium hydrogen carbonate (sodium bicarbonate): given by mouth with sodium thiosulfate to treat methaemoglobinaemia from sodium chlorate poisoning.

Sodium nitrite, 3% solution: for intravenous injection in cyanide poisoning.

Sodium thiosulfate, 25% solution: for intravenous injection in cyanide poisoning; also given by mouth, with sodium hydrogen carbonate (sodium bicarbonate), to treat methaemoglobinaemia from sodium chlorate poisoning.

Succimer (DMSA; dimercaptosuccinic acid): for arsenic poisoning and lead poisoning.

Antibiotic eye ointment: when there is a risk of infection after burns or injury to the eye.

Antivenoms: as appropriate for snakes, spiders, scorpions and stinging fish that are found in the area.

Antihistamine such as chlorphenamine or promethazine: for intravenous injection, in case of allergic reactions.

Diazepam: for injection, to treat fits.

Diphenhydramine: for injection or for giving by mouth, for itching rash caused by irritant plants.

Epinephrine (adrenaline) injection, 1 in 1000 (1 mg/ml) for intramuscular injection: for severe allergic reactions (for example, to insect stings).

Fluorescein: to detect damage to the eye from irritant or corrosive poisons.

Metoclopramide: for intravenous injection, to stop persistent vomiting.

Morphine: for severe pain.

Salbutamol: for inhalation (or theophylline for intravenous injection) for asthma or wheezing caused by severe allergic reactions (for example, to insect stings).