After studying this chapter, you should be able to:

When a person has been poisoned it is important to know what happened. It is easier for a doctor to treat the patient if the poison and the circumstances of the poisoning are known, and it is more likely that the treatment will be successful. Also, it may be possible to take steps to prevent someone else being poisoned in the same way.

There are two ways to find out what happened. You can ask people for information, and you can look for the poison and other things that show you what might have happened.

However, your first priorities are to give first aid and then to get medical help. You should never delay taking the patient to hospital or to a local doctor. You may spend about ten minutes talking to people and looking for the poison, if you can do so without leaving the patient alone. You may be able to spend longer if you have to wait for a local doctor to visit, or for an ambulance. It may be possible to go back and have another look after you have handed the patient over to a doctor. When there is another person to help you, one of you can find out what happened, while the other looks after the patient or takes him or her to hospital.

Remember!

Never leave the patient alone while you talk to people or search for the poison.

Do not delay in getting medical help.

You need to find out as much as possible about:

• how the poisoning happened. Was the poison swallowed, breathed in, injected, or in contact with the skin or the eye, or was the patient bitten or stung?

• where the poisoning happened;

• what the poison is;

• how long ago the patient was poisoned. Did it happen a few minutes ago, or was it several hours or even days ago?

• how long the exposure lasted. For example, if the poison was breathed in, for how long was the patient breathing it in? If the poison was spilt on the skin or clothes, how long was it before the patient washed or took off the clothes?

• how many people were affected.

You may be able to find out some information by talking to people, and you may be able to find things that show you what happened or what the poison is.

As you gather information you may need to make notes to help you to remember all the facts.

Talking to people

The patient

In some cases the patient is the best person to tell you what happened. You may have found out some of the facts by talking to the patient as you examined him or her, but a small child or a confused person may not be able to tell you much, and an unconscious patient cannot tell you anything. Some people who poison themselves may not want to tell you the truth.

Other people

You may be able to find out more about what happened from other people. Compare their story with what the patient tells you.

If the patient is a child:

• Talk to anyone who was looking after the child, or playing with him or her. Someone may have seen the child drink from a bottle containing chemicals, open a bottle of medicine, or eat some leaves from a plant. Ask whether the child was left alone at any time, even if it was only for a few minutes, and ask where the child was left alone.

If the accident happened at work:

• Talk with other workers who were with the patient. They may know what happened and they may know what substances the patient was using.

• Talk with the supervisor or nurse. They may know if this kind of accident has happened before and what chemicals are used or kept in the workplace.

If you think the patient meant to take poison:

• If the patient cannot or will not tell you what happened, ask the patient's friends or family if he or she was unhappy or had problems.

If no-one knows what happened:

• Find out if there are any chemicals or medicines the patient could have been exposed to in the home or at work. Ask people the following questions:

  • Has the patient been taking medicines or home cures? Does anyone else in the family take medicines? What medicines, pesticides and cleaning products are kept at home? Where are they kept? Are they locked away? If the patient is a child, find out whether a child could reach them.
  • Has the patient been in a place where poisonous snakes or animals are found?
  • Has the patient eaten a plant, mushroom, or fish that might have been poisonous? Talk to the family, fellow workers or friends who may have eaten with the patient in the past two days. Ask them what food the patient ate. Is anyone else who ate the same meals also ill?
  • Is it possible that the patient ate food contaminated with poison? Has food been near poisonous chemicals such as pesticides, in the shop, at home or when it was moved from one place to the other?
  • Does the patient use chemicals, cleaning products or pesticides at home or at work? Where are these chemicals kept? Are they locked away or can anyone use them?
  • Has the patient used chemicals recently, either at home or at work? How long for? Has the patient used the same chemicals before and in the same way? Was the patient wearing protective clothing if it was needed?
  • Was anyone nearby using a chemical? For how long?

Look for the poison or other things that show you what happened

Sometimes nobody can tell you what happened and the only way to find out is to look for the poison or for things that show you what might have happened.

Even if people have been able to tell you what happened, you may still need to look for the poison. If the poison is a medicine, a pesticide, a household product or industrial chemical, you need to seethe container so that you can check the exact name on the label, and see if there is any information about the chemicals in the product. Do not rely on the names that people tell you; they may read the label wrongly or be confused by the chemical names.

Take a pencil and a notebook with you when you look for poisons, in case you find products that you cannot take away with you, such as large drums of pesticide. Carefully write down the information from
the product label. Look for the name of the product, the names of chemicals, the name and address of the manufacturer, and any information about what to do in case of poisoning. Try to copy any symbols or pictures on the label, and write down any numbers. This information may help a poisons centre to identify the product.

If the patient has been harmed by an animal that has been caught or killed, ask to see it. It is important to identify the animal. Snakes and spiders can be recognized by their colour and markings. Keep them in a safe container so that nobody else is harmed.

If the patient has eaten a wild plant or mushroom, ask for a sample so that you can identify it. If necessary, ask where it was found and send a responsible person to get some.

What to look for and where to look

Search the place where the patient was found. Ask members of the patient's family if they will help you search the home. Ask the patient's employer if you can search the workplace.

Look for:

• bottles, packets, boxes or other containers that might have contained tablets, medicine, household chemicals, or pesticides. Read the labels of any containers you find;

• drinks bottles that have been filled with pesticide or kerosene, which could be mistaken for fizzy drink or alcohol;

• old pesticide containers that are being used to store food or as toys;

• liquid fuel burners that are not working properly (you can usually see that they are not working properly because there will be black sooty marks near the air vent and outlet pipe);

• poisonous snakes, insects, or plants; rosaries or beads made from plant seeds.

If the patient is a child:

• Look inside high cupboards as well as low cupboards because the child might have climbed onto a chair or table.

• Look inside the waste bin for containers that might not have been completely empty, and for button batteries.

• Look for chemicals that have been spilt on the floor or on the child's clothes. Look for stains or wet patches. When small children try to drink from bottles they often spill the liquid.

• Look for tablets on the floor and look for staining or pieces of tablets in the child's mouth. Look for the child's own medicines to see if the containers are open.

• Look for household products and pesticides in open bottles, jars, cups or buckets, for example, paint brush cleaner in ajar or cup, laundry detergent or another cleaner that has been added to a bucket of water, or rat poison in an open dish on the floor.

If the patient is an adult:

• Look for poison on the patient's clothes or skin, and look for pieces of tablets, plants, or food in the vomit or inside the mouth.

• Look in the patient's pockets. Search the room where the patient was found and look in waste bins.

• Look for tablets, medicines, pesticides, or household chemicals. Look for a syringe, which could mean the patient abuses drugs and has just injected some. Look for a suicide note.

Remember that some people take care to leave no evidence of the poison they have taken. Some people do not tell you the truth when you ask them what poison they took.

What to do next

When you telephone a hospital or poisons centre, have with you the chemical products, medicines, plants or animals, or the notes that you have made about them, so that you can describe them accurately and read product labels. Describe what happened and the condition of the patient.

When the patient goes to hospital make sure the chemicals, medicines, plants or animals you have found go also, if it is possible to move them, together with the notes you have made.