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CHAPTER 9: HOW TO LOOK AFTER A POISONED PATIENT OUTSIDE HOSPITAL |
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| Objectives After studying this chapter, you should be able to:
This chapter describes
how someone with no medical training can look after a person who
has been poisoned, when there is no doctor.
If you can get the patient to a local doctor or hospital within two hours, it is more important to go without delay than to do any of the things described here, except perhaps to give the patient some water to drink. The actions described in this chapter are not first aid. They are best carried out under the direct supervision of a doctor. You should undertake them only when it is impossible to get the patient to a local doctor or hospital within two hours. If possible contact a doctor or poisons centre by telephone before you proceed. Sometimes these actions can be dangerous and it may be difficult to know whether or not the patient will benefit. Make a note of everything you do and of any change in the patient's condition, with the time and date. Give the note to the doctor when you hand over the patient. What to do when the patient has swallowed poison Do not give anything by mouth if:
If the patient is awake ask him or her to rinse out the mouth several times with cold water and spit it out. Give small sips of water if the patient wants to drink. Do not make the patient drink a lot of liquid at once: the patient may vomit and this may be dangerous. How to stop poison getting into the blood after it has been swallowed When poisons are swallowed they go to the stomach and gut and pass through the gut walls into the blood. A poison will not have any systemic effect until it gets into the blood. If you can stop some or all of it getting into the blood, this may stop the patient getting severe poisoning. There are three ways to stop poison getting into the blood after it has been swallowed:
Sometimes it may be dangerous to do any of these things, and it is usually best to wait until the patient gets to hospital if possible. However if it is safe and useful to take action it is important to do so as soon as possible, because the longer the chemical stays in the gut, the more will get into the blood and the worse the poisoning will be. So, if it will take several hours to get to a health centre or hospital, you will have to decide whether the patient would benefit from any of these treatments and give them yourself. It is therefore very important to understand when they should be used and when they should not be used. In each case, before you decide what to do, you should find out as much as possible about what the poison is and what happened, and if possible telephone a poisons centre, hospital or doctor and ask for advice. Do not make the patient vomit if: It is dangerous to make a patient vomit if any one of the following is true:
If you know what the patient has swallowed, find out what effect it might have by: How to make the patient vomit Make the patient vomit by tickling the back of the throat or giving syrup of ipecacuanha. Do not give salt water to make the patient vomit. Too much salt is poisonous. In the past, patients given salt water to make them vomit have died from salt poisoning. Tickling the throat Make the patient lie face down, or sit well forward with the head lower than the chest, to stop vomit getting into the lungs. Children should lie face down over your knee. Ask the patient to touch the back of the throat with his or her fingers. If the patient cannot do it, lightly touch the back of the throat with your own finger or a blunt object such as a spoon. Take care not to damage the throat. Use two fingers of your other hand to force the patient's cheek between the teeth so that the patient cannot bite your finger. Giving ipecacuanha syrup Give ipecacuanha syrup or ipecacuanha paediatric emetic draught or ipecacuanha Adelaide Children's Hospital formula. Do not use fluid extract of ipecacuanha.
Give a drink of water afterwards. The patient should vomit 15-20 minutes after the dose. If the patient does not vomit after 30 minutes, give a second dose of ipecacuanha syrup. Do not give more than two doses. When the patient starts to retch and vomit, make the patient lie face down, or sit well forward with the head lower than the chest, to stop vomit getting into the lungs. Children should lie face down over your knee. Giving ipecacuanha syrup may remove more poison than tickling the throat because it makes the patient vomit more. However it may cause problems:
After the patient has vomited Look at the vomit. You may be able to see small pieces of tablets, leaves, or berries, which could be the poison. Note the colour and smell of the vomit. Save some of the vomit in a small, closed container and take it to hospital with you so that the doctor can see it. The hospital may be able to test the vomit to show what the patient swallowed. Do not give activated charcoal: How to give activated charcoal Use activated charcoal that has been given to you by a pharmacist or a doctor. Charcoal that you make by burning bread or burning wood is not the same and will not work. Dose: Mix 5-10 g of activated charcoal with 100-200 ml of water. Stir the activated charcoal with the water until it looks like a thick soup. Make sure all the powder is wet. Adults: Give one 10-g dose every 20 minutes up to a maximum of 50 g. Children: Give one 5-g dose every 20 minutes up to a maximum of 15 g or 1 g/kg of body weight (whichever is lower). Sometimes people vomit after drinking charcoal. If this happens do not give any more. Tell the patient, or tell the parents if the patient is a child, that charcoal colours the faeces black. For some poisons,
repeated doses of activated charcoal given over many hours remove
a larger amount from the body than a single dose. If the poison
is only slowly absorbed from the gut, additional doses of
Activated charcoal may cause mild constipation. If giving repeated doses of charcoal, give one dose of laxative with the first dose of charcoal. Do not give a laxative if:
How to look after a very sick patient Keep the patient at rest in a quiet, comfortable place with plenty of fresh air and light. Watch for any change in the patient's condition that tells you if the patient is getting better or worse. Four times a day write down the temperature, pulse, and the number of breaths per minute. If the patient is awake and able to drink, encourage the patient to drink plenty of liquid. Give simple fluids, such as water, soup, maize porridge, or rice-water. Do not give alcohol or coffee. Give frequent small drinks throughout the day. An adult needs to drink two litres or more every day. Watch for signs of dehydration. Write down the amount of liquid drunk and the number of times the patient passes urine or has a bowel movement. Keep this information for the doctor. If the patient is dehydrated because of vomiting, diarrhoea, or skin burns, you will need to give more fluids. Do not give anything by mouth if
What to do if the patient has bad diarrhoea Diarrhoea may be useful for getting poison out of the body but if it is very bad or lasts a long time the patient may lose too much water and become dehydrated. This problem is more likely to be caused by eating food contaminated by microorganisms than by poisoning from chemicals or medicines. Although many poisons cause diarrhoea it does not usually last long enough to cause dehydration. People of any age can become dehydrated but it happens more quickly and is most dangerous in small children. A child with diarrhoea very quickly loses large amounts of water and may die in a few hours. If the diarrhoea lasts a long time another danger is not getting enough food. It is very important to prevent dehydration and malnutrition by giving plenty of good food and drink. Diarrhoea can be very dangerous if:
Medicines should not be given for diarrhoea, especially to small children. To prevent dehydration If a person with diarrhoea is given plenty of liquids from the start, water loss should not be a problem. A patient with watery diarrhoea must drink large amounts of liquid as soon as the diarrhoea starts in order to replace the water and salts lost from the body. Give simple fluids, such as water, soup, maize porridge, rice- water or whatever liquid is available that the patient will take. Give one or two cupfuls (200 ml) of fluid after every loose stool. Even if the patient does not want to drink, gently insist (unless the patient is unable to swallow). Do not stop giving the patient food. When you give large amounts of liquid for diarrhoea, keep giving food as well unless the patient is vomiting, and keep giving breast milk to babies. A baby, a small child, or anyone who is thin, weak and undernourished should eat as soon as they can. An older child or adult who is well nourished should begin taking food after 24 hours. To treat dehydration If the patient is already dehydrated, simple fluids will not be enough. Sugar and salts lost from the body (sodium, potassium and bicarbonate) must be replaced. If you have a packet of oral rehydration salts (ORS) mix it with water and give it to the patient to drink. To make up a drink with oral rehydration salts:
What to do if the patient vomits for a long time A patient who vomits for a long time will lose a lot of water and become dehydrated. Give water or whatever liquids the patient will drink. Give sips every 5-10 minutes for 36 hours, or until the patient stops vomiting. Continue to give drinks even if the patient is vomiting. Give the drink a little at a time, very frequently - several sips or swallows every few minutes (not all of the drink will be vomited). Do not give food while the patient is vomiting a lot. Information for doctors If vomiting does not stop, the patient may need to be given a medicine like promethazine, diphenhydramine, or metoclopramide by injection. What to do if the patient does not pass urine The patient has an empty bladder If the patient does not pass urine and has an empty bladder this means that: To find out if the kidneys are working: The patient has a full bladder What to do if the patient is unconscious
What to do if the patient has a low temperature If the body temperature falls below 35°C measured in the mouth or rectum, cover the body, head and neck, but not the face, with blankets. If the patient is awake give hot sweet drinks. Put an unconscious patient in the recovery position. Keep the room warm, but do not try to warm the patient near a fire, or with hot water bottles next to the body. If the patient is very cold, the pulse and breathing may be very slow. If breathing and the heartbeat stop completely, give mouth-to-mouth respiration and heart massage. Check for the pulse for at least one minute before starting heart massage, because it is dangerous to give heart massage to a very cold patient if the heart is still beating. What to do if the patient has a fever A patient with a temperature higher than 38.5°C, measured by mouth, should lie down, undressed, with no covering, in a cool place. If the temperature becomes very high (over 40°C) it must be lowered at once. Undress the patient and sponge the whole body with cool water or cover the body with a cold, wet sheet and keep it wet. Fan the patient, until the patient's temperature drops to 38.5°C. If the patient is awake give sips of cold water to drink. Do not give aspirin for fever caused by poisoning. Check for other causes of fever besides poisoning. The patient may have malaria. What to do if the patient has liver damage The signs of liver damage are given in chapter 7. Keep the patient resting in bed and warm. If the patient is awake and can swallow, mix at least two tablespoonfuls of sugar in a glass of water or tea and give it to the patient every 2 hours. Get the patient to take these drinks with bread or rice, even if he or she feels very sick. Do not give foods containing protein such as meat, fish, eggs, milk or cheese. If the patient is also drowsy or unconscious, this means that the patient is very ill. What to do if the patient has lung oedema |
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