How do you provide the first aid for poisoning

Poisoning is defined as intoxication that occurs in the body of a human or animal, as a result of ingesting a poison.

Poison can be ingested by mistake, that is, accidental poisoning, or with the desire to commit suicide. Other times, poisoning occurs in someone who regularly handles a toxic substance at work (occupational poisoning).

The use of poison for homicidal purposes (criminal poisoning) is very rarely observed, due to the ease with which modern chemistry recognizes this crime, although it can make it possible.

WHAT ARE THE SYMPTOMS OF POISONING?

Some poisons have a local action, generally irritating the digestive mucosa, in addition to their general action on other parts of the body, this being one of the most common symptoms of poisoning.

For example, a person who ingests concentrated mercury bichloride solution will experience local burning of the mouth, esophagus and stomach, and once the toxic substance has been absorbed, it attacks the kidney.

Other times, the general effect of a poison is not very pronounced, with a very intense local effect, such as the ingestion of a caustic soda solution. On the other hand, other poisons have no local effect and act energetically on some parts of the body, such as strychnine.

The effect of the poison can be modified by various factors: if the stomach was empty and occupied at the time of ingestion, the greater dilution or concentration of the poison, its solubility or insolubility, the route through which it has entered the body, etc.

Age, idiosyncrasy, that is, the person's particular way of reacting, or habituation to the toxic substance also have an influence.

WHAT ARE ANTIDOTES AND HOW ARE THEY CLASSIFIED?

An antidote, also known as an antidote, is a substance capable of neutralizing or preventing the action of a poison. Antidotes can be divided according to the mechanism of their action, making antidotes classified as: mechanical or physical antidotes, chemical antidotes and physiological or antagonistic antidotes.

  • Mechanical or physical antidotes: are those that act by surrounding or absorbing the poison, thus making its absorption difficult, such as coal dust, milk, oil, egg white, etc.
  • Chemical antidotes: are those that react chemically on the poison, transforming it into a non-toxic or low-solubility compound, such as the action of common salt on silver nitrate, that of iron hydroxide on arsenic, etc.
  • Physiological antidotes or antagonists: are those substances that have an action on the organism contrary to that of the poison, such as, for example, the depressing action of barbiturates on the nervous system, which is used to counteract the exciting action that strychnine exerts on it.

What are the most common antidotes in first aid for poisoning?

The most common antidotes for first aid in case of poisoning are:

  • Albuminous water: four egg whites for each litre of water. It does no harm in any case. It forms less soluble compounds with many inorganic poisons and some organic ones.
  • Milk: it works in a similar way to albuminous water. Because of the cream it contains, it is contraindicated in poisoning with arsenic, phosphorus and cantharides, DDT or equivalents.
  • Activated charcoal powder: it works mechanically by absorbing and adsorbing the poison particles. It is preferable to use the so-called Merck ultra-charcoal, which is a mixture of animal and vegetable charcoal, specially prepared to increase its absorption power (quality of fixing the poison on itself).
  • Tannin: also known as tannic acid, dissolve 2 grams in a glass of water. Give by teaspoonful. If it is for gastric lavage, 2 to 5 grams can be dissolved in a litre of water. It precipitates some of the alkaloids and glucosides (quinine, strychnine, digitalis, colchicine). It has little action on cocaine, nicotine, muscarine, solanine, etc. It is inactive on atropine and other belladonna alkaloids and also on morphine.
  • Potassium permanganate: dissolve perfectly (so that no undissolved particles remain) 1 gram of finely pulverized potassium permanganate in 2 liters of water, if it is to be given by spoonfuls, or in 5 liters if it is to be used in gastric lavage. This antidote acts on many of the alkaloids. It also oxidizes phosphorus.

HOW DO YO PROVIDE THE FIRST AID FOR POISONING?

To know what to do and how do you provide the first aid for poisoning, you must take into account that the way to act is different depending on whether you know the poison or not. That is why below we indicate what the first aid is in case of poisoning in case you know the poison or not.

First aid for poisoning if you don't know the poison

  • Wash the stomach with a Faucher tube or its equivalent, using as a liquid, water to which an equal part of activated charcoal suspension has been added (20 grams per liter).

  • If there is no tube to wash the stomach or someone who can use it correctly, give by mouth water with an antidote added (for example, 20 grams of activated charcoal in a liter of water). Drink a glass of this liquid and try to induce vomiting. Save the vomit for analysis. Continue giving glasses of the liquid to induce vomiting.
  • If the above-mentioned antidotes are not available, use in the same way albuminous water (4 beaten egg whites in 1 liter of water), milk or both substances mixed.
  • Try to avoid shock by preventing the poisoned person from cooling down (blankets, etc.). If the patient's breathing is sedated, perform artificial mouth-to-mouth respiration. Give injections of coramine or cardiazol or mycoren.
It is important to mention that this treatment is temporary until the doctor or ambulance arrives, who will have to be called immediately as in any case of poisoning.

Faucher tube
Faucher tube, a tool widely used for gastric lavage in first aid in case of poisoning.

First aid for poisoning when the poison is known

When the poison that causes the poisoning is known, it is much easier to apply first aid since there is a well-established process in each case. That is why below we indicate what the first aid is in case of poisoning according to the poison.

    First aid for poisoning by acetanilides and other aniline derivatives

These poisons include acetanilide, aminopyrine, aniline dyes, antipyrine, phenacetin, aspirin, geniol, etc. The procedure is as follows:

  • Wash the stomach with animal or vegetable charcoal (activated or ultra charcoal), 20 grams in 1 liter of water. If you cannot wash the stomach, make the person vomit by giving the charcoal suspension in glasses. Instead of charcoal, sodium bicarbonate can be used.
  • Avoid cooling the poisoned person by keeping him or her in a warm bed.
  • Inject coramine, cardiazole or mycoren.
  • Try to eliminate part of the poison through the intestine by giving 30 grams of magnesium sulphate (if there is no depression).
  • It may be necessary to resort to oxygen and artificial respiration, and to the administration of serums if there is a lot of perspiration.

    First aid for poisoning by corrosive acids

The most common corrosive acids that cause poisoning are acetic acid, hydrochloric acid, nitric acid, muriatic acid, sulfuric acid, battery fluid, among others. First aid in these cases is:

  • Immediately give milk while looking for something to neutralize the acid. Neutralize the acid by giving water containing 30 grams of magnesium oxide per liter or lime water or milk of magnesia. If nothing else is available, use charcoal water (10 grams in 1 litre of water), chalk (precipitated chalk or calcium carbonate), sodium bicarbonate or ash.
  • If none of the above-mentioned elements are available, you can take a little plaster from a wall (which contains lime) and dissolve it in water to give to drink. Calcium carbonate and sodium bicarbonate produce a lot of gas that can dangerously distend the stomach at a time when its walls are weakened.
  • In the case of pure or slightly diluted sulphuric acid, it is advisable to give the neutralisers with a small quantity of milk or water, to avoid the violent reaction produced by contact with the water.
  • In general, it is advisable not to wash the stomach or induce vomiting. Once the acid has been neutralised, the compound formed is usually not dangerous.
  • Afterwards, treat the burns with oil, linseed water, strained cereal decoctions, egg white, etc.
  • Hydrate the patient with glucose and chloride serum. Avoid cooling. Give circulatory and respiratory stimulants, coramine, cardiazole, etc.
  • To reduce the risk of future esophageal strictures, the doctor often prescribes corticosteroids and antibiotics.

    First aid for caustic alkali poisoning

Caustic alkalis include potash or caustic soda, as well as soda lye, soda carbonate, potash lye, ammonia, limewash, etc.

  • Give the poisoned person milk immediately while you find something to neutralize the alkali with. Neutralize the alkali with diluted acids such as 100 grams of vinegar in 1 liter of water or the juice of several lemons or tartaric or citric acids.
  • The rest of the first aid for poisoning by caustic alkalis is the same as for poisoning by corrosive acids mentioned above.

    First aid for arsenic poisoning

Arsenic is present in many common rat and ant poisons. It is marketed under the name arsenious anhydride or arsenious acid. First aid for arsenic poisoning is:

  • Very thorough gastric lavage with plain water or water to which 30 grams of magnesia oxide or charcoal powder have been added per liter of water or 1% sodium hyposulfite solution. If gastric lavage is not possible, give these liquids by mouth and induce vomiting.
  • Give colloidal iron hydrate or sesquioxide or hydrated iron peroxide to ingest, which should be freshly prepared. They can be given in abundance. The way to prepare colloidal iron hydrate is as follows: dissolve 9 grams of ferric chloride in 1 liter of water. Place 24 grams of calcined magnesia in 1 liter of water in another container. At the time of use, mix a quarter of a liter of each of these liquids and shake.
  • Injections of BAL (British Antilewisite), in the same way as it is studied in poisoning with mercury bichloride. Its effect is very beneficial to neutralize the absorbed arsenic. When BAL is not available, injections of 10 to 20 cc of 20% sodium hyposulfite solution, intravenously, can help.
  • Combat dehydration (water loss) with serums. Treat the state of depression with heat, circulation and breathing stimulants.
  • Some recommend a purgative (despite the diarrhea caused by arsenic) to speed up the elimination of insoluble arsenic compounds. The same calcined magnesia that is given as an antidote will act as a purgative.

    First aid for atropine poisoning

  • Gastric lavage with water containing 30 grams of activated charcoal (Merck Ultra Charcoal) per liter, or 50 drops of iodine tincture per liter, or 4% tannic acid. As the mouth is very dry, it is necessary to lubricate the gastric lavage tube with oil or Vaseline. Induce vomiting, if there is no other means, do a gastric lavage.
  • If the alkaloids have not been ingested but rather the plants that contain them, give 30 grams of magnesium sulfate, so that they are eliminated as soon as possible.
  • For excitation: injections of sodium luminal or sodium amytal or sodium pentothal.
  • There is often bladder paralysis. If this occurs, do a catheterization. For discomfort caused by light, dark glasses or a dimly lit room.

    First aid for potassium cyanide poisoning

Potassium cyanide is present in hydrocyanic acid and its salts. As well as plants and seeds that produce hydrocyanic acid such as bitter almonds, bay leaves, cherry trees, etc.

First aid in case of potassium cyanide poisoning is:

  • Break an ampoule of amyl nitrite and have it inhaled by the poisoned person.
  • Meanwhile, someone quickly loads a syringe with 10 cc of 2% sodium nitrite solution, which is slowly injected intravenously.
  • Through the same vein and needle, or through another vein, inject 10 to 20 cc of a 30% sodium hyposulfite solution.
  • If there is no immediate reaction, give stimulants (coramine, cardiazole, etc.) and perform artificial respiration if the person is not breathing.
  • After 5 or 10 minutes, if necessary, the sodium nitrite and sodium hyposulfite injections can be repeated.
  • As soon as possible (after the injections have been given), wash the stomach with water or, better yet, with 1 gram of potassium permanganate and 20 grams of sodium bicarbonate in 5 liters of water, or with 5% sodium hyposulfite.
  • If the patient reacts, watch him closely for about 8 hours, since the accidents can be repeated due to absorption of the toxin in the intestine, in which case it is essential to repeat the nitrite and hyposulfite injections.
  • Give plenty of oxygen.

    First aid for cocaine poisoning

  • If the injection has been made into an extremity, place a loose tourniquet between the injection site and the heart. Release it for a few seconds every 20 minutes.
  • If cocaine has been ingested, wash the stomach with 20 grams of activated charcoal per litre of water, or alternatively with 50 drops of iodine tincture per litre.
  • Common emetics do not work because the stomach mucosa is anesthetised. If the route of penetration has been through the nose, wash the nasal mucosa with the charcoal suspension.
  • If there is very marked excitement, perform injections of sodium amytal, sodium pentothal or evipan. It has been recommended to inject gluconate or calcium chloride intravenously.

    First aid for phenol poisoning

Among the most common phenols are carbolic acid, creolin, antisamic fluid, creosote, cresols, lysols, etc.

First aid in case of phenol poisoning is described below:

  • Wash the stomach with a 1/5.0000 potassium permanganate solution (1 gram in 5 liters of water), which should be continued until the solution comes out the same color as when it entered. If there is no potassium permanganate, wash with water until the smell of phenol disappears.
  • After gastric lavage, give 60 grams of castor oil to dissolve the phenol without hastening its absorption. At the same time, it helps to evacuate any remaining toxin.
  • If there is no one who knows how to do a gastric lavage, activated charcoal or olive oil or cottonseed oil could be given.
  • If there is depression of respiration and pulse, give stimulants (coramine, cardiazole, etc.) and avoid cooling.
  • Give albumin water to somewhat soothe the burning and irritation of the mucous membranes. The doctor will probably prescribe other medications to slightly anesthetize the mucous membranes if they are painful.
  • Give serums by injection (saline and glucose). If there are skin burns with phenol, wash with alcohol.

    First aid for hydrocarbon poisoning

Hydrocarbon poisoning occurs when one is poisoned by petroleum, kerosene, naphtha, gasoline, benzine, etc., or any other derivative of petroleum activity.

When responding to a suspected victim of this type of poisoning, the appropriate first aid measures are:

  • The main first aid is fresh air. If necessary, mouth-to-mouth artificial respiration and inhalation of a mixture of 95% oxygen and 5% carbon dioxide. Injection of coramine or cardiazole, if there is depression of circulation or respiration.
  • If the amount ingested is very small, it may be enough to give a porridge prepared with one third of powdered milk and two thirds of water. Since the greatest danger is that kerosene passes into the respiratory tract, gastric lavage and even vomiting are generally avoided.
  • Give 50 grams of edible oil or mineral oil. When the doctor considers it necessary, he prescribes oxygen, corticosteroids and antibiotics to prevent injuries to the respiratory system.
  • Give 30 grams of magnesium sulphate as a purgative. If there is circulatory or respiratory depression, give coramine or cardiazole.

    First aid for mercury poisoning

  • While antidotes are being obtained, give the person water to which 4 egg whites have been added per liter.
  • Wash the stomach with water containing 550 grams per liter of sodium methanal sulfoxylate. This compound reduces mercury bichloride to metallic mercury and other nontoxic compounds.
  • If there is no tube for washing the stomach, give it to the person to swallow and then induce vomiting. If this product is not available, wash the stomach with albuminous water (4 egg whites well mixed in 1 liter of water), with milk or with a 10% solution of sodium hyposulfite.
  • Then perform an intramuscular injection of 2 1/2 to 5 milligrams of BAL for each kilo of the person's weight. Since the solution is 10%, for a person weighing 70 kilos the required amount would be 1.7 to 3.5 cc.
  • Repeat every 4 to 6 hours the lower dose, that is, 2 1/2 milligrams per kilo of weight.
  • Give chlorinated and glucose serums. Also coramine and cardiazole.
  • Treat irritation of the mouth and stomach as in the case of acid poisoning.
  • Feed on fruits, cereals and milk for a few days.

    First aid for morphine poisoning

  • Gastric lavage, even when the medicine has been administered by injection, since it is eliminated by the gastric mucosa. Gastric lavage will be done with a 1 in 5,000 potassium permanganate solution, or with a 20 per thousand activated charcoal suspension.
  • Give an intravenous or intramuscular injection of 5 cc of coramine. Also an enema to retain 500 grams of strong coffee infusion.
  • Give to ingest every quarter of an hour 1 tablespoon of a solution of 10 grams of sodium sulfate in a glass of water to which 1 teaspoon of charcoal has been added.
  • Try to keep the patient awake, by means of noises, lifting him, making him walk, helping him, etc.
  • If the patient is already in a coma, inject another 5 cc of intravenous coramine, avoid cooling and give an injection of 1 milligram of atropine sulfate.
  • If necessary, artificial respiration and inhalation of carbogen (a mixture of 95% oxygen and 5% carbon dioxide).
  • Monitor bladder emptying. Give a purgative to facilitate elimination of morphine.

    First aid for nicotine poisoning

  • Gastric lavage with water containing 50 drops of tincture of iodine per liter, or 20 grams of activated charcoal in the same amount of liquid. If there is no material with which to perform gastric lavage, induce vomiting. Tannic acid is not useful.
  • Avoid cooling the patient (blankets and external heat). Give coramine, cardiazole or mycoren.
  • If there is a tendency to suffocation, artificial respiration, sometimes for hours. If asphyxia causes cardiac depression, inject 1 milligram of adrenaline intramuscularly. Carbogen (95% oxygen and 5% carbon dioxide) to be inhaled.