Chapter Eight

Poisoning

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 1 School of Nursing and Midwifery.
 Learning Objectives
At the end of this lesson the student will be able to
►Define poison and poisoning
►Identify different causes of poisoning
►Explain signs and symptoms of poisoning
►Give first aid for different types of poisoning
►Give first aid for bites(stings)

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 2 School of Nursing and Midwifery.
 Poisoning
A poisons
►are any substances (solid, liquid or gas) that tends to
impair health or cause death when introduced in to the
body or on to the skin surface
Poisoning can
►occur accidentally or non accidentally (self poisoning)
►90% of accidental poisoning occur within the home.

80% of poison victims were under 5yrs children

►Mortality is also highest in the 1-5yr age group.

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 3 School of Nursing and Midwifery.
 Cont’d…
Poisoning - can be swallowed, inhaled, injected or
absorbed through the skin.
►Ingestion is commonest (77%) route of exposure

Approximately 50% of cases involve nondrug

substances
►common household products (cosmetics, cleaning
solutions, plants, foreign bodies, hydrocarbons).

Common causes of poisoning in our setup are

►rat poisons (intentional in adolescents or unintentional in
children), hydrocarbons s. a. kerosene, improperly placed
drugs , cosmetics etc.
First Aid and Accident prevention © 2017, Jimma University
By:- Shemsedin Amme (BSc / MSc)) 4 School of Nursing and Midwifery.
 Causes of poisoning
Carelessness –
►leaving agents within reach of children
 Most drug containers easy to open and do not have a
child lock
►many pediatric drug preparation are sugar coated or
sweetened and may be mistaken for sweets.
Illiteracy –
► Inadequate labeling of drugs and chemicals
Over doses of drugs
►taken either accidentally or with suicidal intent
Accessibility of the agent -
►Children of health workers

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 5 School of Nursing and Midwifery.
 Cont’d…
Over doses of drugs
►taken either accidentally or with suicidal intent
►administration of the wrong drug or wrong dose;
►combining some drugs and alcohol

Accessibility of the agent

►Children of health workers or siblings of children on
chronic treatment

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 6 School of Nursing and Midwifery.
 Classifications
May classified based on
►Causes of poisoning
►Types of poisoning agents
►Route of exposure
►Nature (chemical) poisons
►Occurrence –
 Unintentional vs intentional,
 accidentally or with suicidal intent

Poisoning agents are usually household agents,

medicaments and plant material

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 7 School of Nursing and Midwifery.
 Types of poisoning agents
Poisons Descriptions Agents

Man- found in the home - chemicals such as bleach, cosmetics

made and industry. & hair preparations, paint stripper
poisons (glue), & pesticides.
- OTC drugs
- Acids, Ammonia, Glue, Dry cell, DDT,
and Malathine etc.
- Gasoline, and kerosene petroleum
products.
Natural Products of plants, Poisonous plants -Non edible
poisons insects, animals, mushrooms
and Snake venoms
bacteria poisons

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 8 School of Nursing and Midwifery.
 Routes of Exposure
Ways in which poisoning may occur includes
1. Through the mouth (by ingestion)- Most poisoning
happens this way
2. Through the skin (by absorption)
3. Through the lung (by inhalation)
4. By injection –include biting

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 9 School of Nursing and Midwifery.
 Poisoning by Ingestion
whether or not a victim has swallowed poison
determine from
►Information by the victim/from an observer.
►Presence of known poison container
►Conditions of the victim (sudden pain/illness)
►Burns around the lips or mouth.
►Breathe odor
►Pupils of the eyes contracted to pinpoint size (opoid
overdose)

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 10 School of Nursing and Midwifery.
 Sign and symptoms of poisoning
Five key signs for swallowed poisons;
►Nausea and vomiting (sometimes blood-stained)
►Cramping stomach pains
►A burning sensation
►Partial loss of responsiveness
►Seizures
Signs of a life threatening condition - any of these;
►sleepiness, seizures, difficulty of breathing, and vomiting
►activate the EMS immediately if the patient exhibits any of
the se.

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 11 School of Nursing and Midwifery.
 Signs of poisoning
10 common signs for drug poisoning
►Stomach pain, nausea and vomiting
►Shaking hands
►Sleepiness leading to unresponsiveness
►Hallucinations ‒ claim to 'hear voices' or 'see things'
►Confusion and deliriousness
►Unusually slow or fast pulse
►Excitable hyperactive behavior
►Unusually small or large pupils
►Sweating
►Needle marks which may be infected

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 12 School of Nursing and Midwifery.
 First aid for ingested poisons
The objectives of first aid is:
►to dilute the poisons quickly as possible.
►to seek medical advice
►to maintain respiration or circulation.
►to preserve vital functions and to seek medical assistance
without delay.

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 13 School of Nursing and Midwifery.
 First aid for swallowed poisons
If the person is conscious, ask them
►what they have swallowed,
►how much and when.
►look for clues, like plants, berries or empty packaging and
containers.

Call for medical help and give information as

possible. About age, amount, type, and how long
ago ingested

Keep checking of breathing, pulse and level of

response.

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 14 School of Nursing and Midwifery.
 First aid for swallowed poisons
Dilution or inducing vomiting
►Evidences are insufficient
►Only for conscious victims

Dilution with milk or water

►Give him a drink of tepid water with soap in it.
►Continue inducing vomiting until it become clear

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 15 School of Nursing and Midwifery.
 First aid ….
Do not induce vomiting
►if the poison is one which burns or if it is petrol or
kerosene. Instead, give milk with egg or a mixture of whites
flour and water.
If the victim vomits
►save a sample of the vomited material into a bag or
container for analysis to identify the poison
If Become unresponsive
►Check ABC and do CPR.
►don’t give fluids or try to induce vomiting
►if vomiting - position with turning the head

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 16 School of Nursing and Midwifery.
 First aid …
NB;
Take care of victims of severe poisons (e.g rat poison)
Do not leave the victim alone.
Never administer -
vomit inducing syrups (e.g Epicac syrups) or
activated charcoal if you don’t know to do so

Prevention of Re-exposure
 Adult - education
 Child- proofing
 Notification of regulatory agencies & psychiatric referral

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 17 School of Nursing and Midwifery.
 Alcohol intoxication
First Aid Interventions
►Observe for convulsions or hallucinations it may indicate
an acute complications of withdrawal
►Assess patient’s support system and consider possible
referral options. When become sober assess interest in
detoxification program
NB ;
►Policies of CPR and activation of any emergency protocol
still apply.
►Call for help, and Position on side to prevent aspiration
►Protect patient from injury and orientate patient as
arousal occurs
First Aid and Accident prevention © 2017, Jimma University
By:- Shemsedin Amme (BSc / MSc)) 18 School of Nursing and Midwifery.
 Prevention of ingested poisoning
1. Safe storage of drugs and household agents, out of
reach of children and preferably under lock
2. Safe packaging of drugs and chemicals in
unattractive colors in child safe containers.
3. Containers of food and beverages should not be
used to store drugs or harmful chemical agents.
4. Health workers should give health education on safe
use of drugs dispensed to patients.
5. Unused medication should be disposed of.
6. Chemicals and drugs should be clearly labeled with
the pharmacological or chemical names.

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 19 School of Nursing and Midwifery.
 2) Contact poisoning
Chemical skin contact ??
Eye exposure???

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 20 School of Nursing and Midwifery.
 3). Poisoning by Bites
The bite of any animal or a pet may result in an open
wound.
►May cause punctures, lacerations or avulsions.
►Dog and cat bites are common,
►Have a danger of infection such as Tetanus and
►Rabies- is a viral infection which can be transmitted from
infected animals such as dogs and cats to human being.
Human bite
►May break the skin, and become seriously infected
because many bacteria exist in the mouth.

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 21 School of Nursing and Midwifery.
 First aid for bites
Rapid primary assessment and commence BLS if
required
►Irrigate animal bites with copious amounts of water.
►It has been shown to prevent rabies and bacterial infection
from animal bites.
►Call and Contact medical help

Human bite
►Cleanse the wound thoroughly with clean water, dry, cover
it and seek medical attention.

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 22 School of Nursing and Midwifery.
 First aid …
Dog and other animal bites
►Irrigate wound thoroughly with soap and water, flush the
bitten area.
►m avoids movement of the affected part until a victim
receives the medical care.
►Refer to health institution
►All animal bite wounds are not recommended to be
sutured and dressed.

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 23 School of Nursing and Midwifery.
 First aid …
A bite on the face or neck should receive immediate
medical attention, because of the proximity to brain.
Do not kill the animal unless necessary.
Keep the animal under observation if possible at
least for 10 days.

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 24 School of Nursing and Midwifery.
 4. Snake bites
is aggravated by acute fear and anxiety
Factors affecting outcomes of snake bites are
►the amount of venom injected,
►the speed of absorption to the victim circulation,
►time to access to specific anti venom therapy ASP

the speed of absorption of the venom depends on

►the size of the victim,
►location of the bite, and
►protection from clothing shoes and gloves …

Do all kinds of snakes are poisonous?

First Aid and Accident prevention © 2017, Jimma University
By:- Shemsedin Amme (BSc / MSc)) 25 School of Nursing and Midwifery.
 Highly poisonous types of snakes

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 26 School of Nursing and Midwifery.
Signs & symptoms of snake envenomation
Local signs:
►Puncture marks (not always visible), &
►Oedema
►Petechiae (non-blanches)
►Bruising
►Sites may NOT be painful
►May no signs at all

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 27 School of Nursing and Midwifery.
 Systemic envenomation signs
mainly systemic envenomation signs includes
►Signs of bleeding
 gums or nose bleed .
►Neurologic sign
 ptosis, confusion, and
 note any paralysis of limbs

At < 1hr after bite

►Vomiting, Headache, Sweating
►transient hypotension,
►confusion or unconsciousness

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 28 School of Nursing and Midwifery.
 Systemic signs …
 1-3hrs After bite  Over 3hrs:
►ptosis, double vision, ►paralysis of limbs
voice changes
►loss of respiratory muscle
►difficulty in swallowing function
►Confusion ►hypoxia
►abdominal pain ►cyanosis
►dark urine ►shock
►haemorrhage ►myolysis (muscle
►Hypertension, weakness, pain on
►tachycardia movement and dark urine)

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 29 School of Nursing and Midwifery.
 Snake bites…
NB : -
►Snakebites are not necessarily painful, whereas spider
bites usually are
►Most of snakes cause an asymptomatic coagulopathy,
while the patient feels OK.
►In all cases of large envenomation the victim will be
critical in minutes rather than hours
►

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 30 School of Nursing and Midwifery.
 First Aid Interventions
Objectives of first aid
►To reduce the circulation of blood through the bite area
►To delay absorption of venom.
►To prevent aggravation of the local wound and to sustain
respiration

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 31 School of Nursing and Midwifery.
 First aid for Snake bites
Principles of the first interventions includes
►Conduct RAPID primary ASSESSMENT, Call and Consult
EMS
►Reassuring –
 Keep CALM and as STILL, movement will promote
the movement of venom into the bloodstream.
►Delay venom movement
 pressure immobilization bandage (PIB) and
 splinting limb
►Refer to hospital ASP
►Continue monitoring

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 32 School of Nursing and Midwifery.
 Pressure immobilization bandage (PIB).
It is effective and safe way to slow the spreading of
venom by slowing lymph flow.
►Apply PIB immediately with adequate pressure around the
entire length of the bitten extremity
►Mark puncture site outside PIB and do not release PIB
until reaches full medical facility.
►Observe for compromised circulation
The PIB pressure
►is sufficient if the bandage is comfortably tight and snug
but allows a finger to be slipped under it.
►Inadequate  is ineffective
►Too much  cause tissue damage
First Aid and Accident prevention © 2017, Jimma University
By:- Shemsedin Amme (BSc / MSc)) 33 School of Nursing and Midwifery.
 Snake bites ...
Do not apply suction as first aid for snakebites.
►Suction does remove venom, since the amount is very
small and may also aggravate the injury
►Do not wash the area of the bite

Avoid any movement –

►as it will promote the movement of venom into the
bloodstream.
Do not take off clothing
Bandage can be left in place for longer if required

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 34 School of Nursing and Midwifery.
 Snake bites ...
Refer to hospital ASP
►All people with snake bite or suspected snake bites should
be admitted and observed
Continue monitoring level of consciousness and
►for respiratory failure (usual cause of death, & carry out
BLS as required) and
►for signs of systemic envenomation.

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 35 School of Nursing and Midwifery.
 Snake bites ….
Snake bites to lower limb
►Bandage upwards from the lower portion of the bitten limb.
►The bandage should be as tight as you would apply to a
sprained ankle
►Extend the bandage as high as possible up the limb

Or Splint Immobilization-

►Any rigid object may be used as a splint,
►Bind it firmly to as much of the leg as possible
►Lie the patient down to prevent walking or moving around.
 Keep the patient still

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 36 School of Nursing and Midwifery.
 Snake bites …
Bites to the hand or forearm
►Bandage as much of the arm, starting at fingers
►Use a splint to the elbow
►Use a sling to immobilize the arm
►Keep the patient still
Bites to the trunk
►If possible apply firm pressure over the bitten area. Do no
restrict chest movement. Keep the patient still
Bites to the head or neck
►No first aid for bitten area. Keep the patient still

First Aid and Accident prevention © 2017, Jimma University

By:- Shemsedin Amme (BSc / MSc)) 37 School of Nursing and Midwifery.