INTOXICATION AND POISONING

TOXIC AGENTS

Substances that, by chemical mechanisms, not mechanic, cause the intoxication effects. It is impossible to list all toxic substances, since some, when used correctly, are not harmful, but when used erroneously may become toxic (for example, alcohol).

The body exposure mechanisms are detailed on Chapter 12, ACCIDENT AND PROFESSIONAL ILLNESS PREVENTION.

The diagnosis is difficult, since a large amount of toxic substances do not cause characteristic symptoms and others cause similar symptoms to other diseases. Moreover, these symptoms will vary according to the amount of toxic agent that has entered the body.

It is important to trace the toxic that has caused the accident.

1. Intoxication by ingested substances (digestive tract)
   
   They vary in their treatment as well as in their symptoms, according to the kind of toxic that has been ingested. The following table shows the four kinds of poisons (which include a large number of substances), which may enter the body through the mouth, and the main symptoms they may cause
   
   GROUPS OF TOXIC SUBSTANCES VIA DIGESTIVE TRACT




GROUP A

CORROSIVE SUBSTANCES	(acids —sulphuric, chlorhidric...—; Bases —bleach, ammonia…-; phenols, etc.)
SYMPTOMS: BURNING PAIN IN MOUTH, THROAT, OESOPHAGUS AND STOMACH.	Nausea and vomiting. Destroyed and bleeding areas in mouth.
	There may be: Voice loss. Difficulty swallowing and even breathing. Fever. The individual shows an anxious expression.




GROUP B

STIMULATING SUBSTANCES	(strychnine, camphor, chloride)
SYMPTOMS:	Dry and warm skin. Fits, spasms. Asphyxia feeling and difficulty breathing. Fast pulse. Pupil dilation or contraction.




GROUP C

IRRITATING SUBSTANCES	(Iodine, phosphorus, arsenic, zync chloride, potasium nitrate, etc.)
SYMPTOMS:	Nausea Abdominal pain, like colic Blood may appear in vomit and faeces




GROUP D

DEPRESSIVE SUBSTANCES	(barbiturates, alcohol, alkaloids - atropine, morphine…- and many local anaesthetics)
SYMPTOMS:	May start with a short stimulant effect and, later on, the opposite appears: Stupor. Reduction of respiratory movements. Muscle relaxation. Contracted or dilated pupils. Moist and cold skin.





Management of intoxication by ingested substances:

1. Once we are convinced that there is an intoxication, we should try to identify the poison.
2. Quickly try to remove most part of the poison from the stomach by inducing vomiting.
   
   NEVER INDUCE VOMITING IN CASE OF INTOXICATION BY:
   
   
   
   • CORROSIVE SUBSTANCES (acids and bases, such as bleach or ammonia).
   • OIL DERIVATIVES.
   • STRYCHNINE.
   • INTOXICATED PATIENTS WHO ARE UNCONSCIOUS OR HAVE FITS.
   
   
3. Give large quantities of abdominal absorbent and after induce vomiting, repeating the procedure every ten minutes as long as we still suspect that the toxic substance still remains in the stomach.
   
   The intestinal absorbent in the first aid kit is ACTIVATED CARBON, which is provided in two ways:
   
   
   • As tablets (DRAWER 2, first aid kits A and B). Give 2 to 6 tablets, repeating every hour, if necessary (up to 24 tablets / day). Must be swallowed with some water (do not use other drinks, such as coffee, tea, or ice cream or sherbets).
   • As a powder (ANTIDOTE SUPPLIES FOR SHIPS CARRYING DANGEROUS SUBSTANCES ON BOARD - GENERAL ANTIDOTES). Give 1 gr. / kg. weight in 200 ml. of water, continue with 20 to 25 gr. every 4 hours, for 24 hours.
   
   As a household alternative, mix:
   
   
   • PULVERISED BURNT BREAD.
   • MILK OF MAGNESIA (OR SODIUM BICARBONATE).
   • CONCENTRATED TEA.
   
   The adult dose is 15 gr. of the three ingredients mixed and diluting them in water until a clear paste forms, which is given orally.



4. Give an emollient: Every time the victim vomits, administer two raw egg whites or milk.
   
   IF THE INTOXICATION IS CAUSED BY PHOSPHORUS, MILK IS ABSOLUTELY COUNTER INDICATED.



5. If the toxic agent is CORROSIVE, give the emollient between each activated carbon dose (NEVER INDUCE VOMITING).



6. After removing the toxic agent from the stomach give a sodium lauryl sulphate + sodium citrate ampoule (DRAWER 2, first aid kits A and B) rectally and large amounts of water orally.
   
   NEVER GIVE LAXATIVES IN CASE OF:
   
   
   • INTOXICATION BY CORROSIVE AGENTS.
   • IF THE INTOXICATED VICTIM SUFFERS GASTROENTERITIS (as in the case of food poisoning).
   
   
7. Always ask for MEDICAL ADVICE VIA RADIO .


2. Intoxication by inhaled substances
   
   
   • Move the victim from the toxic atmosphere to a well-ventilated and warm place.
   • Check for respiratory arrest. In such case, manage according to Chapter 1.2.
   • Remove contaminated clothing.
   • Give oxygen if available on board (MATERIAL OUTSIDE DRAWERS, first aid kits A and B). Refer to Chapter 6.8, OTHER NURSING PROCEDURES.
   • In intoxications by ammonia, place a handkerchief damped in vinegar close to the nose. If after a while breathing the vapours there has been no improvement, remove the handkerchief.
   • Ask for MEDICAL ADVICE VIA RADIO .
   
   
3. Intoxication through the skin
   
   Remove the toxic as soon as possible following these instructions:
   
   
   1. Remove all clothing that has been in contact with the toxic substance.
   2. Wash vigorously: the skin and mucosa are preferably washed with plain water or abundant saline solution. In the case of skin, soap may be used.
      
      DO NOT USE NEUTRALIZING AGENTS OR ANTIDOTES.
   
   
   
   3. In eye lesions by toxic agents, especially with corrosives: open well (keeping eyelids separate) and wash continuously and abundantly with large amounts of water (refer to Chapter 2, picture 2-8). After that, give ophthalmic ointment (DRAWER 7, first aid kits A and B) or a few drops of clean olive oil and cover.
      
      
      

      Picture 7-116: Giving ophthalmic ointment.

   
   
   4. Ask for MEDICAL ADVICE VIA RADIO .
   
   
4. Intoxication by inoculation or sting
   
   In case of animal poisons refer to Chapter 7.10, ANIMAL WOUNDS.
   
   ANTIDOTES
   
   If the ship carries dangerous substances (listing on APPENDIX, Chapter 5.4), it is compulsory to carry on board an ANTIDOTE SUPPLY FOR SHIPS CARRYING DANGEROUS SUBSTANCES ON BOARD. It contains a list of GENERAL ANTIDOTES, which must be carried on board all ships carrying dangerous substances, regardless of their nature (refer to list of General Antidotes on Chapter 5.2), and SPECIFIC ANTIDOTES, according to the dangerous substance that is being carried (refer to table).




SPECIFIC ANTIDOTES

ACTIVE COMPOUND	PRESENTATION	AMOUNT	DANGEROUS SUBSTANCE
DIMERCAPROL	100 mg. vial	20 vials	Intoxications by: Arsenic and derivatives Chlorine arsine Mercury and derivatives Carbonyl Lead and derivatives Copper and derivatives
AMYL NITRITE	Ampoules to inhale	2 units	Intoxications by: Cyanide Nitriles Hydrogen sulphide Hydrogen cyanide Halogen cyanides
CALCIUM GLUCONATE 2%	25 mg. cream	2 units	Intoxications by: Oxalates Fluorine and fluorides
ETHYLENE BLUE 1%	Oral ampoules 10 ml.	10 ampoules	Intoxications by: Nitrates and nitrites Aromatic amine and nitrate derivatives Chlorate, perchlorate and bromates
ASCORBIC ACID	500 mg. tablets	2 containers	Intoxications by: Nitrates and nitrites Aromatic amine and nitrate derivatives Chlorate, perchlorate and bromates
	5 ml for injection	1 container
ETHYL ALCOHOL 10%	500 ml. solution	2 containers	Intoxications by: Methyl alcohol (methanol) Anti freezing agent (ethylene glycol)
CHLOR- PHENIRAMINE	10 mg. ampoules	1 container	Intoxications by: Methyl sulphate Ethyl sulphate
ATROPINE SULPHATE	1 mg. ampoules10 ampoules	1 container	Intoxications by: Phosphorus and carbamate based organicpesticides Nicotina y sus compuestos
POLYEYI- LENGLYCOL Molecular weight 300	1 litre jar	1 litre	Intoxications by: Phenols Nitro phenols Picrates

BEFORE USING ANY MEDICATION, PLEASE REFER TO THE
«COUNTER INDICATIONS, SIDE EFFECTS AND INTERACTIONS»
LIST (see Chapter 5.2)

Moreover, these ships must carry the FIRST AID GUIDE FOR ACCIDENTS RELATED TO DANGEROUS GOODS (GDGA), edited by the International Maritime Organization, where all information for each chemical substance may be found individually (with signs, symptoms and treatment).

Picture 7-117.