Table 4-7.Sources of inhalation poisoning
Sources of Contact
Wells and sewers
Fires, lightning, heating
and fuel exhausts
Solvents in dry cleaning
fluid, electrical equip-
agents, and fire extin-
Tear, nerve, blister, and
vomiting gases, screen-
ing smokes, thermite and
acid, and other systemic
Ice making and refrig-
Some substances may cause tissue irritation
or destruction by contact with the skin, eyes, and
lining of the nose, mouth, and throat. These
substances include acids, alkalies, phenols, and
some chemical warfare agents. Direct contact with
these substances will cause inflammation or
chemical burns in the affected areas. Consult the
Chemical Burns section of this chapter and the
Chemical Agents section of chapter 12 of this
manual for treatment.
Injection of venom by stings and bites from
while not normally life-
threatening, can cause an acute allergic reaction
that can be fatal. Poisons may also be injected
by snakes and marine animals.
Bee, Wasp, and Fire Ant Stings
Stings from bees, wasps, and ants account for
more poisonings than stings from any other in-
sect group. Fortunately, they rarely result in
death. The vast majority of stings cause a minor
local reaction of pain, redness, itching, and swell-
ing at the injection site. These symptoms usually
fade after a short time.
A small percent of these stings cause a severe
anaphylactic reaction, presenting itching, swell-
ing, weakness, headache, difficulty in breathing,
and abdominal cramps. Shock may follow quickly
and death may occur. The following first aid
measures are recommended:
1. Closely monitor vital signs and remove all
rings, bracelets, and watches.
2. Remove stingers by scraping with a dull
knife (pulling forces venom remaining in
the sac into the wound).
3. Place an ice cube or analgesic-corticost-
eroid lotion over the wound site to relieve
4. For severe reactions, apply a constricting
band above the injured site at the edge of
the swelling. Advance it as needed.
5. For severe allergic reactions, immediately
give the victim a subcutaneous injection of
1:1000 aqueous solution of epinephrine.
Dosage ranges from 0.2 to 0.3 cc for
children to 0.5 cc for adults.
6. Patients with severe allergic reactions
should be evacuated to a medical facility.
The only North American scorpion of medical
importance is the Centruroides sculturatus found
in Mexico and certain areas of the American
Southwest. Its sting causes severe pain and some
weakness in the affected area. It may also cause
vomiting, visual disturbances, and circulatory and
respiratory depression. In some cases, a state of
excitability may occur, with muscle spasms, and
in severe cases, progression to a comatose state.
The following first aid treatment should be given
for scorpion stings:
1. Place ice over the sting site.
2. Morphine and meperidine hydrochloride
are contraindicated as they potentate the
3. Calcium gluconate 10 percent may be given
intravenously to relieve muscle spasms.
4. Valium maybe used to control excitability