and operate on a 24-hour a day basis. Every medical facility should make an attempt to use the services of the poison control center contiguous to its activity.
The basic procedure is as follows:
1. Remove the bulk of the poison out of the stomach quickly. Removal of the poison from the stomach may be accomplished by the use of emetics and by washing out the stomach through use of a stomach tube.
2. Administer an antidote for the remainder of the poison left in the stomach.
3. Eliminate from the system that portion of the poison that has been absorbed.
4. Treat the symptoms as they arise.
5. Take possession of all foods, medicines, vomitus, feces, urine, and anything that may be of value in determining the identity of the poison and whether taken accidentally or intentionally, or criminally administered.
Cases of poisoning are frequently encountered where the services of a physician or poison control center are unavailable. In these cases, it often happens that it is impossible to obtain much or any information relative to the nature or type of poison taken. Since any delay in treatment may result in serious consequences, every hospital corpsman should possess some practical knowledge of how to manage a poisoning case when the nature of the poison is unknown.
For the purpose of general treatment in unknown poisons, the case may be considered as one of two kinds. It may either be a case in which the local effects of the poison have injured the mucous lining of the mouth, esophagus, and stomach to an extent contraindicating the use of instruments or emetics for evacuating the stomach or it may be a case where the poison has had little or no effect on the mucous lining of the alimentary tract and therefore one in which it would be safe to use a stomach tube or an emetic.
Poisonings coming under the classification of corrosives generally produce conditions such as mentioned in the first instance. They have a more or less injurious and even destructive effect on the lining of the mouth and stomach. Naturally, in such cases the introduction of any sort of instrument, even a soft rubber stomach tube, may result in a perforation in the weakened wall. In such 7-34 conditions, rupture of the stomach maybe caused by emesis. Poisons classified as irritants and neurotics generally have no special local or injurious action on the mouth and the stomach and therefore in such cases the stomach may be evacuated and washed with the aid of a stomach tube. In the absence of a stomach tube, emetics may be used without fear of injury.
In cases where there are no signs of injury to the lining of the mouth, the probabilities are that the poison is one of the irritants or neurotoxins; that is, the poison may be a salt of one of the poisonous metals, such as arsenic, mercury, or silver. It may be one of the crude drugs, such as opium, belladonna, or perhaps one of their many alkaloids, the most common of which are morphine, codeine, heroin, atropine, and strychnine.
There are many drugs that produce nausea and vomiting, but the number that may be used intentionally to cause a patient to vomit is relatively small. Vomiting may be stimulated by gagging or stroking the throat with the finger or a tongue depressor when the stomach is full of liquid. When an emetic is required, the following may be considered:
Hospital corpsmen handling controlled substances and other drugs are held responsible for their proper distribution and custody. Nowhere is the demand for strict integrity more important. Misuse, abuse, loss, and theft of these substances has always, sooner or later, ended in tragedy and severe consequences. No one has ever profited by their misappropriation.