quick andexcept in cases of caustic or
petroleum distillate poisoning, or when an
antiemetic has been ingestedcan be used
in almost every situation when the victim is
conscious. In most situations, a Hospital
Corpsman will have access to syrup of
Ipecac. This emetic acts locally by irritating
the gastric mucosa and centrally by
stimulating the medullary vomiting center in
the brain. The usual adult dose is 15-30 cc,
and the dose for a child (age 1 to 12 years) is
15 cc.
The dosage should be followed
immediately by a glass of water.
Most
people will vomit within 30 minutes. The
amount of stomach contents (and poison)
recovered will vary. In an emergency room,
the medical officer can rapidly induce
vomiting by the injection of various
medications. If nothing else is available,
tickle the back of the victims throat with
your finger or a blunt object. This procedure
should induce vomiting.
b. Trained personnel may use gastric lavage by
itself or after two doses of Ipecac syrup has
failed to induce vomiting. After passing a
largecaliber nasogastric tube, aspirate the
stomach contents. Next, instill 100 ml of
normal saline into the stomach, then aspirate
it out again. Continue this flushing cycle
until the returning fluid is clear. Gastric
lavage is preferred when the victim is
unconscious oras in the case of strychnine
poisoningis subject to seizures.
c. Activated charcoal (AC) adsorbs many
substances in the gut and prevents
absorption into the body.
After the
substance is adsorbed to the AC, the bound
substance moves through the gut and is
eliminated with the production of a
charcoal-black bowel movement. AC may
be administered after emesis or lavage, or it
may be used alone.
d. A cathartic (magnesium sulfate or sorbitol)
may be used to speed the movement of the
bound substance and minimize absorption.
4. Collect the vomitus for laboratory analysis.
5. Soothe the stomach with milk or milk of
magnesia.
6. Transport the victim to a definitive care facility
if symptoms persist.
Corrosives
Acids and alkalies (bases) produce actual chemical
burning and corrosion of the tissues of the lips, mouth,
throat, and stomach. Acids do most of their damage in
the acidic stomach environment, while alkalies
primarily destroy tissues in the mouth, throat, and
esophagus. Stains and burns around the mouth, and the
presence of characteristic odors provide clues as to an
acid or base ingestion. Swallowing and breathing may
be difficult, especially if any corrosive was aspirated
into the lungs. Stridor, a high-pitched sound coming
from the upper airway, may be heard. The abdomen
may be tender and swollen with gas, and perforation of
the esophagus or stomach may occur.
NEVER
ATTEMPT TO TREAT AN ACID OR BASE
I N G E S T I O N
B Y
A D M I N I S T E R I N G
A
NEUTRALIZING SOLUTION BY MOUTH.
GIVE WATER ONLY, UNLESS DIRECTED BY A
POISON CONTROL CENTER (PCC) OR
MEDICAL OFFICER. Monitor the ABC+D&Es,
and watch for signs of shock.
Examples of corrosive agents and sources of
contact are listed in table 5-3.
When providing treatment for the above poisons,
DO NOT INDUCE VOMITING. The damage to the
mouth and esophagus will be compounded.
In
addition, the threat of aspiration during vomiting is too
great. Gastric lavage could cause perforation of the
esophagus or stomach. Therefore, use it only on a
doctors order.
First aid consists of diluting the
corrosive and keeping alert for airway potency and
shock. If spontaneous vomiting occurs, administer an
antiemetic.
Irritants
Substances such as automatic dishwasher
detergent, diluted ammonia, and chlorine bleach can
produce local irritation to the mucous membranes and
potentially cause mild chemical burns. The pH of
irritants may be slightly acidic or basic. If a person has
ingested an irritant, direct the patient to spit the product
out and rinse the mouth repeatedly with water. Spit the
rinse water out also. Do NOT administer anything
other than water unless directed by a PCC or medical
officer.
Petroleum Distillates or Hydrocarbons
Volatile petroleum products (such as kerosene,
gasoline, turpentine, and related petroleum products
5-5