quick and—except in cases of caustic orpetroleum distillate poisoning, or when anantiemetic has been ingested—can be usedin almost every situation when the victim isconscious. In most situations, a HospitalCorpsman will have access to syrup ofIpecac. This emetic acts locally by irritatingthe gastric mucosa and centrally bystimulating the medullary vomiting center inthe brain. The usual adult dose is 15-30 cc,and the dose for a child (age 1 to 12 years) is15 cc. The dosage should be followedimmediately by a glass of water. Mostpeople will vomit within 30 minutes. Theamount of stomach contents (and poison)recovered will vary. In an emergency room,the medical officer can rapidly inducevomiting by the injection of variousmedications. If nothing else is available,tickle the back of the victim’s throat withyour finger or a blunt object. This procedureshould induce vomiting.b. Trained personnel may use gastric lavage byitself or after two doses of Ipecac syrup hasfailed to induce vomiting. After passing alarge—caliber nasogastric tube, aspirate thestomach contents. Next, instill 100 ml ofnormal saline into the stomach, then aspirateit out again. Continue this flushing cycleuntil the returning fluid is clear. Gastriclavage is preferred when the victim isunconscious or—as in the case of strychninepoisoning—is subject to seizures.c. Activated charcoal (AC) adsorbs manysubstances in the gut and preventsabsorption into the body. After thesubstance is adsorbed to the AC, the boundsubstance moves through the gut and iseliminated with the production of acharcoal-black bowel movement. AC maybe administered after emesis or lavage, or itmay be used alone.d. A cathartic (magnesium sulfate or sorbitol)may be used to “speed” the movement of thebound substance and minimize absorption.4. Collect the vomitus for laboratory analysis.5. Soothe the stomach with milk or milk ofmagnesia.6. Transport the victim to a definitive care facilityif symptoms persist.CorrosivesAcids and alkalies (bases) produce actual chemicalburning and corrosion of the tissues of the lips, mouth,throat, and stomach. Acids do most of their damage inthe acidic stomach environment, while alkaliesprimarily destroy tissues in the mouth, throat, andesophagus. Stains and burns around the mouth, and thepresence of characteristic odors provide clues as to anacid or base ingestion. Swallowing and breathing maybe difficult, especially if any corrosive was aspiratedinto the lungs. Stridor, a high-pitched sound comingfrom the upper airway, may be heard. The abdomenmay be tender and swollen with gas, and perforation ofthe esophagus or stomach may occur.NEVERATTEMPT TO TREAT AN ACID OR BASEI N G E S T I O N B Y A D M I N I S T E R I N G ANEUTRALIZING SOLUTION BY MOUTH.GIVE WATER ONLY, UNLESS DIRECTED BY APOISON CONTROL CENTER (PCC) ORMEDICAL OFFICER. Monitor the ABC+D&Es,and watch for signs of shock.Examples of corrosive agents and sources ofcontact are listed in table 5-3.When providing treatment for the above poisons,DO NOT INDUCE VOMITING. The damage to themouth and esophagus will be compounded. Inaddition, the threat of aspiration during vomiting is toogreat. Gastric lavage could cause perforation of theesophagus or stomach. Therefore, use it only on adoctor’s order. First aid consists of diluting thecorrosive and keeping alert for airway potency andshock. If spontaneous vomiting occurs, administer anantiemetic.IrritantsSubstances such as automatic dishwasherdetergent, diluted ammonia, and chlorine bleach canproduce local irritation to the mucous membranes andpotentially cause mild chemical burns. The pH ofirritants may be slightly acidic or basic. If a person hasingested an irritant, direct the patient to spit the productout and rinse the mouth repeatedly with water. Spit therinse water out also. Do NOT administer anythingother than water unless directed by a PCC or medicalofficer.Petroleum Distillates or HydrocarbonsVolatile petroleum products (such as kerosene,gasoline, turpentine, and related petroleum products5-5
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