toxicity (such as acetaminophen), most ingestedpoisons produce signs and symptoms in less than 4hours, and most efforts to decontaminate the gut(remove an ingested poison) have little value morethan 1 hour after ingestion.In acute poisonings, prompt treatment is indicated.After the patient has been evaluated and stabilized,general poison management can be initiated. There aresix steps in the initial evaluation and follow-on poisonmanagement:1. Stabilization, which consists of a briefevaluation and assessment directed towardidentifying the measures required to maintain lifeand prevent further deterioration of the patient.Observe the ABC + D & E (Drug-inducedcentral nervous system (CNS) depression,and undressing/uncovering to Expose thepatient for disabilities (injuries) to ensureareas of contact or exposure to a chemicalcan be seen.)Check the pupils for size and reactivity tolight, and do a basic neurologic exam.Administer oxygen as needed, IV line forfluids.Watch for signs and symptoms ofanaphylaxis.2. Evaluation, which must be performed once thepatient is stabilized.Include a full history, physical exam, andordering of appropriate tests (i.e., labs, EKG,x-rays) directed toward identification oftoxic agent, evaluating the severity of toxiceffects, and searching for trauma andcomplications.Periodically reassess the patient. Look forchanges. Monitor vital signs, urine output,and cardiac rhythm.Record your findings (including time), andrespond to important changes appropriately.3. Prevention or limitation of absorption,through skin decontamination, flushing of eyes,ventilation, stomach emptying, administrationof charcoal and cathartics, and whole bowelirrigation.4. Elimination enhancement, through seriallyadministered activated charcoal, ion-trapping(pH adjustment of the urine to promoteexcretion of certain poisons), hemodialysis, andhemoperfusion (similar to hemodialysis, butused for larger size molecules).5. Administration of specific antidotes.Lessthan 5 percent of poisons have specificantidotes. All patients who present shouldreceive glucose, thiamine, and naloxone.Consider supplemental oxygen.6. Continuing care and disposition, including aperiod of observation and education (i.e., poisonprevention) or psychiatric counseling.Establish follow-up.THE DIAGNOSIS OF POISONINGIn most situations, the treatment of a poisoningvictim will be under the direction of a medical officer.However, in isolated situations, a Hospital Corpsmanmust be ready to treat the victim.Poisoning should be suspected in all cases ofsudden, severe, and unexpected illness. You shouldinvestigate such situations by ascertaining, as quicklyand thoroughly as possible, the answers to thefollowing questions:What are the signs and symptoms of the illness?What was happening before the illnessoccurred? (Remember, there may have been achronic exposure over time with the signs andsymptoms just becoming apparent.)What substances were in use? Could more thanone substance have been involved?Is there a container of the suspected substance?If so, how much was there initially, and howmuch is there now? (If possible, bring thecontainer to the treatment facility. The label willoften identify the contents and the recommendedprecautions and treatment. The label may alsolist a contact number for emergency advice.Remember, though, that other people—including you—may become contaminatedthrough contact with the container. Handle itcarefully.)What was the duration of exposure? When did ithappen?What is the location of the bite or injury (ifapplicable)?Has this happened before?5-2
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