IV. Patient Assessment A. Scene size-up 1. Scene safety a. A well-trained dispatcher is of great value to determine: i.

Num er of patients involved ii. !hether additional resources are needed iii. !hether trauma is involved . If this information is not o tained efore your arrival" you must assess the scene thoroughly to ensure your own safety and to determine: i. Nature of illness#mechanism of in$ury ii. Num er of patients involved iii. Need for additional resources iv. !hether spine sta ili%ation is re&uired c. 'se the appropriate personal protective e&uipment to avoid eing contaminated. (. )echanism of in$ury#nature of illness a. *he dispatcher may give important information a out a poisoning call. . If this information is not o tained efore your arrival" loo+ for clues and as+ yourself the following &uestions: i. Are there medication ottles lying around the patient and the scene, If so" is there medication missing that might indicate an overdose, ii. Are there alcoholic everage containers present, iii. Are there syringes or other drug paraphernalia on the scene, iv. Is there an unpleasant or odd odor in the room, If so" is the scene safe, v. Is there a suspicious odor and#or drug paraphernalia present that may indicate the presence of a drug la oratory, B. Primary assessment 1. -orm a general impression. a. . tain a general impression of the patient. . Assess his or her level of consciousness. c. /etermine any life threats. d. /o not e fooled into thin+ing that a conscious" alert" and orientated patient is in sta le condition. (. Airway and reathing a. 0uic+ly ensure that the patient has an open airway and ade&uate ventilation. . /o not hesitate to egin o1ygen therapy. c. 2onsider inserting an airway ad$unct to unresponsive patients.

d. 2onsider the potential for spinal in$ury. 3. 2irculation a. Assess the patient4s circulatory status. . 5ou will find variations depending on the su stance involved. c. Assess the pulse and s+in condition. 6. *ransport decision a. A delay on the scene to further assess and treat patients is rarely indicated. . 2onsider decontamination of the patient efore transport depending on the poison the patient was e1posed to. i. /econtamination is especially important when transporting in a helicopter. C. History taking 1. Investigate the chief complaint. a. . tain the patient4s medical history. . If your patient is responsive" egin with an evaluation of the e1posure and the SA)P78 history. c. If the patient is not responsive" attempt to o tain the history from other sources: i. -riends ii. -amily mem ers iii. )edical identification $ewelry iv. 2ards in wallets (. SA)P78 history a. *he SA)P78 history guides you in what to focus on as you continue to assess the patient4s complaints. . In addition to the SA)P78 history" you should as+ the following &uestions: i. !hat is the su stance involved, ii. !hen did the patient ingest or ecome e1posed to the su stance, iii. 9ow much did the patient ingest or what was the level of e1posure, iv. .ver what period did the patient ta+e the su stance, v. 9as the patient or a ystander performed any intervention, 9as the intervention helped, vi. 9ow much does the patient weigh, D. Secondary assessment 1. *he secondary assessment is a more detailed" comprehensive e1amination of the patient that is used to uncover issues that may have een missed during the primary assessment. (. Physical e1aminations a. -ocus on the area of the ody involved with the poisoning or the route of e1posure.

. .nce the A:2s have een addressed and managed in the primary assessment" conducting a thorough physical will provide additional information on the e1posure. c. A general review of all ody systems may help to identify systemic pro lems. 3. Vital signs a. )any poisons produce no outward indications of the seriousness of the e1posure. . Alterations in the level of consciousness" pulse" respirations" lood pressure" and s+in are the more sensitive indicators that something serious is wrong. E. Reassessment 1. 2ontinually reassess the ade&uacy of the patient4s A:2s. (. 8valuate the effectiveness of interventions you have provided. 3. ;epeat the assessment of vital signs: a. 8very 1< minutes for a sta le patient . 8very < minutes" or constantly" for a patient who has consumed a harmful or lethal dose 6. Interventions a. Supporting the A:2s is your most important tas+. . /ilute air orne e1posures with o1ygen. c. ;emove contact e1posures with copious amounts of water unless contraindicated. d. 2onsider activated charcoal for ingested poisons. e. 2ontact medical control or a poison center to discuss treatment options. <. 2ommunication and documentation a. ;eport as much information as you have a out the poison to the hospital. . If the poisoning or e1posure occurred in a wor+ setting" ring" or have the company fa1" the material data sheet to the hospital. V. 8mergency )edical 2are A. Ensure scene safety. 1. -ollow standard precautions. (. Perform e1ternal decontamination. B. Remove ta !ets or fragments from t"e patient#s mout". C. $as" or rus" t"e poison from t"e patient#s skin. D. Assess and maintain t"e patient#s ABCs. E. Provide o%ygen and perform assisted venti!ations if necessary. &. 'f t"e patient demonstrates signs and symptoms of s"ock( 1. Position the patient supine with the feet elevated.

(. =eep the patient warm. 3. Provide the patient with supplemental o1ygen. 6. *ransport the patient promptly to the nearest appropriate hospital. ). 'f approved y medica! contro!* give activated c"arcoa!. 1. Activated charcoal is not indicated for patients: a. !ho have ingested an acid" an al+ali" or a petroleum product . !ho have a decreased level of consciousness and cannot protect their airway c. !ho are una le to swallow (. Activated charcoal adsor s" or stic+s" to many commonly ingested poisons" preventing the to1in >poison? from eing a sor ed into the ody y the stomach or intestines. a. 5ou will li+ely carry plastic ottles of premi1ed suspension" each containing up to <@ g of activated charcoal. . Some common trade names are Insta-2har" Actidose" and 7i&ui-2har. c. *he usual dose for an adult or child is 1 g of activated charcoal per +ilogram of ody weight. i. (< to <@ g for adults ii. 1(.< to (< g for children 3. :efore you give a patient charcoal" o tain approval from medical control. a. Ne1t" sha+e the ottle vigorously to mi1 the suspension. . 5ou may need to persuade the patient to drin+ it" ut never force it. 6. *he ma$or side effect of ingesting activated charcoal is lac+ stools. <. If the patient has ingested a poison that causes nausea" he or she may vomit after ta+ing activated charcoal. VII. -ood Poisoning A. &ood poisoning is a!most a!+ays caused y eating food contaminated y acteria. B. ,"ere are t+o main types of food poisoning. 1. *he organism itself may cause disease. (. *he organism may produce to1ins that cause disease. a. A to1in is a poison or harmful su stance produced y acteria" animals" or plants. C. -ne organism t"at produces direct effects of food poisoning is t"e Salmonella acterium. 1. Salmonellosis is characteri%ed y severe gastrointestinal symptoms within A( hours of ingestion" including nausea" vomiting" a dominal pain" and diarrhea. (. Proper coo+ing +ills acteria" and proper cleanliness in the +itchen prevents the contamination of uncoo+ed foods.

D. ,"e more common cause of food poisoning is t"e ingestion of po+erfu! to%ins produced y acteria* often in !eftovers. 1. (. 3. 6. *he acterium Staphylococcus is &uic+ to grow and produce to1ins in food. -oods prepared with mayonnaise" when left unrefrigerated" are a common vehicle. ;esults in sudden BI symptoms" including nausea" vomiting" and diarrhea Symptoms usually start within ( to 3 hours after ingestion or as long as C to 1( hours after ingestion.

E. ,"e most severe form of to%in ingestion is otu!ism. 1. :otulism can result from eating improperly canned food. a. *he spores of Clostridium acteria grow and produce a to1in. (. *he symptoms are neurologic. a. :lurring of vision . !ea+ness c. /ifficulty in spea+ing and reathing 3. .ften fatal" symptoms may develop within the first (6 hours after ingestion or as long as 6 days later. &. 'n genera!* you s"ou!d not try to determine t"e specific cause of acute gastrointestina! pro !ems. 1. Bather as much history as possi le from the patient. (. *ransport him or her promptly to the hospital. 3. !hen two or more persons in one group have the same illness" you should ta+e along some of the suspected food. VIII. Plant Poisoning A. ,"ere are severa! t"ousand cases of p!ant poisoning annua!!y. 1. )any household plants are poisonous if ingested. (. Some cause s+in irritation. 3. Some can affect the circulatory system" the gastrointestinal tract" or the central nervous system. B. 't is impossi !e to memorize every p!ant and poison* !et a!one t"eir effects. 1. 5ou can and should do the following: a. Assess the patient4s airway and vital signs. . Notify the regional poison center for assistance in identifying the plant. c. *a+e the plant to the emergency department. d. Provide prompt transport. C. 'rritation of t"e skin and.or mucous mem ranes is a pro !em +it" t"e common "ousep!ant ca!!ed dieffen ac"ia. 1. 8mergency medical treatment includes:

a. )aintaining an open airway . Biving o1ygen c. *ransporting the patient promptly to the hospital for respiratory support