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Management of Poisoning: A handbook for health care workers
The issue of this document does not constitute formal publication. It should not be reviewed, abstracted, or quoted without the written permission of the Manager, International Programme on Chemical Safety, WHO, Geneva, Switzerland.
This report contains the collective views of an international group of experts and does not necessarily represent the decisions or the stated policy of the United Nations Environment Programme, the International Labour Organisation, or the World Health Organization.
Management of Poisoning
First draft prepared at the National Institute of Health Sciences, Tokyo, Japan, and the Institute of Terrestrial Ecology, Monk's Wood, United Kingdom
Published under the joint sponsorship of the United Nations Environment Programme, the International Labour Organisation, and the World Health Organization
World Health Organization
Geneva, 1997
The International Programme on Chemical Safety (IPCS) is a joint venture of the United Nations Environment Programme, the International Labour Organisation, and the World Health Organization. The main objective of the IPCS is to carry out and disseminate evaluations of the effects of chemicals on human health and the quality of the environment. Supporting activities include the development of epidemiological, experimental laboratory, and risk-assessment methods that could produce internationally comparable results, and the development of manpower in the field of toxicology. Other activities carried out by the IPCS include the development of know-how for coping with chemical accidents, coordination of laboratory testing and epidemiological studies, and promotion of research on the mechanisms of the biological action of chemicals.
WHO Library Cataloguing in Publication Data
Henry J.A. Management of poisoning: a handbook for health care workers / J.A. Henry Wiseman.
1.Toxicology - handbooks 2.Poisons - handbooks 3.Poisoning - prevention & control I.Wiseman, H.M. II.International Programme on Chemical Safety III.Title 3. I.Series
ISBN 92 4 154481 3 (NLM Classification: QV 600) ISSN 0250-863X
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© World Health Organization 1997
Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
Contents
Preface
Acknowledgements
Introduction How to use this book Poisons centres and poison control programmes
Part 1. General information on poisons and poisoning
1. Poisons and poisoning
Objectives
What is a poison?
Exposure to a poison
How poison gets into the body
What happens when poison is inside the body
The effects of poison
When systemic effects happen
2. How poisoning happens
Objectives
Accidental poisoning
Self-poisoning
Using poison to harm other people
Poison in food or drink
Medical poisoning
Abuse of drugs, chemicals or plants
The benefits and dangers of using chemicals
3. How to prevent poisoning
Objectives
How you can help people make their homes, workplaces, and the community safer
What can be done to prevent poisoning?
How to make homes safe
How to prevent poisoning with pesticides
What employers can do to prevent poisoning at work
How to avoid snake bites
How to prevent insect, spider and scorpion stings and bites
How to avoid eating poisonous plants, mushrooms and fish
How to avoid infection from food contaminated with germs
4. What to do in an emergency
Objectives
The dangers to look out for
What to do in an emergency
5. First aid
Objectives
Give first aid at once
First aid for poisoning
Using traditional medicines to treat poisonous bites and stings
6. Getting medical help
Objectives
If you can get to a hospital in less than two hours
If you are a long way from a hospital
If you cannot get medical help quickly
Taking the patient to hospital
What to do after you have read this chapter
7. Examining the patient objectives symptoms and signs
What the examination cannot tell you
When the patient does not have any symptoms or signs
How to examine a patient and find out the symptoms and signs
Patterns of symptoms and signs
8. Finding out what happened
Objectives
Talking to people
Look for the poison or other things that show you what happened
What to do next
9. How to look after a poisoned patient outside hospital
Objectives
What to do when the patient has swallowed poison
How to stop poison getting into the blood after it has been swallowed
Making the patient vomit
Giving activated charcoal
Giving a laxative
How to look after a very sick patient
10. Medicines and equipment
How to care for medicines and first aid equipment
Medicines
First aid equipment
Part 2. Information on specific poisons
Introduction
The information in each section
Pesticides
Aluminium phosphide and zinc phosphide
Arsenic and arsenic-containing chemicals
Chlorophenoxyacetate weedkillers
Dinitro-o-cresol (DNOC), dinitrophenol, dinoseb and pentachlorophenol
Insect repellent
Metaldehyde
Organochlorine pesticides
Organophosphorus and carbamate insecticides
Paraquat
Phenol and related substances
Pyrethrins and pyrethroid insecticides
Rat poisons
Sodium chlorate
Strychnine
Thallium
Warfarin and other pesticides that stop blood clotting
Chemicals and chemical products used in the home and the workplace
Aerosol sprays
Air-fresheners, deodorant blocks and moth-balls
Benzene, tetrachloroethylene, toluene, trichloroethane, trichloroethylene and xylene
Borax, boric acid and sodium perborate
Button batteries
Carbon monoxide
Carbon tetrachloride
Caustic and corrosive chemicals
Cosmetics and toiletties
Cyanide
Disinfectants and antiseptics
Ethanol and isopropanol
Ethylene glycol and methanol
Glue
Lead
Petroleum distillates
Phosgene
Soap and detergents
Tobacco products
Volatile oils
Products that are not usually harmful
Medicines Acetylsalicylic acid, choline salicylate, methyl salicylate, salicylic acid
Amfetamine-like medicines, atropine-like medicines, antihistamines, cocaine, ephedrine, and pseudoephedrine
Aminophylline and theophylline
Amitriptyline-like medicines, chloroquine, quinidine and quinine
Barbiturates, chlorpromazine-like medicines, diazepam-like medicines and meprobamate
Carbamazepine, phenytoin and valproic acid
Chlorpropamide-like medicines and insulin
Colchicine
Dapsone
Digitalis, digitoxin and digoxin
Glyceryl trinitrate, hydralazine, and propranolol-like medicines
Ibuprofen
Iron-containing medicines
Isocarboxazid, phenelzine and tranylcypromine
Isoniazid
Lithium carbonate
Magnesium hydroxide, magnesium sulfate, phenolphthalein, and senna
Opiates
Oral contraceptives
Paracetamol
Penicillin and tetracycline antibiotics
Proguanil
Rifampicin
Salbutamol
Plants, animals and natural toxins
Plants that contain atropine
Cannabis
Irritant plants
Oleanders
Ornamental beans
Mushrooms
Snakes
Spiders
Venomous fish
Poisoning from eating seafood
Word list
Index
Preface
This handbook has two main aims: to give people living in rural places, far from medical help, information on what to do when someone is poisoned; and to suggest ways of preventing poisoning in the community.
It is written for people with little or no medical training who are likely to be the first to come into contact with someone who has been poisoned, such as community health workers (CHWs), first-aiders, or professionals in other sectors working in rural communities. Some information has also been included for health workers with a knowledge of clinical medicine and diagnostic procedures, working in rural health stations and health centres where there may be some medical equipment and medicines available.
The handbook is meant to be used as a practical reference book in an emergency. It can also be used by people who teach community health workers and others practical skills, such as mouth-to-mouth respiration and heart massage, that can only be learnt by practising under trained supervision. It may also be useful as a teaching aid for student doctors, nurses, and paramedical personnel.
The book will be most useful if it is translated into local languages and adapted to local conditions, which may vary in terms of: the tasks authorized for CHWs, such as giving injections; the functions assigned to CHWs; the functions assigned to local health centres and doctors at rural hospitals; the availability of medicines; and the particular problems prevalent in the area.
Only a small amount of information is given about chronic poisoning, which is often caused by using chemicals at work. Readers who wish to know more about chronic poisoning should find a book that deals with the health of people at work (occupational health).
The intended readership
Community health workers. CHWs can generally read, write, and do simple arithmetic, and have basic training in:
- first aid,
- taking body temperature,
- counting the pulse,
- dispensing medicines.
CHWs may also be trained to give intramuscular and subcutaneous injections.
First-aiders. First-aiders are trained to rescue people from danger, and to give immediate help to the victims of accidents until a trained health care worker can take charge. People who are likely to be the first on the scene of an accident, such as workers in factories or offices, firefighters, or policemen, are often trained in first aid.
Professionals with no medical training. Many highly educated professional workers, such as teachers, agricultural advisors, pharmacists, scientists and technologists, know about the use and effects of chemicals. In communities where there are no doctors, they may be the only people who know about chemicals and poisons. They may be first on the scene of an accident or they may be called upon to help someone who is thought to have been poisoned. They need to know the first aid for poisoning due to pesticides, medicines, household products, and other substances. They should also be able to advise people on how to prevent poisoning.
In some countries professional people with no medical training may attend courses run by poisons centres to learn basic first aid skills.
Nurses, medical students and paramedical staff. The book may be useful as a handbook and training manual.
Doctors. Some information has been included specifically for doctors working in rural health stations and health centres where there may be some medical equipment and medicines available. This information has been separated from the main text. It does not include details of medical treatment that can be given only in a hospital.
Acknowledgements
This handbook has been prepared on the recommendation of a group of experts convened by the International Programme on Chemical Safety (IPCS)1 in February 1987. A draft text was prepared by Dr J.A. Henry and Ms H.M. Wiseman, and commented on by a number of experts, in particular Dr E. Fogel de Korc (Montevideo, Uruguay), Dr G.R. Gardiner, Dr J. Jackson and Mr W. Tardoir (Brussels, Belgium), and colleagues from UNEP's International Register of Potentially Toxic Chemicals (IRPTC) and the Occupational Safety and Health Branch of ILO. An editorial group, convened by the IPCS to review the text, consisted of Dr J.-C. Berger (Luxembourg), Dr N. Besbelli (Ankara, Turkey), Professor M. Ellenhorn (Los Angeles, USA), Professor B. Fahim (Cairo, Egypt), Dr Sming Kaojarern (Bangkok, Thailand), Professor A. Furtado Rahde (Porto Alegre, Brazil), Dr N.N. Sabapathy (Fernhurst, England), Professor A.N.P. van Heijst (Utrecht, Netherlands), and Dr A. David (ILO). The text was tested at an IPCS Workshop, held in Harare, Zimbabwe, from 28 January to 1 February 1991, and subsequently in two training workshops in Zimbabwe. Parts of the text were also reviewed at an IPCS Workshop held in Dakar, Senegal, 24-27 January 1995. For the IPCS, Dr J. Pronczuk de Garbino provided the editorial inputs and Dr J.A. Haines coordinated the work.
The first aid manual of the Joint Voluntary Aid Societies in the United Kingdom, and publications of the Global Crop Protection Federation, were particularly useful as source materials for the first draft. The United Kingdom Department of Health, through its financial support to the IPCS, provided the resources for the drafting of the text and for the editorial group to meet. The illustrations were prepared by Picthall & Gunzi, London.
1The IPCS is a cooperative venture of the World Health Organization (WHO), the International Labour Organisation (ILO) and the United Nations Environment Programme (UNEP). WHO is the executing agency for the programme, which aims to provide the internationally evaluated scientific data basis for countries to develop their own chemical safety measures, and to strengthen national capabilities to prevent and treat harmful effects of chemicals and to manage chemical emergencies.
How to use this book
This book is in two parts. Part 1 gives general information on poisons and poisonings, how poisonings happen and how you can prevent them. It also gives guidance on how to deal with poisoning emergencies. Part 2 gives specific information on the effects of poisoning with various pesticides, medicines, household chemical products, and poisonous plants and animals, and guidance on what to do when you think someone has been poisoned. A word list and an index are also provided.
To be ready for emergencies
1. Keep a first aid kit, like the one recommended in Chapter 10, in the house, in the community, or at work.
2. Study this book before it is needed, especially Part 1, Chapters 4-9, which tell you what to do when someone is poisoned.
3. Practise some of the first aid, so that you know what to do in an emergency.
To look up a chemical, plant or animal
Use Part 2 when you see someone who is poisoned. Look in the index at the end of the book to find the medicine, chemical, plant or animal you think may have caused the poisoning.
Information for doctors
In Chapter 5, "First aid", and Chapter 9, "How to look after a poisoned patient outside hospital", and in Part 2, parts of the text are separated off by horizontal lines. This information is meant for doctors.
If you do not understand the meaning of some of the words in this book
Look for the word in the word list (medical words used in the boxes of information for doctors are not explained in the word list).
Poisons centres and poison control programmes
In many countries there are poisons centres which give advice about the treatment and prevention of poisoning. They have information about medicines, pesticides, poisonous plants, venomous animals, and household products, and chemicals used at work. The doctor in the poisons centre can tell you what to do when someone has swallowed or breathed in a chemical, spilt it on the skin, or splashed it in the eyes.
Most poisons centres can be contacted at any time of day or night by telephone or, in some countries, by radio. They may have supplies of special antidotes (for example snake or spider antivenoms). Some poisons centres have hospital wards where they can treat poisoned patients.
In many countries, other organizations work with poisons centres in a national poisons control programme to improve the treatment and prevention of poisoning. These organizations include:
-hospitals and other places where poisoned patients are treated;
-organizations that collect information on poisoning;
-organizations that make or use substances which might cause poisoning;
-government authorities that control the use of chemicals within the country;
-universities and colleges where doctors and other people are taught about poisoning.
There is space in the back of this book where you can write the addresses of organizations in your country that might help you deal with cases of poisoning or give advice on how to prevent poisoning.
Management of Poisoning: A handbook for health care workers:
1,2,3,4,5,6,7
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