Toxins/Poisonings (HB)

Toxins are a substance produced within living cells or organisms that cause dysfunction or destruction of other living tissue. They occur naturally in the environment or they can be produced from within the body itself.

The four main routes that toxins can get into the body are:

• Injection
• Ingestion
• Inhalation
• Absorption

Two types of toxins that affect our body are poisons and venom.

Our body will try to get rid of toxins through metabolism—we try to expel toxins by breathing it out, peeing it out, pooping it out, sweating it out, burning it out, or waiting it out.

You must also take care not to expose yourself to the toxins if they are in the environment. Some toxins are colorless and odorless and you could enter an unsafe area. Scene safety is very important here—if you see a patient unresponsive in an area with no obvious mechanism, enter the area very carefully if at all.

Signs and Symptoms

Signs and symptoms of exposure can be almost anything. The patient’s skin can blister, their airway can constrict, and mental status can be affected. It all depends on the vector. A good scene size up and history can help narrow down the cause. Once the source is identified it is important to learn what the specific effects of the exposure are. Ultimately you need to treat what you see and consider rapid evacuation.

A common example is “cherry red” lips from carbon monoxide poisoning. If you see cherry red lips and notice that the patient was sleeping in a tent with a stove, carbon monoxide is a good guess.

Be on the looking out for patients that are salivating, tearing up, have lost bladder control, are defecating, having gut issues, or are throwing up.

Treatment

“The solution to pollution is dilution.” Most toxic exposures can be handled by removing the source causing the exposure (or removing the patient from the area). This could be washing the toxin off, getting the patient to expel the toxin (vomiting) if appropriate, or getting the patient to clean air. In cases of injections, hydrate the patient as aggressively as possible, and try and prevent the toxin from pooling in a particular area.

The above are general guidelines—the best first action is to call poison control (800-222-1222). They can walk you through the best actions to take for any given substance.

Depending on the level of exposure you might just have to manage the patient with basic life support and rapid evacuation.