Drowning and Poisoning PPT for Nurses and Paramedical

1. First Aids in Common Emergency Condition
(Drowning – Poisoning)
Presented By; Mr.Mihir Patel,
Nursing Tutor,
GCON,Siddhpur.

2. DROWNING
Drowning is a cause of accidental death in children Accidental drowning may
occur because children do not have adequate protective supervision. It may be
defined as submersion incident leading to death within the first 24 hrs.
Near Drowning
It is a submersion incident in which the individual survives for more than 24
hrs ,irrespective of the eventual outcome.

3. CAUSES
Most Childhood drowning occur in fresh water, bathtubs, Swimming Pools,Ponds,Large Buckets,
Washing Machine, Toilets and Tanks.
In Adolescents drowning occurs Lake and Rivers.
Causes of Hypoxemia in Drowning
Laryngeal Spasm
Pulmonary Shunting through Non ventilated Alveoli.
Collapse of Alveoli.
Fluid in Alveoli and Pulmonary Edema.
Decreased Lung Compliance.
Complications- Aspiration Pneumonitis, Altered Alveolar Capillary Membrane,
Formation of Protein rich exudates and infection.

4. PATHOPHYSIOLOGY
Pathophysiology
Effects occurs as a Consequence of
Hypoxemia
Aspiration and Failure of other Organs.
Death is either due to Immediate
asphyxia following Laryngeal spasm,
Aspiration of Fluid or Due to late
Complication.
Reaction to Submersion.
1. Panic
2. Frantic
3. Struggling
4. An Attempt to hold the Breath.
5. Gasping
6. Vomit and Aspirate Vomits
7. Laryngeal Spasm
8. Unconsciousness

5. MANAGEMENT
Emergency Care: Mouth to Mouth Ventilation Start Immediately.
Oxygen Should be given as soon as possible.
Cardiac Massage: Effective External Cardiac Massage 80 – 100 Compression/
Min in Children.100 – 120 compression/min in infant. Maximum Ventilatory
And circulatory support should be continued and transport the patient to
Hospital.

6. MANAGEMENT IN THE HOSPITAL
Clear the Airway and Oxygen at the rate of 8 – 10 litre /Min.
Provide Mechanical Ventilatory Support if required.
Stomach content should be Aspirated.
Monitor the Circulatory Status with Frequent BP Measurement.
Obtain Blood Sample for Investigation.
Arterial Blood Gas Analysis (ABG) and Ph should be Monitored.
Insertion of CVP (Central Venous Pressure) for status of blood Volume.
Keep IV Line Open.
Administer drug as Per Order.
Chest X-ray to determine Foreign Bodies.
Insert foley Catheter

7. CONT…
Near Drowning Children admitted to the Hospital Should be kept under
Observation and Treated for at least 24 to 48 hrs periods which includes;
Bed Rest
If Patient Unconscious then Give Care as Per Unconscious Care.
Change Position frequently.
Make Continuous Observation and Assessment of Child.
Administer Medication and Treatment as per Plan.
Provide emotional support to child and parents.

8. SUPPORTIVE TREATMENT
Quick Warming and Administration of IV fluid to maintain renal output.
Treatment of Comatose patient to prevent Brain Edema.
Maintain a state of hypothermia.
Head elevated to about 60 degree and should be kept in a dark and quiet area.
Prevention
Awareness of the danger and depth of Water.
Parents and Caretakers should never leave the child unattended.
Keep the bathroom doors and lid on toilet closed.
Fence around swimming pool and lock gate.

9. POISONING

10. INTRODUCTION
Poisons are the harmful substances and when sufficient doses are
consumed either accidently (by mistake or by ignorance) or for
suicidal purpose, it may prove very dangerous or may kill a person.
Route of Taking Poisons
1. Eating or drinking poisonous substance by mouth.
2. Inhaling household or industrial gases, chemical vapours or fumes from the
and exhaust by lungs.
3. By injection into the skin as a results of bites from some animals, insects,
snakes or by hypodermic syringes.
4. Absorption through the skin by contact with poisonous sprays such as
pesticides and insecticides.

11. MECHANISM OF ACTION OF POISON
1. Swallowed (Ingested) poisons act directly on the food passages resulting in
vomiting, pain and diarrhea.
2. Corrosive Poisons may severely burn the lips,mouth,gullet and stomach thus
causing intense pain.
3. Fumes and gases cause chocking which may result in difficulty of breathing and
unconsciousness.
4. Some Poison work in the blood stream, central nervous system and prevent
breathing, heart action and other vital life process.
5. Some poison act by displacing the oxygen in the blood and preventing its
distribution to the tissue.

12. ASSESSMENT OF THE PATIENT WITH POISONING
It Includes Following;
1. Great Information from patient or witness suggesting contact with a poison.
2. Checking of the container having poison or poisonous plant.
3. Observing the patient for the following sign and symptoms;
A. The patient may be delirious having convulsions without previous history of such condition.
B. Signs and symptoms of Asphyxia Such as;
• Fast and Shorter Breaths
• Fast and Feeble Pulse
• Cyanosis on Face, Lips, Fingers and Nails.
• Consciousness is lost partially or totally.
• Froth may appear at the mouth and nostrils
• Fits may occurs

13. CONT….
C. Vomiting
D. Diarrhea
E. Burns on lips, mouth after contact with corrosive poisons.

14. FIRST AID MANAGEMENT OF PATIENT WITH POISONING
General Steps to be followed in treatment of the patient with poisons.
1. First of All inform the police.
2. Collect information from the patient or persons accompanying the patient.
3. Preserve any suspecting material like a bottle containing pills or liquid for
information to the treating doctor.
4. If the Patient had Vomitus preserve the vomitus material
5. If the Patient is Conscious;
• No burn on lips or mouth then induce vomiting by giving plenty of fluid or milk
• If the lips or mouth show signs of burning cool them by giving water or milk to
drink. Do not induce Vomiting.

15. CONT….
6. If the patient is unconscious but breathing normally, treat as for the
shock
7. If Breathing and heart beat stop begin resuscitation immediately.
8.If convulsions are present treat as per treatment of seizures.
9. Shift to immediately to Hospital.

16. TYPES OF POISONING AND THEIR FIRST AID
MANAGEMENT
The various common types of poisoning and their first aid treatment are
mentioned below in the box.
Types and Meaning Signs and Symptoms Treatment
1. It occurs by consumption
of food. Which is
contaminated by bacteria
and is stored or cooked
incorrectly.
2. The Most Common types
of Bacteria are;
A. Staphylococci
They multiply in food and
produce a poisonous
substance toxin.
B. Salmonella
They multiply in bowel and
cause dysentery like illness
A. Staphylococcal Poisoning
The following s/s appear within two to six
hours of eating the contaminated food;
• Nausea and Vomiting
• Headache
• Abdominal Pain
• Diarrhea
• Sign and Symptoms of Shock
B. Salmonella Poisoning
They appear within few hours of eating the
food or are delayed for a day or two.
• Fever
• Nausea and Vomiting
• Diarrhea
• Abdominal Pain
•Keep the patient at rest
•Give Plenty of Fluids to drink.
•Induce Vomiting
•Shift the patient to Hospital.

17. II. Acid Poisoning
It can be Suicidal or
Homicidal or Accidental.
The various common acids
used are nitric, Suphuric,
Hydrochloric, Carbolic,
Oxalic and acetic Acids.
•Burns on around the
Lips.
•Burning in the mouth,
throat and stomach often
followed by heavy
vomiting.
•Diarrhea and intense
thirst.
•In severe case
unconsciousness
1. General : Same as in General
Management of Poisoning.
2. Specific
• Do not Induce Vomiting
• Give half liter of water or milk
to which milk of magnesia (50
grams) has been added.
• Shift the Patient.
III. Alkali Poisoning
• It can be also suicidal or
accidental.
• Alkalies commonly used
are ammonia. potassium
hydroxide and sodium
hydroxide, bleachers,
detergents washing soda.
• Membrane of the mouth
may be white and swollen.
• There may be soapy
appearance in the mouth.
Abdominal pain.
• Vomiting may contain
blood and mucous.
Specific:
• Do not induce vomiting.
• Give plenty of fluids: vinegar
and citric acid, lemon or orange
juice or barley water.
• Shift the patient immediately to
hospital.

18. IV. Common Indian Plant Poisoning
a) Castor Oil Plant
Poisoning is common among
children.
• Pain in throat and abdomen.
• Nausea
• Vomiting
• Diarrhea
• Give plenty
water
• Induce
vomiting
• Shift to hospital
b) Jamal Gota •Burning pain in mouth, throat
and abdomen.
•Salivation, vomiting
•Diarrhea
C) Dhatura (Safed Dhatura and
Kala Dhatura)
•Bitter Taste, Dry Mouth and Throat.
•Burning pain in the Stomach.
•Difficulty in Swallowing and Talking.
•Giddiness, Ataxia, Intoxication.
•Dry hot skin, rise in Temperature.
•Delirium
•Hallucination (Sight and Hearing)
•Convulsions and Coma.

19. Cocaine :
Obtained from coca
plant
• Restlessness, Talkativeness.
• Dry Mouth and Throat.
• Reflexes are Increased.
• Tinglinng and numbness in hands,
feet and tongue.
• Giddiness, Nausea and Vomiting.
• Cyanosis, Dilated Pupils, Fast Pulse
• Profuse Perspiration
• Delirium, Hallucination and
Convulsions
Mushroom • Burning of throat and Stomach
• Pain in Abdomen
• Vomiting and Diarrhea
• Urine may contain Blood.
• Cyanosis, Rapid Pulse, Convulsions.
• Headache, Giddiness,Cramps,Visual
Disturbances.
• Coma
•Give Caster Oil to Drink
•Induce Vomiting
•Shift Patient to Hospital.

20. h) Tobacco
Tobacco Poisoning may occur due
to excessive smoking, Accidental
Swallowing or the application of
leaves or juice to skin or wound.
Burning, Acid Sensation in mouth,
thorat, esophagus and stomach.
Increased Salivation
Nausea and Vomiting, Headache,
Giddiness.
Numbness, Trmors
Profuse Perspiration
Visual and Auditory Disturbance
Rapid Pulse and Respiration.
Give Plenty of Fluid Orally
Induce Vomiting
Shift patient to Hospital.
Opium (Afin) 1. Stage of Euphoria
• Increased Sensation of well being.
• Talkativeness
• Fast Pulse
• Convulsions in Children
2. Stage of Stupor
• Headache
• Giddiness
• Desire to Sleep.
• Cyanosis
• Itching
3. Stage of Nacrosis
• Coma
• Pinpoint Pupil
• Difficulty in Respiration
Give Plenty of Fluid Orally
Induce Vomiting
Shift patient to Hospital.

21. DRUGS
Type and Meaning Sign and Symptoms Treatment
A. Phenobarbitone
Overdose
• Euphoria
• Talkativeness
• Headache
• Giddiness
• Desire to Sleep
Plenty of Fluid Orally
Induce Vomiting if patient is
conscious.
Give hot coffee or Tea
B. Aspirin Overdose • Abdominal Pain
• Vomiting
• Drowsy
• Ringing in the Ears
• Difficulty in Breathing
• Profuse Sweating
• Fast Pulse

22. METAL POISONING
Type and Meaning Signs and Symptoms Treatment
Lead •Metabolic taste in Mouth
•Nausea and Abdominal Pain
•Vomiting
•Stools may be bloody dark in color.
•Headache, Drowsiness, Cramps,
Convulsions, Numbness.
•Give Plenty of Warm Water
•Milk, White of Egg, Barley water can be
given.
•Induce Vomiting
•Shift to Hospital.
Mercury Metabolic Taste In Mouth.
Burning pain in mouth and stomach
Tongue and Throat is corroded with grey
white coating.
Nausea and Vomiting
Stools may be bloody dark in color
Headache, Convulsions,Numbness.
Same As Above

23. ORGANIC CHEMICAL POISONING
Type and Meaning Signs and Symptoms Treatment
A. DDT Nausea, Vomiting, Vertigo, Tremors
Convulsions
Coma
Respiratory Failure
Give Plenty of Tape Water
Induce Vomiting
Shift to Hospital
B. Insecticides Pain in Abdomen
Vomiting
Tremors
Ataxia
Convulsions
Give Plenty of Fluid Orally
Induce Vomiting
Shift the Patient immediately to
Hospital.

24. Type and Meaning Signs and Symptoms Treatment
A. Organophosphrous Compounds
• Used as a pesticides and
insecticides in agriculture and
homes.
• Very Lethal.
• Used in Suicidal and Homicidal
Purpose.
•Characteristics Smell
•Nausea and Vomiting
•Pain in Abdomen , Diarrhea
•Lacrimation, Sweating and Bronchial
Secretions
•Blurring of Vision
•Pin-Pointed Pupil
•Cramps
•Confusion,Convulsions,Coma.
•Remove Contaminated Clothing
•Wash the skin with soap and water
•Give Plenty of Water
•Artificial Respiration
•Resuscitation
•Shift to Hospital.
B. Cyanide
Very Lethal Poison.
Used as Inhalation and Ingestion.
•Headache, Dizziness.
•Nausea , Hypotension.
•Dyspnea, Drowsiness
•Convulsions , Cyanosis
•Unconsciousness
•Foam in the Mouth
•Respiratory Failure
•Characteristics smell of bitter
•Start Resuscitation immediately
•Shift to Hospital

25. Type and Meaning Signs and Symptoms Treatment
Alcohol Poisoning Smell of Alcohol
Vomiting, Convulsion
Slurred Speech
Incordination
Double Vision
Visual Impairment
Flushing of Face
Rapid Pulse
Dilated Pupils
Shallow Breathing
Give Water, Milk or white of egg
Induce vomiting
Shift to Hospital