The difference between poisoning and accidental first aid

The first principle of ordinary accidental injury first aid is "controlling existing injuries and avoiding secondary injuries", while the core of poisoning first aid is "cutting off the ingestion path of poisons and accelerating the discharge of toxins." The traceability logic, treatment steps, and preparations for sending to the hospital are completely different and must not be confused.

When I led practical first aid classes in the community two years ago, I saw novices confusing the two.

At that time, two dummies were placed in the simulation scene: one was a worker who stepped on a rusty iron nail on the construction site and his ankle was bleeding (an ordinary accident), and the other was a cook who ate sprouted potatoes in the construction site canteen and foamed at the mouth (poisoned). A student came up and first lifted the poisoned cook to a flat place to stabilize his head. Then he turned around and poured half a bottle of mineral water into the worker's legs to induce vomiting. The teachers present were stunned.

In fact, there are always different voices in the emergency circles regarding the priorities of these two types of treatments: one group insists on "general procedures first" and believes that no matter what the situation, the three major vital signs of airway, breathing, and circulation should be assessed first, and then the cause will be investigated. The advantage of this logic is that it will not make mistakes at the scene where the situation is completely unknown, and it is especially suitable for first-time emergency volunteers.； The other group advocates "scenario traceability first" and believes that the golden disposal window for poisoning is often shorter than ordinary accidents. For example, for patients who take paraquat orally, even if their vital signs are temporarily stable and are induced to vomit and detoxify 10 minutes later, the subsequent survival rate will drop by more than 30%. At this time, following a step-by-step general process will delay things. This logic is more suitable for practitioners with certain on-site handling experience. There is no absolute right or wrong between the two views, they just have different applicable scenarios.

I encountered a typical case of abuse when I was on duty in the emergency department last year: an old man in his 70s was already semi-conscious when his family members brought him to the hospital. When the family members came up, they said that the old man had high blood pressure and must have had a stroke. The doctor ruled out a cerebrovascular accident. After more than 0 minutes, when the nurse was changing the old man's clothes, he found half a bottle of leftover dichlorvos. Only then did he find out that the old man had a conflict with his family and secretly drank the pesticide. Although he was finally rescued, the extra 20 minutes of delay caused him to stay in the ICU for an extra half month. In fact, if we had followed the logic of tracing the origin of poisoning from the beginning, asking if there was any abnormal contact history and looking through the belongings, we would not have taken this detour at all. To put it bluntly, ordinary accidental injuries are holes on the surface, which can be repaired. Those who fell have wounds, those who were burned have blisters, and those who were in car accidents have impact marks. Follow the physical signs to find out the cause. ； But poisoning is a thief hiding in the body. When toxins enter the body, the external symptoms of convulsions, vomiting, and coma are almost the same as those of many common diseases and accidental injuries. If you don’t look for the contact history first, you won’t be able to figure it out.

The difference in disposition is even more obvious. Last month, we received a call from a police officer who was poisoned by pesticides in an orchard. The patient did not wear a mask when spraying pesticides, and fell off a ladder and cut his leg. When the family came up, they put a band-aid on his leg and helped him to the car to take him to the hospital. When we arrived, our first reaction was to remove all the pesticide-stained clothes on his body and rinse his skin three times with water before we dared to treat the wound on his leg. Why? In ordinary accidental wounds, you treat them first to stop bleeding and avoid infection, which may put your life in danger for a while. However, in the case of poisoning, every extra second the pesticide is left on the skin will cause one more toxin to enter the blood. If the source of the poison is not cut off first, people may say it is gone. There is also common sense that many people make mistakes: In the past, people thought that people should induce vomiting when they were poisoned. Now evidence-based medicine has long updated its conclusion. Patients with strong acid or strong alkaline poisoning must not induce vomiting, otherwise the corroded esophagus and stomach will rupture for a second time, which will harm people. This kind of detailed distinction is not involved in ordinary accident first aid.

Even if you need to send the patient to a hospital after on-site treatment, the things you need to prepare for the two situations are completely different. For ordinary accidents, you just need to tell the doctor clearly the cause and time of the injury. For example, "I fell from a two-meter-high shelf and landed on my butt first. It has been hurting for 40 minutes." The doctor can just arrange for a X-ray to be taken directly. ； But if you are poisoned, you have to bring everything you can find related to the poison: leftover food, empty medicine bottles, vomit, and even strange pills that fell out of the patient's pocket. If possible, take photos of the scene, such as whether there are scattered pesticide bottles and whether there are traces of gas leaks. Once the doctor gets these, he can directly prescribe the corresponding antidote. He does not need to spend time guessing what the poison is, which can save a lot of life-saving time.

Of course, not all situations can be distinguished so clearly. For example, someone fainted due to carbon monoxide poisoning, fell down and broke his head. There was both poisoning and trauma. At this time, there is no need to worry about which one to press first. Deal with the quickest and most fatal thing first: if the head is broken and bleeding heavily, stop the bleeding first. At the same time, open the window to ventilate and turn off the gas. No delay on either side. There is no force in the industry to say which one must be treated first. The core is to "cut off the risk of quick death first." This is recognized by both general-purpose and scenario-based first responders.

To put it bluntly, the first aid logic of distinguishing between poisoning and accidents has never been to test ordinary people, but to enable you to do the most important things first when you are so panicked that your hands are shaking. After all, there is no perfect first aid process. If you can avoid detours during the golden time, it is better than anything else.