POISON, NOSEBLEEDS,

SUCKING CHEST
WOUND, ABDOMINAL
EVISCERATION

By:
Laarni D. Reyes, RN
Clinical Instructor
Care for the Nose Injuries – Nose Bleed

 Keep the victim in a sitting position – up position

to reduce blood pressure. Keep the victims head
tilted slightly forward so blood can run out of the
front of the nose, not down back to the throat,
which can cause choking, nausea, or vomiting.
Vomit could be inhaled into the lungs.

 Pinch (or have victim pinch) all the soft parts of

the nose together between thumb and two fingers
with steady pressure for five minutes. Compress
the pinched parts against the bone of the face.
 3. If bleeding persists, have the victim gently
blow the nose to remove any irregular clots
and excess blood and to minimize sneezing.
This allows new clot to form. Then pinch the
nostril again for five minutes.

 4. Apply an ice pack over the nose and cheeks

to help control bleeding-especially if caused by
a blow to the nose.

 5. Place an unconscious victim on his or her

side to prevent inhaling of blood and try the
procedures listed above.
6. Seek medical attention if any of the following
applies:

 The nostrils pinching and other methods do not

stop bleeding.

 You suspect a posterior nosebleed

 The victim has high blood pressure or is taking

anticoagulants (blood thinners) or large doses of
aspirin.

 Bleeding happens after blow to the nose and you

suspect a broken nose.
Care for Dental Injuries – Knocked-Out Tooth

1. Have the victim rinse his or her mouth and put rolled
gauze pad in the socket to socket control bleeding.
2. Find the tooth and handle it by the crown, never the root,
to minimize damage to control bleeding.
3. The best place for knocked-out tooth is its socket. A tooth
often can be put back in its socket within 30 minutes after
injury.

 When immediate reinsertion is not possible, one of the

worst things you can do a knocked-out tooth is to
transport it dry. Consider using saliva for the short
term (less than one hour).
 Some experts recommends that the tooth be place in the
victims mouth to keep it moist until dental treatment is
available. This method, through the convenient,
presents risk, especially in children, of the tooth’s being
accidentally swallowed.
save any lost of teeth of bone fragments following an injury of the mouth
Care for Impaired Objects

1. Is an object that is embedded in an open wound. It

should never be removed in the field unless it is
through the patient’s cheek or it interferes with
airway management or CPR.

2. Do not remove or move an impaled object.

Movement of any kind could produce additional
bleeding and tissue damage.

3. Expose the area. Remove or cut away any clothing

surrounding the injury. If the clothes cover the
object, leave them in place; removing them could
cause the object to move.
4. Control any bleeding with direct pressure. Straddle
the object with gauze. Do not press directly on the
object or along the wound next to the cutting edge,
especially if the object has sharp edges.

5. Stabilize the object. Secure a bulky dressing or clean

cloth around the object. Some experts suggest
securing 75 % of the object with bulky dressing or
clothe reduce motion.
6. Shorten the object even if necessary. In the
most cases, do not shorten the object allows for
easier transportation. Be sure to stabilize the object
before shortening. Remember that the victim will
feel any vibrations from the object being cut and
that the injury could be worsened.
Care for Amputations

1. Amputated body parts left un-cooled for more than 6hrs,

have little chance of survival; 18 hrs is probably the
maximum time allowed for a part that has been cooled
properly. Muscles with out blood viability within 4 to
6 hours:

2. Control the bleeding with direct pressure and elevate the

extremity. Apply dry dressing or bulky cloths. Be sure
to protect yourself against disease. Tourniquets are
rarely needed and if used will destroy tissue, blood
vessels, and nerves necessary for re-implantation.

3. Treat the victim shock.

4. Recover the amputated part and, whenever possible. Take
it with the victim. However, it multi casually, in
reduced lightning conditions or when untrained people
transport the victim, someone maybe requested to
locate and take the severed body part to the hospital
after the victims departure.

5. Care for the amputated body part:

 If possible, rinse with clean water to remove any

debris; do not scrub. The amputated portion does
not need to be cleaned.
 Wrap the amputated part with a gauze or clean cloth.
 Put the wrapped amputated part in a plastic bag or
container with the wrapped part on the bed of ice.
https://www.youtube.com/watch?v=FFeG0tBwI
g4
Care for Sucking Chest Wound
 Open chest injuries pose an additional problem

because they upset the delicate balance of pressure

between the inside and outside of the chest. A sucking
chest wound results when a chest wound allows air to
pass in and out of the chest with each breath.

1. Have victim take breath and let it out; seal the wound
with anything available to stop the air from entering
the chest cavity. Plastic wrap or plastic bag works
well. Tape it in place with one untapped. That creates
a flutter valve to prevent air from being trapped in the
chest cavity. If plastic wrap is not available, you can
use your hand.
2. If the victim experiences troubled breathing or
seems to be getting worse, remove the plastic
cover (or your hand) to let the air escape, then
reapply.

3. Seek medical attention.

https://www.youtube.com/watch?
v=XlMnI1CFSvY
Care for Abdominal Injuries Protruding Organs

1. An evisceration occurs when internal organs protrude from an open

wound. This is the most commonly occurring with abdominal
wounds.

2. Cover protruding organs with a dressing or clean cloth.

3. Pour drinkable water on the dressing to keep the organ from drying
out.
According to Nickerson, D., & Freiberg, A. (1995). Moisture-Retentive
Dressings: A Review of the Current Literature. Canadian Journal of
Plastic Surgery, 3(1), 35–38. 

Moisture-retentive dressings allow rapid epithelialization, reduce pain, reduce

fibrosis, reduce infection and yield better cosmetic results. Furthermore,
occlusive dressings allow less painful debridement and stimulate
granulation tissue. Despite these advantages, moisture-retentive dressings
are still underused

4. Seek medical attention.

An evisceration is an open wound in the abdominal
cavity in which internal organs or fat protrude from
the wound.
https://www.youtube.com/watch?
v=UXN81dMeiHA
 Poison
Is any substance: solid, liquid or gas that tends to
impair health or causes death when introduced
into the body or onto the skin surface. A poisoning
emergency can be life threatening.
Causes

 Common in suicide attempts.

 Occasional accidental poisoning.
Ways in which Poisoning May Occur
 Ingestion - by mouth
 Inhalation - by breathing
 Injection - by animal bites, stings, syringes
 Absorption - by skin contact
 alkali poisoning - poisoning resulting from the
ingestion of an alkali compound (as lye or
ammonia). This chemical pathway is especially
damaging to human tissue within the
esophagus. 
 caffeine intoxication, caffeinism - poisoning
resulting from excessive intake of caffeine
containing products. According to the 
Mayo Clinic, the recommended amount of
caffeine is up to 400 milligrams per day for
healthy adults
According to Center for Science in the Public
Interest (Healthline 2021)

Serving size Caffeine (mg)

Black coffee 12 oz. 50–235

Black tea 8 oz. 30–80
Soda 12 oz. 30–70
Red Bull 8.3 oz. 80
Chocolate bar (milk) 1.6 oz. 9
NoDoz caffeine tablets 1 tablet 200
Excedrin Migraine 1 tablet 65
 carbon monoxide poisoning - a toxic condition that
results from inhaling and absorbing carbon
monoxide gas; "carbon monoxide combines with
hemoglobin and displaces oxygen in the blood"
https://www.youtube.com/watch?v=eXmOTIsesBk
 cyanide poisoning - poisoning due to ingesting or

inhaling cyanide; common in smoke from fires and

in industrial chemicals

 ergotism - poisoning by ingestion of ergot-infected

grain products; characterized by thirst and diarrhea
and nausea and cramping and vomiting and
abnormal cardiac rhythms; in severe cases it can cause seizures
and gangrene of the limbs
 ergotism - poisoning by ingestion of ergot-
infected grain products; characterized by thirst
and diarrhea and nausea and cramping and
vomiting and abnormal cardiac rhythms; in severe cases
it can cause seizures and gangrene of the limbs
 mercury poisoning - a toxic condition caused by
ingesting or inhaling mercury; acute mercury
poisoning causes a metallic taste and vomiting
and diarrhea and kidney problems that may lead
to death https://www.youtube.com/watch?
v=KqNwAOTquwY
 naphthalene poisoning - toxic condition resulting
from inhaling or ingesting naphthalene
 nicotine poisoning - toxic condition caused by
the ingestion or inhalation of large amounts of
nicotine
 ophidism - poisoning by snake venom
 paraquat poisoning - poisoning caused by
ingestion of paraquat; characterized by
progressive damage to the esophagus and liver
and kidneys
 pesticide poisoning - toxic condition resulting
from ingesting or inhaling a pesticide
 salicylate poisoning - poisoning caused by the
excessive ingestion of salicylates (usually
aspirin)
 Common Household Poisons
• Sleeping pills
• Pain relievers
• Insect and rodent poisons
• Kerosene
• Denature alcohol
• Lye and acids including boric
• Poisonous plants
• Contaminated water
• Fume
Ingested Poison
 is one that is introduced into the digestive tract
by way of the mouth. One form of ingestion
poisoning is food poisoning, a general form
that covers a variety of conditions. Suspect
food poisoning if:
1. The victim ate food that “didn’t taste right” or that
may have been old, improperly prepared,
contaminated, left at room temperature for a long
time, or processed with an excessive amount of
chemicals.
2. Several people who ate together become ill.
 Signs and Symptoms:
 Altered mental status
 History of ingesting poisons
 Burns around the mouth
 Odd breath odors
 Nausea, vomiting
 Abdominal pain
 Diarrhea
 Instances when vomiting should not be
induced:
 If unresponsive
 Cannot maintain an airway
 Has ingested an acid, a corrosive such as lyle,
or a petroleum product such as gasoline or
furniture polish
 Has a medical condition that could be
complicated by vomiting, such as heart attack,
seizures and pregnancy.
 First Aid
 Try to identify the poison by seeking information
from the victim or bystanders and look for clues.
 Place the victim on his or her left side to position
the end of the stomach where it enters the small
intestine (pylorus) straight up. Gravity will delay
(by as much as two hours) advancement of the
poison into the small intestine, where absorption
into the victim’s circulatory system is faster. The
side position also helps prevent aspiration
(inhalation) into the lungs if vomiting begins.
 Save any empty container, spoiled food for analysis.
 Save any vomitus and keep it with the victim if he
or she is taken to an emergency facility.
 Reminders
 Do not administer anything by mouth unless
advised by a poison control center. The results of
some animal studies suggested that dilution or
neutralization of a caustic agent by water or milk
after ingestion reduces tissue injury, but no human
studies have demonstrated a clinical benefit of this
practice. Administration of milk or water may be
considered if a large amount of an industrial-
strength caustic or a solid caustic has been
ingested, but call the poison control center first.
 Ipecac contains chemicals that irritate the digestive tract and
trigger the brain to cause vomiting.

At this time there is insufficient data to support or exclude

administration of ipecac to induce vomiting in poisoning
victims. The potential danger of aspiration and the lack of clear-
cut evidence of a benefit support our recommendation: do not
administer ipecac unless specifically directed by a poison
control center or other authority (e.g. local emergency
department physician). If ipecac is administered, it should be
given only within 30 minutes of ingestion and only to victims
who are alert and responsive. The decontamination effects of
ipecac have been extrapolated from studies performed in dogs,
but the findings are probably not applicable to humans. Results
of studies performed in human volunteers are not applicable to
poisonings because the volunteers were given non toxic drugs.

 Administration of activated charcoal immediately after drug

ingestion decreases the amount of drug absorbed, but the
amount varies and decreases with time. Activated charcoal
is an palatable and difficult to administer, and death due to
its aspirations has been reported.
 FYI
 Carbon Monoxide (CO) is a poison gas that is especially lethal. The
gas is invisible, tasteless, odorless, and nonirritating. The incomplete
burning of organic material such as gasoline, wood, paper, charcoal,
coal, and natural gas produces it.

 Signs and Symptoms

 Headache
 Ringing in the ears (tinnitus)
 Chest pain (angina)
 Muscle weakness
 Nausea and vomiting
 Dizziness and visual changes (blurred or double vision)
 Unconsciousness
 Respiratory and cardiac arrest
 First Aid
 Remove the victim from the toxic environment
and into fresh air immediately.
 Seek medical attention. All suspected CO
victims needs 100% oxygen and should obtain
a blood test to determine the level of CO.
 Absorbed Poisons
 A poison that enters the body through the skin
 Signs and Symptoms:
 History of exposures
 Liquid or powder on the skin
 Burns
 Itching, irritation
 Redness, rash, blisters
 First Aid
 Remove the clothing that came in contact with
the poison
 Then with the dry cloth blot the poison from
the skin. If the poisons is a dry powder, brush
it off.
 Flood the area with copious amounts of water.
A shower or garden hose are ideal for this
purpose. Continue until medical personnel
arrived.
 Continually monitor the patient’s vital signs.
Be alert for sudden changes. Seizures and
shock are not common.
 Injected poisons
 A poison that enters the body through a bite,
stings, or syringe.
1. Insect Bites
 Signs and Symptoms
 Stinger may be present
 Pain
 Swelling
 Possible allergic reaction
 First Aid
 Removes stinger - scrape it away or use
tweezers.
 Wash wound
 Cover the wound
 Apply a cold pack
 Watched for signal of allergic reaction
2. Spider Bite/ Scorpion Sting
 Sign and Symptoms
 Bite mark
 Swelling
 Pain
 Nausea and vomiting
 Difficulty breathing and swallowing
 First Aid
 Wash wound
 Apply a cold pack
 Get medical care to receive antivenin
 Call local emergency number if necessary
3. Marine life stings
 Signs and Symptoms
 Possible marks
 Pain
 Swelling
 Possible allergic reaction

 First Aid
 If jellyfish, soak area in vinegar
 If sting rays – soak in nonscalding hot water until
pain goes away. Clean and bandage wound.
 Call emergency number if necessary
4. Snake Bites
Signs and Symptoms
 Bite mark
 Pain
 First Aid
While waiting for medical help:

 Move the person beyond striking distance of the snake.

 Have the person lie down with wound below the heart.
 Keep the person calm and at rest, remaining as still as
possible to keep venom from spreading.
 Cover the wound with loose, sterile bandage.
 Remove any jewelry from the area that was bitten.
 Remove shoes if the leg or foot was bitten.
 https://www.youtube.com/watch?v=nH8o-bgwo_g
5. Human and Animal Bites
 Signs and Symptoms
 Bite mark
 Bleeding

 First aid
 If bleeding is minor-wash wound
 Control bleeding
 Apply antibiotic ointment
 Cover the wound
 Get medical attention if wound bleeds severely or if you suspect
animal has rabies
 Call local emergency number or contact animal control personnel
 General care for poisoning
 Survey the scene to make sure it is safe to approach and
gather clues about what happen
 remove the victim from the source of the poison
 do a primary survey to assess the victim’s airway,
breathing, and circulation
 care for any life-threatening condition
 if the victim is conscious, do a secondary survey to gather
additional information. Look for containers or pills
 contact hospital with or without Poison Control Center
and/or summon more advanced medical personnel
 do not give the victim anything by mouth unless advised
by medical professionals. If poison is unknown and the
victim vomits, save some of the vomitus, which maybe
analyzed later to identify the poison.