Poisoning on board ship - May occur after

exposure to medical drugs, cargo, or substances used during

work
• should be used in conjunction with the most recent
versions of the IMO’s MFAG Procedures for Ships
Carrying Dangerous Goods
• Most cases of poisoning can be dealt with on board ship:
only about 5% of serious poisonings require Rx in a
hospital and, of these, only 1–2% are fatal
• The commonest substances that cause fatal poisoning
are carbon monoxide and the simple analgesics
paracetamol and acetylsalicylic acid Aspirin
• The first Q to ask oneself about a case of poisoning or
toxic exposure are: ■ With what? ■ In what quantity? ■
When
• POISONING WITH INGESTED DRUGS AND CHEMICAL
Organophosphate and carbamate insecticides
Anticoagulants (warfarin, rat poison)
Petroleum products
Caustics
Disinfectants and bleach
Dangerous prescription drugs
• POISONING FROM EXPOSURE TO COMMON GASES OR
VAPOURS
Carbon monoxide
• Cyanide
• Irritant gases – phosgene , chlorine , ammonia
• Carbon dioxide
• Flammable liquid vapours
• Freons and Hydrogen sulphide (“Rotten egg gas”, “Sewer gas”
• BITES AND STINGS Rat Snakes and Gellyfish
• Note
■ A pt may not say what the drug or chemical was
■ Pts may take several substances at the same time
■ Supportive care in poisoning consists of reducing the
absorption of any poison still in the bowel with activated charcoal
• What to do
■ Search the pt’s cabin and belongings for empty medicine
containers or a suicide note
■ Check the pt’s work environment for opened containers of
toxic chemicals, especially insecticide and rat poison.
■ Check the medical records to see if the pt has been prescribed
any medication, either on board or ashore.
■ Remember that tablets and capsules can be identified by their
colour, size, shape, and markings: seek medical advice if you find
unidentified medicines
Examine the pt, paying particular attention to
● pupil size
● mental state (drowsy/alert) – assess with the Glasgow Coma Scale –
rational/confused, sad/euphoric
● vital signs
Decide to which drug type the pt’s condition corresponds
● amphetamine-like
● belladonna-like
● sedative-hypnotic
● insecticide-like
● tricyclic antidepressant
For symptoms and signs of intoxication with opioids and
hallucinogens, see Chap 22, Tobacco, alcohol, and drug use
Seek medical advice at this point
Red flags
• Plan for evacuation of the pt if ANY of the following
signs, symptoms or conditions are present
■ GCS score of 6 or less
■ agitation severe enough to need restraint
■ systolic BP less than 100 mmHg
■ seizures (fits, convulsions)
■ PR irregular or less than 50 beats per mins
■ evidence of poisoning with slow-release tablets (often
labelled “SR” or “ER” on the packet, after the trade-name
■ chest pain
■ poisoning by a dangerous prescription drug
• Paracetamol poisoning is common, largely because the drug is
easily available. An overdose can cause liver damage
• Note ■ Liver damage is likely in an adult after a single dose of para
15 g (30 tablets). ■ Severe liver damage is almost certain to occur in
an adult after a single dose of para 20–25 g (40–50 tablets).
• Signs and symptoms ■ In the first 24 hrs: ● no symptoms, even
after a large overdose. ■ After 48 hrs: ● pain and tenderness in the
right upper abdomen ■ After 3 to 4 days ● evidence of severe liver
damage
• What to do ■ If the pt has taken an overdose less than 4 hrs
previously, give activated charcoal, 1 g/kg BW ■ If the pt has taken an
overdose more than 4 hours previously, the drug will have been fully
absorbed: consider if the amount taken is dangerous. ■ If you
suspect that the pt has or is likely to develop liver damage, arrange
for evacuation
• Acetylsalicylic acid (Aspirin) There are several closely
related forms of salicylate , which all produce the same signs and
symptoms of poisoning
 Aspirin tabs used to relieve pain and fever
 salicylic acid - ointment for warts;
 methyl salicylate (oil of wintergreen) - liniment for sore muscles and joints
• Note ■ A dose of 10 g (30 tablets) of acetylsalicylic acid or two
teaspoons of oil of wintergreen is dangerous in an adult.
• Signs and symptoms
■ Rapid breathing
■ nausea and vomiting
■ ringing in the ears (tinnitus), which is nearly always present and is
typical of salicylate poisoning
• What to do ■ Give activated charcoal, 1 g/kg BW. ■
Repeated doses may be needed but give them only on medical
advice.
• Methanol and ethylene glycol are used in anti-
freeze and deicing liquids, in some cleaners and solvents, and in
illicit (“moonshine”) alcohol.
• Note
• Swallowing more than 150 ml of anti-freeze containing this is
likely to be fatal
• When first swallowed, it cause intoxication similar to that
caused by alcohol but they are converted by the body to toxic
acids that can cause blindness (in the case of methanol) and/or
kidney damage (in the case of ethylene glycol
• What to do
• Seek medical advice immediately if you believe that early
evacuation may be necessary
• Retrieve the original container and have it available when you
seek advice.
• Ethanol
• can slow or prevent the formation of the toxic acids responsible
for the poisoning
• therefore, if evacuation is not possible immediately
• give one standard drink of a concentrated form of ethanol
(whisky, vodka, etc.) per 10–15 kg BW over one hour; FOLLOWED
BY
• one to two drinks per hour (adjust the dose to keep the pt
obviously drunk but not staggering).
• What not to do
• DO NOT give activated charcoal: it is of little benefit in methanol
and ethylene
Organophosphate and carbonate
insecticides
• Signs and symptoms - profuse saliva , tears , sweating ,
diarrhea , frequent urination , small pupils , slow pulse , wheezing
• The most dangerous symptoms – excessive lung
secretions , wheezing muscle weakness , if not sure if the pt has
taken organophosphate , give atropine 1 mg IM
• What to do – give activated charcoal , 1 g/kg BW , put on
rubber gloves , remove all of pt’s clothing and wash contaminated
skin with soap and water , give O2 with high flow rate , give
atropine , 2 mg IV at once ; double every 5 mins until pt stops
coughing and wheezing
• Arrange for emergency evacuation
 Petroleum products
• Are generally not absorbed from the bowel
• poisoning result from lung exposure
• Petrol (gasoline)
• turpentine
• kerosene and
• cigarette lighter fluid cause lung inflammation if they enter the
lungs
• Petrol , propane ,
• butane benzene and
• toluene from vapors easily pass through the lungs into the blood
and carried to the brain
 Signs and symptoms
• breathlessness
• cough (in case of lung inflammation)
• drossiness ,confusion ,
• slurred speech (if the brain is affected)
What to do
• remove contaminated clothing to prevent further exposure and
have the pt shower with soap for 10 minutes
• If there evidence of lung damage
• seek medical advice with a view to evacuation
Caustic

• Strong alkali , such as sodium or potassium hydroxide found

in drain cleaners and
• strong acids , such as sulphuric and phosphoric acid found in
toilet cleaners
• Causes burns to the esophagus and stomach

• Signs and symptoms – vomiting , pain in chest and

upper abdomen

• What to do – seek medical advice with a view to urgent

evacuation
Cyanide
• Cyanide is used to fumigate ships

• Exposure can occur if fumigation is carried out carelessly

• Sodium and potassium cyanides are solids , hydrogen cyanide is a

gas which is lighter than air
• Signs and symptoms
• irritation of eyes and nose , difficulty breathing and headache ,
• vomiting ,confusion ,seizures and coma ,death after 5 -10 minutes
of exposure
Irritants gases – phosgene , chlorine and
ammonia
• Heavier than air and accumulate at the bottom of enclosed
spaces

• Signs and symptoms

• irritation of eyes , skin , nose , throat ,lungs and airways ;
• severe burns , cough and breathlessness ,burning of eyes
especially with ammonia exposure

• What to do – seek medical advice with a view to evacuation

of pt , give O2 by a non rebreathing mask at the highest possible
flow rate ,treat eyes burn as directed eye injuries and diseases
Carbon dioxide
• CO2 - One of the most abundant gases in the atmosphere
• Is formed during respiration , combustion and organic
decomposition ,
• is used in food refrigeration , carbonated drink ,fire extinguishers
and aerosol , not toxic but displaces breathable air from enclosed
space ,heavier than air and accumulates at the bottom of
enclosed spaces

• Signs and symptoms – Breathlessness headache ,a

feeling of warm and sweatiness

• What to do – remove the pt from the area of exposure