# Double Poisoning



## spnjsquad (Jun 23, 2014)

I actually had a call like this a while back. A pregnant mother and her daughter live in a comlex where the laundry room is in another part of the building. The mother says she doesn't like carrying the huge laundry bottle back and fourth to do laundry, so she stores it in a water bottle. One night, her 3 year old takes the water bottle with the detergent in it (clear, no odor) and takes a few sips. She hands it to her mom and says it doesn't taste good, so the mom checks herself and takes a swig. You walk in, and they are both sitting on the floor with vomit everywhere, and they both complain of dizzyness. The dad can't drive them to the hospital because he's had a few drinks. You only have one ambulance with you, but you have a full crew at the station ready with the second one.

Mother: BP: 130/70, Pulse: 125, RR:22, Temp. 99.1, o2 Sat: 98%
Child: BP: 115/62, Pulse: 130, RR:30, Temp. 101.1, o2 Sat: 81%

Where would you go from here?
Tell me if I missed anything!


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## STXmedic (Jun 23, 2014)

Call poison control to get their recommendation, and transport both. No need for a second ambulance.

I'd be curious as to exactly what they ingested. I wouldn't have guessed a standard detergent would cause vomiting and dizziness after just a single swig.


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## EMSComeLately (Jun 23, 2014)

Put them both in the same ambulance and transport.  O2 for the kid at least.  Contact poison control and bring the detergent bottle with you.  Consult with med control on any poison control interventions. 

And kick the dad in the sack for being an irresponsible drunk? (Jk...or am I?)


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## NJEMT95 (Jun 23, 2014)

EMSComeLately covered it for the most part.

The kid is emergent enough that I wouldn't want to wait for another rig. Kid on the cot with NRB (or blow-by if she won't tolerate the mask) and monitor the mother on the bench seat. Bring the detergent (water bottle & original container along) and contact poison control. No need for ALS at this point, but I would make sure to notify the hospital en route. If dad won't be a nuisance, let him ride up front if he wants.
Although, I am surprised that such a small amount of detergent caused all these symptoms especially in an adult.


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## DrParasite (Jun 23, 2014)

one on the cot, one on the bench.  call poison control.  take both to the hospital.

as long as they are both concious, and there are no airway complications, no need for a second ambulance.


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## Rialaigh (Jun 23, 2014)

likely transport both with the kid on the stretcher. Would really depend on the presentation of the kid and how long ago they ingested. 81% SPO2 is not a good number but patient presentation would dictate entirely how to proceed with a child this age. I mean if this happened 10 minutes ago and the kid is tanking rapidly (minute by minute) and hospital is a ways away I would really have to think hard about securing an airway in the child prior to transporting (and calling for a second unit for the mother then). If the 81% comes right up with a non rebreather and the child is not rapidly tanking then sure a nice smooth ride to the hospital is in order. 

The last place I want to be is riding code 1 for the next 25 minutes with an unresponsive child, a panicking mother, no secure airway, and vomit everywhere with no easy fix in sight. 


Maybe give some more information on how the child presented, able to walk? airway clear? altered? etc...


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## medichopeful (Jun 23, 2014)

spnjsquad said:


> I actually had a call like this a while back. A pregnant mother and her daughter live in a comlex where the laundry room is in another part of the building. The mother says she doesn't like carrying the huge laundry bottle back and fourth to do laundry, so she stores it in a water bottle. One night, her 3 year old takes the water bottle with the detergent in it (clear, no odor) and takes a few sips. She hands it to her mom and says it doesn't taste good, so the mom checks herself and takes a swig. You walk in, and they are both sitting on the floor with vomit everywhere, and they both complain of dizzyness. The dad can't drive them to the hospital because he's had a few drinks. You only have one ambulance with you, but you have a full crew at the station ready with the second one.
> 
> Mother: BP: 130/70, Pulse: 125, RR:22, Temp. 99.1, o2 Sat: 98%
> Child: BP: 115/62, Pulse: 130, RR:30, Temp. 101.1, o2 Sat: 81%
> ...



I'm currently studying for my nursing boards so my brain might be fried and I could be reading this wrong, but is there any chance the SpO2 for the kid is a typo or a possibly false reading?


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## chaz90 (Jun 23, 2014)

medichopeful said:


> I'm currently studying for my nursing boards so my brain might be fried and I could be reading this wrong, but is there any chance the SpO2 for the kid is a typo or a possibly false reading?


I'm thinking there's a pretty darn good chance it's an unreliable number...I don't know what kind of detergent she drank, but the presentation doesn't seem to match the event well.


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## Handsome Robb (Jun 23, 2014)

chaz90 said:


> I'm thinking there's a pretty darn good chance it's an unreliable number...I don't know what kind of detergent she drank, but the presentation doesn't seem to match the event well.




Tachy-lordia maybe. 

I thought the same thing. Something doesn't add up.


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## Underoath87 (Jun 24, 2014)

So, the mom actually took a swig of what I assume to be bleach, and swallowed it...after her kid warned her that there was something wrong with it?  Yikes.


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## spnjsquad (Jun 24, 2014)

Underoath87 said:


> So, the mom actually took a swig of what I assume to be bleach, and swallowed it...after her kid warned her that there was something wrong with it?  Yikes.


I actually did have a call exactly like this a while ago. It sounds weird, I know. I was thinking the same thing during the call. I couldn't remeber the paitents vitals though so I just plugged in numbers. Would it help if the detergent was oxy clean (a stronger detergent) and the kids SpO2 was 95 instead of 81?


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## DesertMedic66 (Jun 24, 2014)

spnjsquad said:


> I actually did have a call exactly like this a while ago. It sounds weird, I know. I was thinking the same thing during the call. I couldn't remeber the paitents vitals though so I just plugged in numbers. Would it help if the detergent was oxy clean (a stronger detergent) and the kids SpO2 was 95 instead of 81?



Same as what everyone else has said. Contact poison control and then contact medical direction. 

Kid on the gurney and mom on the bench or jump seat. Monitor vitals on both. Ideally IV/fluids and Zofran on both if still vomiting. O2 possibly for the kid. If it was at 81, I would also like to get a ETCO2. Safe transport to the hospital.


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## OnceAnEMT (Jun 24, 2014)

Underoath87 said:


> So, the mom actually took a swig of what I assume to be bleach, and swallowed it...after her kid warned her that there was something wrong with it?  Yikes.



Reminds me of when my folks stored gin in water bottles while on the lake. My little brother, 8 at the time, took a swig and swiftly initiated the refilling of the lake.

I'd begin a hasty search of the house depending on what the mom says. If she says it was the detergent and provides a location, go get it and call Poison Control. If she was AMS, I'd look quick but not dig too hard. Maybe even call Fire and get them to look. Anyway, big points are Poison Control and then transport both in the same truck, assuming they don't deteriorate (and my guess is that they didn't, or if they did, it wasn't for long. They didn't ingest much.) 

I'd be finding another pulse ox or readjusting if the kiddo presented 81%. Only zebra thought on this is an allergic reaction secondary to managing to aspirate some of the substance, which happened to be an allergen. Lung sounds. If trouble shooting fails, pop on 2-3L via NC and see what happens.


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## medichopeful (Jun 24, 2014)

spnjsquad said:


> \Would it help if the detergent was oxy clean (a stronger detergent) and the kids SpO2 was 95 instead of 81?



That would make a lot more sense! Some of the other vitals were elevated, but 81% for a simple detergent poisoning seemed off, especially with the rest of the clinical presentation.  81% is pretty dang low for someone without an underlying condition.


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## rmena (Jun 25, 2014)

Oxy clean breaks down into hydrogen peroxide which the body can handle but only in small amounts...what was the end result? Did you call the ER and follow up?


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## spnjsquad (Jun 25, 2014)

rmena said:


> Oxy clean breaks down into hydrogen peroxide which the body can handle but only in small amounts...what was the end result? Did you call the ER and follow up?


In the actual call we took both the mom and kid on the bench seat to the closest hospital (no lights or sirens) with no O2 or anything except emesis bags, brought the detergent but did not call poison control.


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## rmena (Jun 25, 2014)

Yeah I would have called poison control. Did they say that they had thrown up immediately after ingesting the soap? That could have saved them a great deal of gastric burning due to the caustic nature of H2O2.


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## spnjsquad (Jun 26, 2014)

rmena said:


> Yeah I would have called poison control. Did they say that they had thrown up immediately after ingesting the soap? That could have saved them a great deal of gastric burning due to the caustic nature of H2O2.


Yeah the mom said they both vomited within 2 minutes of them initially drinking it.


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## samiam (Jun 29, 2014)

rmena said:


> Oxy clean breaks down into hydrogen peroxide which the body can handle but only in small amounts...what was the end result? Did you call the ER and follow up?



Do they have liquid oxyclean?


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## Underoath87 (Jun 29, 2014)

samiam said:


> Do they have liquid oxyclean?



Yeah, but it comes in a spray bottle for stain removal.


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## spnjsquad (Jun 29, 2014)

Underoath87 said:


> Yeah, but it comes in a spray bottle for stain removal.


It comes in standard detergent bottles too. This is what they had: http://www.drugstore.com/products/p...d=183225&aid=338666&aparam=508794&kpid=508794


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## Underoath87 (Jun 29, 2014)

spnjsquad said:


> It comes in standard detergent bottles too. This is what they had: http://www.drugstore.com/products/p...d=183225&aid=338666&aparam=508794&kpid=508794



Yeah, but I imagine that it would be viscous like most detergents.  Couldn't confuse that for water.


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