Let’s continue with preparing to treat accidental and intentional poisonings. The only off-grid medicine text providing this information is The Ship’s Medicine Chest and Medical Aid at Sea, from which all the following is taken.
Central Nervous System Depressants
(as Barbiturates, Tranquilizers, Sedatives, and Alcohol)
Various preparations of these central nervous system depressants have been given descriptive synonyms by users which include the following, among others: knockout drops, downers, and sleeping pills. (See p. 210.)
These depressants affect the nervous and cardiovascular systems. Excitement and hallucinations may precede the depression, which varies from stupor to coma. Respiration decreases, blood pressure falls, urine output decreases, and shock may occur.
Treatment
If there is difficulty in breathing, oxygen should be administered. Artificial respiration should e administered if breathing has stopped. (See p. 115.) If the patient is conscious, induce vomiting unless the patient is very drowsy. Stimulants (such as caffeine or amphetamines) should not be used. If coma or stupor occur, medical advice by radio should be obtained.
Narcotics
(as Morphine, Meperidine, Codeine, Paregoric)
The drug propoxyphene is included in this group. Although it is not classified as a narcotic, the treatment is the same.
Respiratory arrest is the main cause of death with these compounds. Some of the symptoms of poisoning are drowsiness, respiratory depression, convulsions, and coma.
Treatment
Naloxone, a narcotic antagonist given by injection, is the specific antidote for treating respiratory depression in poisoning by narcotics. (See p. 284.) Oxygen and artificial respiration should be administered, if respiratory difficulties develop. Obtain medical advice by radio.
Stimulants
(as Amphetamine, Cocaine)
Various preparations in this group have been given descriptive synonyms which include the following: bennies, speed, meth, uppers, and snow.
These are central nervous system stimulants. Effects from an overdose include excessive activity, frenzied excitement, exaggerated reflexes, tremors, fever, dilated pupils, and sweating. Sometimes coma and convulsions, elevated blood pressure, very rapid heart action, and irregular heart beat will occur. These patients often display aggressive behavior and feelings of persecution, and are capable of violent action.
Treatment
Actions that might be interpreted as antagonistic should be avoided and one should remain calm while talking to the patient. Diazepam 5 to 10 mg may be given intramuscularly every 4 hours, for sedation. Medical advice by radio should be obtained on the dosage and frequency of medication.
Antihistamines
(as Cyclizine, Diphenhydramine)
Symptoms of poisoning with these drugs are lethargy or drowsiness, followed by coma. Some patients exhibit excitation, nervousness, and convulsions.
Treatment
If the patient is conscious, induce vomiting unless the patient is very drowsy. If respiratory difficulties develop, oxygen and artificial respiration should be given. If convulsions occur, the treatment given on p. 212 should be followed. Medical advice by radio should be obtained for additional treatment.
Salicylates
(as Aspirin, Methyl Salicylate, or Oil of Wintergreen)
Poisoning by a salicylate results in rapid, deep, and pauseless breathing because of the direct effect on the brain. Vomiting, extreme thirst, profuse sweating, fever, and convulsions or delirium may occur. Shock, coma, convulsions, a decreased urine output, and blood in vomitus may appear as the intoxication becomes severe.
Treatment
Unless the patient is convulsing or unconscious, vomiting should be induced immediately or a gastric lavage performed. For an adult, 50 or more tablets of aspirin, 300 mg (5 grains) would be a potentially poisonous quantity. Also, about 15 ml (1/2 ounce) of oil of wintergreen may be poisonous. If convulsions occur, the treatment given on page 212 should be followed. Seek medical advice by radio.
Reference: The Ship’s Medicine Chest and Medical Aid at Sea, 1978, 111-13.
