Choosing Wisely: Toxicology

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Choosing Wisely logoThe Choosing Wisely campaign, conceived by the National Physicians Alliance, provides evidenced-based and practical recommendations in a number of clinical disciplines to help patients and physicians make good decisions. The campaign focuses on clearing up misconceptions and avoiding unnecessary and costly interventions.

The American College of Medical Toxicology and the American Academy of Clinical Toxicology have created a list of 10 items that are relevant to primary, emergency, and specialty care providers regarding specific toxicological treatment and evaluation.

The Northern New England Poison Center has nurses, physicians and pharmacists ready to assist you 24/7. Let us help you choose wisely when a toxicology-related question arises, or even if you are unsure if it’s toxicology related. Call 1-800-222-1222.

Choosing Wisely, Toxicology: Ten Things Physicians and Patients Should Question
American College of Medical Toxicology and American Academy of Clinical Toxicology

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Stay safe this Halloween

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Jack-O'-Lantern
Jack-O’-Lantern by William Warby. Creative Commons.

For many of us October means Halloween—picking out costumes, carving pumpkins, and maybe dipping into the candy stash a little too early!

While a little spookiness is part of the fun, none of us want anything actually scary to happen. Follow these tips for a fun and safe Halloween:

  • Dress trick-or-treaters in brightly colored costumes made of flame-resistant materials. Add reflective tape to costumes or trick-or-treat bags to make sure your child is visible after it gets dark.
  • If you use makeup, test it on a small area of skin first. Keep an eye out for skin irritation or an allergic reaction, such as a rash or itching. If this happens, remove the makeup right away with soap and water. Remove all makeup before bedtime to prevent skin and eye irritation.
  • Keep an eye on kids playing with glow sticks. They can break and sometimes children chew them open. The insides of a glow stick can irritate the skin and eyes and cause an upset stomach.
  • Bring along your own candy to give your children while trick-or-treating so they will not eat candy you have not inspected from their bags.
  • Inspect all treats before kids eat them. Only eat treats that are in their original, unopened wrappers. Throw out candies with wrappers that are faded, have holes, tears or signs of rewrapping.
  • Keep candy, such as chocolate, away from dogs and other pets. It can be poisonous to them.
  • Keep candle-lit jack-o-lanterns off doorsteps and out of the way of foot traffic. They can be a fire hazard for trick-or-treaters with long or flowing costumes.
  • Keep dry ice out of drinking glasses. Dry ice can cause frostbite if it touches your skin or mouth.

Most importantly, always supervise your child, and remember you can call the poison center at any hour at 1-800-222-1222 or chat online if your child chews on or swallows something that may be harmful.

Posted in Poison Prevention | Comments Off on Stay safe this Halloween

Make poison prevention part of your emergency preparedness plan

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The right preparation can help you get through an emergency. For a poisoning, that includes having the poison center help line, 1-800-222-1222 saved in your phone.

For other emergencies, such as natural disasters, it’s important to be prepared to take care of yourself and your family for at least three days. Follow these three steps from the Federal Emergency Management Agency:

  1. Family prepares for emergencies
    Every September is National Preparedness Month. Photo from ready.gov.

    Make a kit

    • Pull together items your family will need during a disaster. Visit www.ready.gov for a list.
    • Make sure your kit includes at least a three-day supply of any medications you need.
    • Keep the kit out of the reach of children.
  2. Make a plan
    • Choose someone you know in a different town that you can have your family call if you are separated.
    • Set up a meeting place for your family to gather.
    • Check with your workplace and your children’s schools to find out what their emergency plans are.
  3. Be informed
    • Learn about different types of emergencies and how they can affect your family. This will help you make quick changes to your family plan. Visit www.ready.gov for a list of possible dangers you could face.                                                                        

You can be prepared for personal emergencies by saving other important help lines in your phone. Visit the NNEPC’s R U Prepared program page for more information.

Posted in National News, Poison Prevention | Comments Off on Make poison prevention part of your emergency preparedness plan

Fentanyl and carfentanil exposures in first responders

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Download this as a printable fact sheet

Summary

The risk of significant opioid exposure is minimal for first responders who encounter fentanyl, carfentanil or other fentanyl analogs in the field. The evidence suggests that limited precautions, such as nitrile gloves, provide sufficient protection from harm. Use of excessive protective equipment could delay patient care and prevent first responders from performing their duties well.

Background

Fentanyl and fentanyl analogs, such as carfentanil, are very powerful opioid drugs sometimes found in or sold as heroin, leading to accidental overdoses. First responders have concerns about the risk associated with performing their duties when these drugs may be involved. The Drug Enforcement Agency and the National Institute for Occupational Safety and Health have warned of potentially significant harm and suggested protective equipment. Anecdotal reports suggest that minimal exposure while performing normal duties can cause dizziness or feeling like one’s body is “shutting down.” However, no reports have yet involved clinical effects consistent with a significant opioid poisoning. The evidence to date indicates there is minimal risk to first responders encountering patients who have overdosed on these substances or encountering situations involving small amounts of the drugs. First responders need to balance safety with mobility and efficiency.

Risks

Risks from inhalation, skin exposure and eye exposure are all minimal.

  • Inhalation: Even in circumstances involving manufacturing of fentanyl and analogs, nearly 200 minutes of exposure is required to reach a starting dose of fentanyl. It is extremely unlikely a significant exposure would occur in a first responder.
  • Dermal: Therapeutic fentanyl patches intended for skin absorption require prolonged contact time, an occluded area and a delivery system. Short exposure to powder which is then brushed or washed off with water would be extremely unlikely to lead to significant absorption. Note: Alcohol hand sanitizers will not remove the drug and may increase absorption.
  • Ocular: Eye contact is unlikely, but should be avoided.

Treatment

Naloxone is indicated only for a patient who has respiratory depression—a patient breathing very slowly or not at all. These patients will also be unarousable or unconscious. Although limited information is available related to fentanyl and its analogs, animal data suggest that humans should respond to naloxone in these cases. Note that large doses, greater than 10 mg, are unlikely to be helpful.

Recommendations

Standard precautions are reasonable, despite limited data.

  • Recognize opioid effects:
    • Drowsiness (naloxone NOT indicated)
    • Pinpoint pupils (naloxone NOT indicated)
    • Respiratory depression (naloxone indicated)
  • Dermal protection:
    • Use nitrile gloves for routine handling (evidence processing)
    • Wear coveralls in heavily contaminated areas
  • Eye protection:
    • Safety goggles/glasses if face splashing is expected (unlikely)
  • Respiratory protection:
    • N95 or P100 ONLY IF there are significant amounts of powder in the air (unlikely)
  • After skin or eye exposure:
    • Wash with large amounts of water if the skin or eyes are exposed
    • Do not use hand sanitizer

Adapted from the ACMT/AACT position statement “Preventing Occupational Fentanyl and Fentanyl Analog Exposure to Emergency Responders.”

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How to use bug spray safely

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Summer is here and many of us in northern New England will be spending more time outside. It’s a busy time for everyone, including the Northern New England Poison Center. During the warmer months, the poison center manages many calls about pesticides, such as insect repellants, often  referred to as bug spray.

Insect repellants with DEET can be very effective at preventing bites from mosquitos, ticks and other pests. This can this help you avoid pain and itchiness from bites, and also help prevent diseases such as Lyme. Depending on the amount of DEET in the product, an insect repellent will keep ticks away for two to ten hours, and mosquitoes for two to twelve hours.

Use insect repellants safely by following these steps: 

  • Read the directions on the product label each time you use it, and follow the directions carefully.
  • Do not apply insect repellant over cuts, wounds, or irritated skin.
  • Do not apply it near your eyes or mouth.
  • Wash the product off with soap and water once you are indoors, and wash treated clothing before you wear it again.
  • Call the poison center at 1-800-222-1222 if you spray into eyes or get in mouth, or if you think you are having a bad reaction to DEET.

Take special care with children. Products with a concentration of 30% DEET or less have been shown to be safe for children older than two months. An adult should always apply insect repellants to children. Avoid using the product on children’s hands.

Pesticide SafetyGuide to reading a pesticide label

Pesticides include many more products than just insect repellants, though. Common pesticides found in the home include weed killers, ant traps, flea treatments, rat poison and disinfectants. Every product classified as a pesticide is required to give standard information on the label. Click on the graphic to the right for a guide to reading a pesticide label.

Here are some general tips for using pesticides safely:

  • Read and carefully follow the directions on the pesticide label for use, safety, storage and disposal. Read the label each time you use the product.
  • Use pesticides in a well-ventilated area and keep kids and pets away during application.
  • Never use an outdoor-use pesticides indoors.
  • Store all pesticides out of reach of children and pets.
  • Keep pesticides in their original labeled containers, and store them separately from food, drinks, medications and other products.
  • If you have pesticides you no longer need, be sure to dispose of them properly. Call your town office or local waste facility to find out the best way to get rid of these products in your community.

If someone swallows or inhales a pesticide, or gets one in their eyes or on their skin, call the poison center at 1-800-222-1222, chat online or text POISON to 85511. The poison center is available 24/7, and all calls are free and confidential.

For general questions about the choosing, storing or using pesticides, call the National Pesticide Information Center at 1-800-858-7378 or visit npic.orst.edu.

Crossposted with the UVM Medical Center blog.

Posted in Poison Prevention | Comments Off on How to use bug spray safely

Fiddleheads: How to safely enjoy a seasonal treat

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There is a rich tradition of foraging for fiddleheads in northern New England. These wild-growing ferns can be a tasty treat, as long as you take care when harvesting and cooking them.

Ostrich fern fiddlehead by David Fuller
Ostrich fern fiddlehead by David Fuller, UMaine Cooperative extension

Find only ostrich ferns

The fiddleheads we know as a regional delicacy are the coiled fronds of the ostrich fern. They take their name from their similarity to the scrolls at the top of a violin. These ferns grow in the early spring, generally in a four- to six-week window between late April and early June.

Most types of ferns have fiddleheads, though, so it’s important to be sure you can expertly identify the ostrich fern before you go foraging. Other types of fern may not be nearly as tasty—and can be harmful.

The University of Maine Cooperative Extension has a helpful guide to identifying ostrich ferns. If you are unsure, it’s better to play it safe.

Thorough cooking is key

Eating raw or undercooked fiddleheads has been associated with a number of outbreaks of foodborne illness over the years. While the exact cause of the food poisoning is not known, symptoms are similar to other kinds of foodborne illness, including vomiting and diarrhea. These symptoms may show up in as little as half an hour, but can take as long as 12 hours to appear.

Take these steps to lower your chances of getting foodborne illness from fiddleheads:

  • Wash the fiddleheads thoroughly, until the brown, papery covering has rubbed off and the water runs clean.
  • Cook the fiddleheads thoroughly before using them in any recipe. You can steam them in the microwave or on the stove for 10-12 minutes, or boil them for about 15 minutes.

If you have questions about fiddleheads, poisonous plants or foodborne illness, remember the poison center is here 24/7 to help. Just call 1-800-222-1222 or chat online.

Posted in Poison Prevention, Regional News | Comments Off on Fiddleheads: How to safely enjoy a seasonal treat

Three ways you can help prevent poisonings: Safe use, safe storage, safe disposal

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Most poisonings that happen at home involve products like medications and cleaners. Following three basic principles when it comes to medications and household products can help you prevent poisonings and make you and your family safer.

SAFE USE

Follow all the directions on the product packaging. Read the directions each time you use the product.

A medicine cabinet  
Storing your medications up high in a locked cabinet can help prevent poisonings.

For medications, the directions may include information like:

  • When to take it and how often
  • Whether to take it with food or water
  • Whether you need to avoid alcohol, certain foods, or certain other medications

 If it is a prescription medication, it should only be taken by the person it was prescribed to.

It’s important to know what medical conditions your medications are for. If you are uncertain, have a conversation with your doctor or pharmacist.

For cleaning products, the directions will give you information such as:

  • How to apply the product
  • Whether you need to dilute it by mixing it with water
  • Whether you need to ventilate the room while using it
  • Whether you need to wait awhile before returning to the room

Many other household products will have directions on the label for safe usage. A few examples are:

  • Pesticides, such as bug spray and weed killer
  • Art and office supplies
  • Personal care items, such as deodorants and dental products.


SAFE STORAGE

Keep all potentially poisonous products up high, out of the reach of children and pets—in a locked cabinet if possible.

Re-seal the product as soon as you are done using it, and put it away as soon as possible.


SAFE DISPOSAL

The best way to prevent poisonings is to have as few potentially poisonous products in your home as possible. For that reason, it’s important to safely get rid of products you no longer need as soon as possible. These can include:

  • Expired medications
  • Cleaning products you no longer use
  • Broken household items such as compact fluorescent lightbulbs

Disposal methods depend on the type of product, as well as state and local regulations. If the product label does not give directions on how to get rid it, try contacting your town office. Many towns have specific medication take-back days or household hazardous waste collection days for items such as old cleaners and broken CFLs.

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Are your art supplies toxic? Look for the ACMI seal

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Have you ever walked into a room to find a child’s face covered in marker ink?

Fortunately, most common kids’ art supplies are nontoxic, and a quick call to the poison center at 1-800-222-1222 can put your mind at ease.

You can also get some peace of mind when you buy art supplies by looking for a seal from the ACMI—the Art and Creative Materials Institute. Most art supplies have one of two ACMI seals.

  • ACMI AP SealIf the product has the AP seal, which stands for approved product, that means it has been certified as nontoxic. Products with the AP seal do not have any materials in a large enough quantity to cause short- or long-term health problems. These include products like crayons and children’s markers. All products aimed at children fall into this category.
  • ACMI Cautionary Labeling SealIf the product has the CL seal, which stands for cautionary labeling, that means the product is safe if it is used according to the directions, but may cause some harm if used improperly—for example, if a child swallows it. These include products like glazes, spray paints and rubber cement. The ACMI recommends that children in grade 6 or lower not use these products.

Learn more about the ACMI seals on the organization’s website. Note that the ACMI only certifies products that are sold as art supplies, not office supplies or home improvement products.

Keep in mind that even though most art supplies are not poisonous, they may present a choking hazard. Keep small pieces out of the reach of young children, and keep an eye on young kids when they are using art supplies.

For more information on a few specific art supplies, visit these pages in our A to Z index:

Posted in Poison Prevention | Comments Off on Are your art supplies toxic? Look for the ACMI seal

Eyes, nose, mouth, skin: Four ways poisons can enter the body

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Woman with eye irritation
Many substances can be irritating to the eyes, and the poison center can help. Call 1-800-222-1222.

When you hear the word poisoning, what comes to mind? Is it a young child swallowing something, like a cleaning product?

While swallowing something, such as a medication or a household product, is the most common reason people call the poison center from home, there are several other ways potential poisons can enter the body. Fortunately, the Northern New England Poison Center is here to help you with all of them. Just call 1-800-222-1222, chat online or text POISON to 85511.

Here are the most common ways besides swallowing that poisons enter the body.

Getting something on your skin: Many things can cause symptoms if they come in contact with your skin. Some examples are:

  • Mild irritation from getting gasoline on your hands
  • Itching and burning from touching poison ivy
  • Severe chemical burns from products like drain cleaners

The poison center can give you over-the-phone advice for cleaning up safely and walk you through any other steps you may need to take at home. The poison specialist will also let you know whether you need to go to your doctor or the hospital.

Getting something in your eyes: The eyes are one of the most sensitive parts of the body, and many common products can be quite irritating or even harmful to your eyes. They may cause symptoms like:

  • Burning or stinging from breaking a glow stick open
  • Corneal abrasions from squirting laundry pod liquid
  • Sealing your eyelid shut from mistaking glue for eye drops

The poison center will let you know what to do in each of these cases. Often all you will need to do is rinse your eyes with warm water, and the poison specialist will walk you through the best way to do that. In other cases, the poison center may recommend another treatment, or may suggest you see your doctor or go to the hospital.

Breathing something in: Many fumes and gases can cause symptoms. These can be short-lived, like a headache from briefly inhaling the fumes from an aerosol (spray paint, hair spray), or more serious, from breathing in a dangerous gas like carbon monoxide.

If you are having symptoms after breathing something in, or if your carbon monoxide alarm is going off, get to fresh air. The poison center will let you know when it is safe to go back inside, and will let you know whether you need medical treatment.

Remember the poison center is here for you 24/7, offering quick expert advice in all kinds of situations. Just call 1-800-222-1222, chat online or text POISON to 85511.

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Are you at risk for a medication interaction?

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Woman holding two pill bottlesDo you regularly take more than one medication?

The more medicine you take—including prescription medications, over-the-counter medications and supplements—the more likely you are to have a medication error or a harmful interaction between your medications.

The risks are especially high for older adults, who often take multiple medications. According to a study released this year, about 1 in 6 adults age 62 and older are at risk for a harmful drug interaction.

What can you do to decrease your risk?

  • Keep a list of all the medications you take, including supplements and natural products.
  • Share this list with your health care provider and your pharmacist at every visit.
  • Fill all your prescriptions at one pharmacy if possible. This makes it easier for your pharmacist to identify possible prescription drug interactions.
  • Keep track of your medication schedule. Consider using a written calendar and checking a box each time you take a medication.

The poison center is here to help. Call 1-800-222-1222, chat online or text POISON to 85511 if:

  • You took the wrong medication
  • You took too much of your medication
  • You took your medication at the wrong time
  • You aren’t feeling well after taking a medication
Posted in Medication Safety | Comments Off on Are you at risk for a medication interaction?