Gwenn is a Senior Partner and Team Leader at the Indiana Poison Center at Methodist Hospital. When you call the Poison Center, you talk to Gwenn.
“My mom was an ER nurse and she was an inspiration to me. I enjoy helping people and being able to tell a parent that their child is going to be OK.”
Gwenn has five children who are her primary passion. She loves to read, collects books by some rather obscure authors, and enjoys embroidery and classic Broadway musicals.
You can read more about where Gwenn works at Clarian's ACallToChange.org website: Find Nursing Position in Indiana.
Whew, it’s another scorcher - hot enough to make your ears sizzle! Makes you break out into a sweat just thinkin’ about it! Am I talking about the weather? Well, I could be, especially with our unseasonal heat wave the past few weeks, but actually I’m not. What I’m really talking about is the Capsicum species, otherwise known as hot peppers!
Hot peppers, jalapeno peppers, habanera peppers, chili peppers – they’re a staple of Poison Center calls this time of year. The species grows well in Indiana and when they ripen and have to be prepared for storage, exposures (and calls to the Poison Center) sky rocket. That capsicum juice is HOT! When you get it on your skin, it burns - and without treatment, keeps on burning for 6 to 8 hours or longer. That can result in a pretty miserable afternoon or evening for the unlucky victim.
So, what should you do? First, repeat after me, “ALWAYS wear rubber gloves when working with hot peppers”. If you prevent the exposure, you’ll never have the sad experience of searching for relief from the burning pain of pepper juice.
What if it’s too late? What if you’ve already let the fierce pepper juice come into contact with your hands and arms, and now you are very, very sorry? The following tips and tricks should help you out!
First, you need to flush the exposed skin with comfortable temperature running water for 30 minutes. Lather well with a mild soap several times. Rinse with alcohol (rubbing alcohol or beer work well), to cut the oil, several times, and then go back to using water.
Once the flushing is done, the pain may be gone. If so, hurray! Make sure to change your clothes and launder them several times before you wear them again. And, from now on, ALWAYS wear rubber gloves when working with hot peppers!
If the pain continues, proceed to Step 2. You’ll need to apply zinc or magnesium based ointment or liquid to your skin. You can soak your hands and arms in an antacid like Mylanta® or Maalox®, or you can apply a zinc oxide ointment such as Desitin® diaper rash ointment to your skin, and then wear something such as white cotton socks over your arms. You should have significant relief within an hour or so. Re-apply the topical product as needed, until the pain is completely gone.
And finally, ALWAYS wear rubber gloves when working with hot peppers!
Keep in mind that you can call the Indiana Poison Center at 1-800-222-1222 any time for help with this and any other dermal, ocular, inhalational or oral poison exposure.
Gwenn
Gwenn Christianson, MSN, RN, CSPI
Senior Partner and Team Leader
Indiana Poison Center, Methodist Hospital
The first week in May is the week of the American Association of Poison Control Center’s national examination for Certified Specialists in Poison Information. As employees of Indiana Poison Center, passing this examination is central to our continued careers – we all must be certified to work at the Center. Certification involves passing the exam the initial time and then re-certifying every 7 years.
Four of my colleagues are taking the exam this year, 2 re-certifying and 2 certifying for the first time. Naturally the anxiety level around the center has been high. People are constantly quizzing each other, researching answers on-line, even digging out textbooks to confirm their conclusions.
While I appreciate the natural nervousness that comes with taking exams, especially exams upon which one’s job is dependent, I am always glad to see exam time come around each year. It does wonders for the level of intellectual stimulation in the center! Instead of approaching days as routine, RNs are starting each day looking for new and different things “that might be on the test.” “Old” topics are reviewed and novel themes are discovered. Fresh approaches to known subjects are suddenly found, resulting in new knowledge.
It would be delightful if we could each find it within ourselves to keep that “study” mindset available year round. If we were always open and ready to learn, actively seeking knowledge, not just waiting for it to be fed to us, think what a difference it would make in our careers and our enjoyment of them!
Gwenn
Gwenn Christianson, MSN, RN, CSPI Senior Partner and Team Leader Indiana Poison Center, Methodist Hospital
What does May in Indiana mean? The Indianapolis 500 race of course! Racing cars are on everyone’s minds, as we keep a close eye and ear on the results of Poles and Bumps and the Race itself. Races are fun to watch and of course cars are essential for most of us for transportation. At the same time, cars are also a source of toxins that can wreak havoc upon the individual who encounters them.
Starting with their fuel, cars are filled with fluids that can harm you. Gasoline is a hydrocarbon, which if swallowed and aspirated, can result in hydrocarbon pneumonitis. The end result can be devastating or even fatal. How might someone swallow gasoline?
Usually people do this when they are siphoning fuel from one vehicle to another. The moral of this is to never siphon orally! Motor oil and transmission fluid are also hydrocarbons, but because they are so much thicker than gasoline, they are much harder to aspirate, so are less likely to be a problem.
Other automotive fluids that are poisonous are radiator and windshield washer antifreezes. Radiator antifreeze contains ethylene glycol, while windshield washer antifreeze contains methanol. Both are extremely toxic in extremely small (teaspoons) amounts. Ethylene glycol can cause kidney failure, while methanol can cause blindness, and both can cause death, if very much is ingested. Brake fluid is similar to the antifreezes in toxicity.
How do people accidentally swallow these fluids? The most common error they make is to drain the fluid into a handy pop can or cup, which they then mistake for the can or cup that contains their drink. They take a big swig from it and unfortunately, one swig is enough to be a problem. Young children see the can sitting there and sip from it too – and can also wind up with serious problems.
Fortunately most hydrocarbon exposures don’t end up as aspiration pneumonitis and we have very effective treatments for both methanol and ethylene glycol exposures. Still, the best treatment for any exposure is Prevention. Don’t siphon gasoline or any automotive fluids. Drain automotive fluids into clearly marked waste containers and never use beverage containers for drainage purposes.
Enjoy May and Race Fans……. start your engines!
Gwenn
Gwenn Christianson, MSN, RN, CSPI Senior Partner and Team Leader Indiana Poison Center, Methodist Hospital
I took my 21/2 year old grandson to the library last week. Our library has a great children’s area. It has a big play area with a train table, a Lego table and a puzzle area.But he wasn’t interested in any of those – he wanted to play with my purse!Fortunately he was more interested in my car keys than any of the other contents.
Purses, book bags and other items you use to carry items you use daily, are all sources of potential poisons for the children in your life.Let’s take a look inside the average bag & see what should be avoided.
Makeup – generally not a problem
Perfume – contains alcohol, small amounts cause local irritation
Visine®,Afrin® etc – allergy nasal sprays & eye drops – extremely toxic in small amounts, can cause extreme sleepiness, respiratory depression and bradycardia
Medicine – whatever you are taking – remember, Child-Resistant Caps are just that – Resistant, not Child Proof!The average 2 year old can remove them after a few minutes work.
Inhalers – albuterol or other inhalers – can be a problem if used excessively
Tylenol®, Advil® - or other OTC pain killers – can always be toxic if a little one gets too much of them
Cough drops – choke hazards
Tums® – safe, choke hazard
Gum – Despite what you may have heard, swallowing gum does not cause “gum balls” to develop in your stomach.However, eating large amounts of sugar-free gum may cause diarrhea, because most of those gums are sweetened with sorbitol, a laxative.
Nicotine gum – potentially quite toxic. Eating 1 piece of nicotine gum is the equivalent of eating one cigarette, which is a problem for a small child
Cigarettes – one cigarette is potentially toxic
Tobacco Dissolvables® – Orbs, Sticks, Strips – one of these is equivalent to one or more cigarettes and children tend to eat several, since they look like candy
Cigarette lighters – contain butane, which is a hydrocarbon and can cause pneumonitis
Matches – large amounts can cause kidney problems
Sunscreen – not toxic but eating some may cause a child to vomit, since it has a slimy texture
Insect Repellent –most contain DEET, which is quite toxic. If a small amount of repellant is ingested it will cause only local irritation, but if a large amount is ingested it can cause seizures
Hand Sanitizer – contains ethanol, small amounts cause local irritation
Batteries – small button sized batteries are a risk if swallowed, because they can lodge in the esophagus without causing symptoms. All batteries can be a problem if ingested
Coins – the larger the coin the greater the risk if ingested because they can become stuck in the esophagus
Cold sore meds – often these contain camphor, which can cause seizures if enough is ingested
Hair Spray – contains ethanol, small amounts cause local irritation
Mace – greatest risk is being accidentally sprayed with the mace, which causes immediate pain and tearing and can cause respiratory irritation
Keys – not toxic, but not good for your teeth!
Cell Phone – pieces can come off & be a choke hazard
Pens & Pencils – may make a mess but are not toxic
So, keep your bag “up and away” from children and be aware of what dangers lurk inside.If you suspect a poison exposure has occurred, don’t wait, call the IndianaPoisonCenter at 1-800-222-1222 right away!
Gwenn
Gwenn Christianson,MSN, RN, CSPI Senior Partner and Team Leader IndianaPoisonCenter, MethodistHospital
A Light exists in Spring Not present on the Year At any other period - When March is scarcely here
A Color stands abroad On Solitary Fields That Science cannot overtake But Human Nature feels.
Part of human nature seems to be the overwhelming urge to touch and feel, to smell and taste, all that is a part of nature. Now that the days are growing longer and the weather is growing warmer, we find ourselves going outside to play or to relax and too often our encounters with Nature are somewhat less than benign.
I am thinking specifically of plants, and the almost irrepressible urge to eat them felt by some young children. And why not? Plants, and flowers in particular, are pretty, brightly colored, smell good – why wouldn’t they be something good to eat? And when you think of all of the plants we strongly encourage our children to eat – broccoli, lettuce, peas, beans, celery, squash, tomatoes, peppers – every color, shape and size under the sun – why should they see any difference in a leaf of lettuce vs. a leaf of a hickory tree? Why would yellow pepper strips be any different from yellow river reeds?
What plants are a problem? Well, the list is so long that there is no way I can cover it all in one short blog. If you want the entire list, you can get it by going online to www.clarian.org/poisoncontrol and downloading it, or you can call IPC at 1-800-222-1222 to request a free information packet be mailed to your home. I will talk about just a couple of poisonous plants below. Some of the more common landscaping plants that are toxic include Yews, Holly, Azaleas, and Rhododendron. Flowers include Lily of the Valley and Foxglove, as well as Morning Glory, Wisteria, and Delphinium. “Wild” plants that can be trouble include: jimson weed, nightshade, water hemlock, and acorns.
So, what do you do if an exposure occurs? First, make sure the child is awake and breathing normally. If not, call 911. If the child is OK, take a clean wet cloth and wipe their mouth out, removing all plant material. Wash their face and hands well with soap and water. Get a good sample of the plant (leaves, stems, berries, flowers – all of the different parts), then bring the child and the plant to the phone and call IPC at 1-800-222-1222. We will help you obtain a plant ID and have the child appropriately cared for, most often safely at home.
What can you do to prevent or prepare for an exposure? There are two main things:
Know what is in your yard!! Get a good plant guide or a knowledgeable friend or neighbor and go around and identify each plant, shrub, flower and tree in your yard. Label them with indelible markers. Make a map showing where each one is and the name(s). Remember, you may not be home when the exposure occurs, so relying upon your memory alone is not a good method!
Only buy non-toxic plants. Check the list of non-toxic plants. If the plant isn’t listed on our short list, does that mean it’s OK? NOT AT ALL! It just means we didn’t have room to include it. Call IPC BEFORE you purchase, with the common and scientific (Latin) name of the plant and we can look it up and tell you whether it is safe to have around little children. Don’t rely upon what birds or other animals eat – children aren’t birds and what birds can safely eat can sometimes be very dangerous for children!
Enjoy the lovely weather, while it lasts, and have a safe & happy Spring!
I really don’t have a math obsession, although sometimes it must seem as if I do to parents when I bombard them with questions like, “How many months old? How many minutes ago? How many pounds does she weigh?” What I do have is a fixation on accuracy, because accuracy is so important to my work.
Over the course of time, I’ve found that parents have an aversion to counting pills. In the world of the Poison Center, we count pills because we are trying to narrow down the number of pills a child could have ingested to a safe amount. “So, we started out with 24 tabs, you’ve used 2 doses of 2 tabs each, and you’ve counted 16 left, that means 4 tabs were ingested, right? 4 tabs x 160 mg/tab / 14 kg = 45 mg/kg and we don’t need to send him to the ER until he’s ingested more than 100 mg/kg, so he’s OK. That’s great!”
Or, we count pills because we want to establish the absolute maximum number of tablets the child could have ingested ….. “The bottle held 50, you’ve got 30 left and you know you’ve used at least 7 and probably more, so the maximum she could have taken would have been 13 …. 13 tabs x 200 mg/tab / 15 kg = 173 mg/kg - > 200 mg/kg is toxic, so we’re OK – let’s just watch her for an upset stomach or drowsiness ….”
Finally we count pills because sometimes, rarely but not impossibly, we are given the gift of finding all of the pills. “You know the bottle holds 100 tablets but you don’t know how many might have been taken already - why don’t you count them and we’ll see if that narrows the amount down to a safe range, OK? “98, 99, 100 – they’re all there!” “That’s great! That means he couldn’t have eaten any. That’s fantastic news, and I’m so glad you took the 2 minutes to count the pills to be sure.” At the end of the day, the finding of “no exposure” is the best count of all.
When people find out where I work, they inevitably ask what the funniest call I’ve ever received is. The answer to their question is easy - superglue calls!
Callers have used superglue to stick themselves to a wide range of items, and even though you sympathize with them and do all you can to help them, sometimes, when the call is complete, you have to laugh. Most commonly people have their fingers or hands stuck together. But we’ve had callers that were glued to the tile around the bathroom mirror, the basement floor in front of the washing machine and a cabinet door in the kitchen. The things they glue to themselves are equally funny – the superglue tube, of course, but also china, picture frames, Christmas ornaments, various vinyl items they are attempting to patch, jewelry, eyeglasses and miniature locomotives.
Superglue is not the only culprit, either. “Instant insulation” also sets up almost immediately and has a fierce attachment to whatever it touches.
What DO you do if you become attached to superglue? Of course, call IPC at 1-800-222-1222 and we’ll walk you through the instructions.
The main treatment is to remember the 2 main things NOT to do. Do NOT pick and pull at the glue or insulation – that will tear the skin and tissue below it. Do NOT use any kind of chemical on the glue or insulation (not nail polish remover, not gasoline or kerosene, not paint stripper) – that can burn the skin.
Soak the area in warm soapy water for about 20-30 minutes. If you are attached to a building or other item that can’t be submerged, use warm wet towels to wrap the area and get your skin as wet as possible. Then goop the area up with something greasy – baby oil, baby lotion, hand lotion, cooking oil, whatever you have handy – and massage that into the area for 20-30 minutes.
A couple of rounds of soaks and massage will loosen the bond of the glue from the skin and let everything come loose. Any remaining glue can be loosened with more soaks and massage or will fall off over a day or two. If you have any open areas, wash them with soap and water and apply antibiotic ointment and a bandage. Large open areas should be checked by a physician.
Something unusual has happened. An ivory-billed woodpecker hasn’t landed in my backyard and howler monkeys haven’t taken over my office, but something nearly as rare has occurred - we have an open position at the Indiana Poison Center!
One of our team members, “Deb,” has decided to flee the freezing temperatures and snow, ice and slush of Indianapolis and is headed for a warmer climate. This means her position is available for interested parties to pursue. This is truly unusual – our last open position was 3 and half years ago! Our staff members, in fact, have an average tenure of 13 years – with 6 of 15 being here more than 20 years – obviously those of us who work here, love it.
What is it like to work at the Indiana Poison Center (IPC)? You have to love to be constantly challenged and be happy with a consistently unpredictable work day. Each call is different and you never know who will be there on the other end of the line …. an anxious mother, a hurried ER physician, a belligerent intoxicated person, a freaked-out father, or a harried ICU nurse. Will the substance be a mild soap or an extremely toxic cardiac drug? Will it be a garter snake bite (non-toxic) or a cobra bite (oh no, neuro toxic!) Will there only be one toddler for your patient or a whole class of high school chemistry students that just mixed up some toxic fumes? Can you care for them at home or do you need to obtain EMS and a Hazmat consult while you’re at it? Can you juggle multiple cases, prioritize them, coordinate different protocols and databases and facilitate communication amongst different health care professionals, all at the same time?
These are just a few of the questions we deal with every day, every shift. Sound interesting? If you are an RN, preferably with ER or ICU experience, consider applying to IPC. The chance doesn’t come around too often – the next member of our team could be you!
I just finished a 12-hour shift. Maybe it’s the cold, cold weather, maybe it’s the post-holiday let-down, maybe it’s the phase of the moon… but there were an unusual amount of suicide attempts for the day shift today. Most intentional ingestions happen on evenings and nights.
(All details below changed to protect confidentiality.)
I talked to two concerned moms with distraught daughters. One was a 13-year old girl who took 10 Ibuprofen after her boyfriend broke up with her. The other was a 24-year old lady with a history of bipolar disorder and post-partum depression who took a double-dose of her Elavil®, “but wanted to take the whole bottle.” Fortunately, mom had wrestled the bottle away. I also spoke with the ER nurse caring for an 18-year old girl “whose parents are out of the picture” and who was brought in by her live-in boyfriend after they had an altercation. She had drunk half a bottle of Nyquil® and taken four tablets of Benadryl® – because she “wanted to go to sleep.”
Now, none of these sound like very serious ingestions to most people – they aren’t ingestions of hundreds of pills, they aren’t particularly toxic substances in the amounts ingested, and none of the patients were having significant symptoms when we were called. Still, each patient was referred to the ER for (or the ER was advised to provide) a thorough medical evaluation – on the general theory that a person who is upset enough to intentionally take an overdose can’t be relied upon to be the most accurate historian. Psychiatric evaluation was also recommended.
At some point you may encounter a friend, relative or acquaintance that has made a suicidal gesture. The circumstances (a teenage romance, the baby blues, a squabble with a boyfriend) may not seem very significant to you. The exposure itself may not seem particularly toxic. Of course, we recommend that you call Indiana Poison Center and let us help you determine what to do in each circumstance.
I encourage you to treat these events EXTREMELY SERIOUSLY for these reasons:
Although the “motive” may seem “insignificant” in your eyes, if the patient has judged it to be an adequate reason for an attempt, disastrous results may occur.
You don’t really know what has been ingested or the quantity involved and you shouldn’t wait to find out what may develop.
If initial suicidal attempts are ignored or minimized, subsequent attempts may be more aggressive.
What happened with these three young ladies? All three were medically evaluated and medically cleared. All were evaluated by the respective Crisis Teams at their facilities. Two were admitted for in-patient psychiatric care and one was referred back to her current therapist for on-going out-patient therapy. Were these ER evaluations worthwhile? Absolutely. They were a very effective method to establish physical stability and acquire an entry to the mental health system.
Someone may call on you for help. Be sure you are listening.
Oh the joys of the holiday season! The sweet smells of baking and evergreens, the glittering lights, candles, ornaments and tinsel, the crackling of wrapping paper, the glow of a cheerful fire, the lovely sounds of voices raised in song and laughter …… and the multitude of opportunities for poisoning abounding everywhere!
Here’s just a smattering of common exposures & their general risks:
Bubble lights – not a problem unless you drink more than one
Tiny glass bulbs – not a problem if you crunch one
Poinsettias – NOT toxic! If you eat the entire plant, you’ll vomit
Jerusalem cherry – toxic
Christmas cactus – not toxic
Flocking – not toxic
Tinsel – a problem for cats
Chocolate – a problem for dogs
Christmas ornaments – foreign bodies / choke hazards; ancient ornaments may have lead-based paint
Candles – “dry” wax is not toxic; Liquid candles or “wet” wax are aspiration risks
Oil lamps – aspiration risks
Plug in air fresheners – aspiration risks
Left over alcoholic drinks – hypoglycemic risks for kids
Cigarettes and cigarette butts – toxic
Silica gel (the desiccant in purses, stereos, new shoes) – not toxic, choke hazard
Button or disc batteries – toxic! Child will need an immediate X-Ray to locate the battery’s position; further treatment depends upon where the battery is.
Have a wonderful, joyous holiday time! Keep those little ones – and everyone else – safe. If you think an exposure has occurred, call the Indiana Poison Center at 1-800-222-1222 – we’ll be there 24/7, just like the rest of the hospital world, ready and waiting to help you if you need us.
“Indiana Poison Center, this is Gwenn RN, how may I help you?”
“My son just ate Santa Claus!” wailed the caller. “What am I going to do?”
Unique ingestions happen around the holidays. This one was perhaps more unique than is typical.
“Ma’am? Could you explain that a little more thoroughly for me? What do you mean, he ATE Santa?”
Turned out “Santa” was an antique glass ornament, handed down through the family, and mom had unfortunately hung it on a lower branch on the Christmas tree. Her 18 month old son had promptly grabbed the shiny object and bit off it’s head. The baby was fine, had no cuts in his mouth, and was able to drink juice without any problem. The tiny fragments of thin old glass would pass through his GI tract without problem, so only a little instruction on diet adjustment and observation during the next week was necessary.
How mom was going to explain this to Grandma was a whole other story, one that I couldn’t assist her with.
At Indiana Poison Center our staff are called Specialists in Poison Information, conveniently abbreviated as SPIs. Sometimes I think our Registered Nurse jobs should actually be known as real Spies, since we spend so much time digging out hidden information ...
Indiana Poison Center, this is Gwenn RN, how may I help you?
“This is Kate, the school nurse from Happy Valley Elementary. Several of our parents have seen this e-mail that is circulating about alcohol based hand sanitizer and the dangers involved if children should lick the hand sanitizer off of their hands. The parents want us to switch to alcohol-free hand sanitizer. Can you tell me anything about this?”
Well, I can tell you that as long as your students weigh more than 30 pounds and are licking less than a teaspoon of hand sanitizer from their hands, they are going to be perfectly fine. Ethanol based hand sanitizers typically contain 62% ethanol, and ingestion of a teaspoon or less in a 2 year old, 30 pound child is not enough to be a problem. If you have kindergarten aged children and above, they should weigh more than 30 pounds, so they should be fine. I’d be glad to e-mail you our news release on hand sanitizer – you’re not the only school nurse being besieged by parents who have read this mis-information and are worried about it!
“Hi, this is Dr House from Memorial Community ER. I have a guy here who says he shot up heroin, but he sure doesn’t act like it. He’s agitated, tachycardic and hypertensive. I remember seeing something about heroin that was contaminated ... Can you fill me in on that?”
Sure, Epi-X had an alert out on heroin that is contaminated with clenbuterol. It resulted in symptoms like you describe – agitation, tremors, hypertension, tachycardia – plus hypokalemia and hyperglycemia. Treatment is basically symptomatic and supportive care – benzodiazepines and temperature control, plus correction of the electrolytes. Would you like me to fax you the alert?”
A weeping mom: “I just gave my baby some Motrin and some cold medicine - Then my sister-in-law told me that ibuprofen and cold meds could kill him! She saw it on the internet! Should I take him to the Emergency Room?”
No, ma’am, you don’t need to take him to the hospital, he’s going to be perfectly fine. I’ve seen that internet entry too and it’s not true at all. It’s what we call an urban legend, or what they used to call an old wives’ tale. Ibuprofen, which is what’s in Motrin, and Dextromethorphan, which is the cough ingredient they’re concerned about, are not toxic together. Both are safe when used as directed, together or separately. I’ve checked several drug interaction sites and they have no drug interactions, and I’ve also checked some reputable web-sites that investigate web rumors like this and they say there’s no support for this one.
Indiana Poison Center, this is Gwenn RN, how may I help you?
8:00 am “My 20 month old, 19 pound daughter just took the medicine we had laid out for my 12 year old son. That’s Concerta® 36 mg, 2 tablets. Will she be OK?”
“Well, she’s going to need to come into the Emergency Room and be monitored for awhile. This is a pretty strong medication and it can affect her heart and her neurological status. But I think with appropriate care she’ll be just fine. What hospital will you take her to?”
08:05 amI called report to Community Memorial ER about the child who ingested the Concerta®. Talked to Kylie RN and suggested Activated Charcoal PO, EKG monitor, benzodiazepines if symptomatic, monitor for at least 6-8 hours for this SR product.
08:07 am “My 2 year old son just drank some cologne! He’s spitting and carrying on something awful! What should I do?”
Cologne has a lot of alcohol in it and it tastes horrible. However, a little bit of it’s not going to harm him. Wipe his mouth out with a clean wet cloth and start him on some juice or Koolaid, then bring the bottle back to the phone …
08:32 am I’m 79 years old and I do NOT have dementia. But I think I just took a double dose of my Tylenol Arthritis Extra Strength. I usually take 2 tablets 3 times a day, at 7 am, 3 pm, and 11 pm. But I got up early this am and took my Tylenol at 7 am and I think I took it again just now!”
One time a double dose of Tylenol®, even Tylenol Arthritis Extra Strength®, should not harm you. But you will need to restrict the total amount of Tylenol® that you take for the day, so you don’t take too much for the 24 hour period. I suggest you skip your 3 pm dose and resume your dose at 11pm, OK? Or you can check with your Doctor’s office and see what they say.
08:44 am This is Officer Mitch Jones calling from Happyvale Police Dept. and I want to identify a pill confiscated at a traffic stop. There has been no exposure. It’s a round yellow tablet with the imprint TL 177.
This is cyclobenzaprine, common name Flexeril; it is a prescription but not a Scheduled drug.
0851 am This is Deb RN calling from Memorial General ER. These parents just brought in a 7 month old who chewed on a paint brush that had been dipped in oil based paint, wrapped in tin foil, and stored in the refrigerator. He is coughing and spitting. He seems to be oxygenating OK, as his color is good and his biox is 98% on RA.
OK, oil based paint is a concern because it is a Hydrocarbon and if even a few drops are aspirated into the lungs, it can cause a nasty hydrocarbon pneumonitis. Treatment is basically symptomatic – O2, RT treatments, CXR, biox, ABGs – the usual. Real rarely these kids will require mechanical ventilation. Antibiotics only if there are signs of a secondary infection and no need for steroids…
Vicky, a school nurse called. A special-needs student, a little boy aged 8, had eaten a good portion of a toy. “Well, not the toy itself. It’s this special kind of “Real-Life Reptile” and he chewed a hole in the tail and ate a bunch of these little white beads …. what we want to know is if those beads are toxic or not?”
First I established that the little boy, Ricky, was generally healthy and having no obvious problems at this time. He had been given a glass of water to drink and was doing so without problem. They estimated the amount of beads he had ingested as ¼ cup….
"Do you have the original packaging on the toy, and does it say non-toxic?"
"Oh no, we never keep all that stuff."
"Then do you know the manufacturer’s name or number?"
"Only what it says on the tag..."
Turned out the tag said the product was a "Real-Life Reptile" made by Boinky Ball Toys (all names changed to protect the innocent), but nothing more. The particular reptile he had ingested was a "Fast & Friendly Gecko," blue-green with bulging orange eyes and red toes.
I advised Vicky that I doubted this was a toxic exposure, as toys are generally made with non-toxic components, because kids do tend to nibble on them. I suggested that I take her number, and that I would call the company and track down the actual ingredients, just to be sure. Meanwhile she would closely monitor little Ricky. She was agreeable with that approach.
I called Boinky Ball Toys and spoke to Tiffany in their Customer Service department. Eventually I got her to understand that I wasn’t interested in placing an order but I needed to speak with someone in charge of product development, to find out what the product was made of. Then I spoke to Shelly, who said I needed to talk to Dave, "but he’s in a meeting right now, may I have him call you?" I explained, yet again, that we had a child that had EATEN their toy and we needed to know sooner, rather than later, what the toy was composed of. Shelly promised to interrupt Dave’s meeting.
A few minutes later, Dave called back. He had obtained the MSDS on the toy and was pleased to report that the white pellets were vulcanized plastic and totally non-toxic. I thanked him for his time and called Vicky back.
"Good news, it’s just plastic, completely non-toxic," I told her. "The only risk would be a concern for obstruction, but that’s unlikely since the format that Ricky swallowed was all tiny pellets." Still I recommended that he be fed a high fiber, high fluid diet for a few days and that he be watched for any signs of an acute abdomen. Of course, if he developed any symptoms, he should be checked by his FMD and that the physician needed to be informed of this exposure.
Was all that necessary? Well, I could have slept pretty well that night, knowing that the chance was 99.9% that Ricky’s ingestion was non-toxic... but I’d rather take the extra time, make the extra calls, and make 100% certain there was NO risk – treating that child like my child. So that’s what I did.
All morning long the phone has been ringing and everyone I’ve spoken to has apologized for calling me. “I’m sorry for bothering you.” “I’m sure this is nothing, but … ” “This is a stupid question.” “I feel really silly bothering you with this …”
And all morning long my response has been some version of “There are no stupid questions,” “It’s no bother at all,” “I’m here to help you,” or “That’s why we’re here.”
It reminds me of an old song, but I can’t for the life of me remember what it is ...
One of the major challenges in working at Indiana Poison Center is persuading the public to call us right away, and not to wait for symptoms to develop. Despite all of our attempts at educating the public, a great majority of callers still worries about “bothering” us with trivial calls. So we go on attempting to educate, one at a time, that there are NO trivial calls and we welcome ALL calls. The best policy when it comes to poison control is better safe than sorry.
I don’t expect the average parent to be able to recognize or determine when a toxic exposure has occurred. I do expect them to realize when a non-food substance has been ingested, sprayed into the eyes, inhaled, or spilled on the skin, and to call for help right away. MY job is to help you determine how serious it is.
I don’t expect a parent to know which will be a problem: ear drops or eye drops (it's eye drops), Advil infant drops or Tylenol infant drops (Tylenol), Grandma’s beta-blocker or her ACE-I (BB), or pansies or petunias (neither). Figuring out what is toxic is a complicated process. It involves more than just the substance, but also includes the patient’s age, weight, PMH, current condition and other pertinent factors.
So, our conversation continues. Most of the time the exposure turns out to be a trivial event. Occasionally it is a serious situation and we send that child to the nearest ER. But even the calls that are not emergencies are important – they give me a chance to interact with the parent, to do some teaching regarding normal childhood development and poison proofing, to discuss when it is appropriate to call the PCC (always!) and to send them some educational literature about the PCC.
So the moral of the story is – ALWAYS CALL US. We’re here to help!
And thanks to Google, I found the song I was thinking of. It’s by Conway Twitty and the words are: That’s my job That’s what I do Everything I do is because of you To keep you safe, you see …… That’s my job.
Gwenn is a Senior Partner and Team Leader at the Indiana Poison Center at Methodist Hospital. When you call the Poison Center, you talk to Gwenn.
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