– Hi, I’m Jeni with Denver Metro Moms Blog and it is Poison Prevention Week. Every year over 2 million
Americans come in contact with, or swallow a poisonous substance. Here at Swedish Medical Center
to talk with Darcy Martin, an Injury Prevention Coordinator, and Dr. Dylan Luyten, who is an Emergency Medicine Physician. They’re gonna help us
talk about what chemicals and poisons might be in
and around our homes, and what to do if we think our child may have ingested one of those. Let’s get started. First Dr. Luyten, I’m curious to hear what are the most common
poisoning incidents you find in the ER – Yeah, thank you, thanks so much for giving me the chance to talk with you. This is an important topic, I appreciate you taking the time. So, pediatric exposures to
toxins are very, very common. And you know, the good
news is that the majority of exposures that we see in
the emergency department, or potential exposures
are not seriously toxic, and are usually the result of kind of common household substances. So, the reassurance I wanna offer people is that by and large
most pediatric exposures are not terribly serious, and thankfully, you
know, mostly result from kind of common household products. We do however see some
extremely serious ingestions in poisonings in children
in the emergency department. And the majority of
those, kind of stem from a small number of things. Amongst household products the substances that are most serious would be Antifreeze, and maybe we’ll take a few minutes to talk specifically about Antifreeze. The other thing is button
batteries exposures can be very, very serious,
and even life threatening. – Where would you find a button battery? – Good question, so many people have button batteries, you know, for watches, or heart rate monitors, or other small-like electronic devices. They look like, you know,
there’s different sizes, but typically about the size
of a nickel, or a quarter. And they’re kinda
ubiquitousness in our homes. The problem with these batteries is that they sort of look like, look like coins, or look like lozenges, or something like that,
and occasionally toddlers or small children will swallow them. And unfortunately they can
get lodged in the esophagus, which is the food pipe, between
the mouth and the stomach. And if they do become
lodged, very quickly create a little electric current with the moist, kind of mucosa lining of the intestine, or the esophagus, and very
rapidly create a burn, which can lead to other perforation, you know, through the GI tract
which can even be lethal. So, these are extremely,
extremely serious ingestions. – So, what are some of the
other common poisonings you’ve seen in the ER, in addition to the button batteries.
– Yeah! So, you know, if you look at the very, and I’m gonna focus on the
very serious ones first, but if you look at the
other very serious one that we see from time to time,
it’s exposure to Antifreeze. So, Antifreeze contain something
called ethylene glycol, and ethylene glycol is
a kind of an alcohol. It’s not alcohol like ethanol, that’s in an alcohol
beverage, but it’s related. And unfortunately, ethylene
glycol is extremely toxic. So, a 25-pound toddler,
you know, a toxic dose of ethylene glycol for the toddler may be less then a table spoon. So, really just a single
sip of ethylene glycol could be potentially fatal in a toddler. And unfortunately this
is something that’s also kinda ubiquitous, most of us have something like this in our garage. And Antifreeze is kind of
colorful, it’s sweet tasting, and so it runs the risk. We probably see more exposures
to Antifreeze amongst pets, because there’s more kind of home aware, I think, awareness now about this, but we still see it, and
if we evaluate a child who, for whom there’s even a question
of an Antifreeze exposure, we’re embarking on a significant work-up in the emergency department, and a pretty high
likelihood that that child is either hospitalized or observed for a prolonged period in the hospital. Unfortunately with an
exposure like Antifreeze there’s no real irritant effect. So, their child is not
necessarily symptomatic. – Okay.
– And the toxicity is delayed by hours, to even a day or so. So, a child could be at very high risk of a very dangerous poisoning, and be essentially asymptomatic, until they’re quite sick. And while there are some antidotes for ethylene glycol exposure, a lot of the problem is it’s often unclear what exactly happened. So, people are doing
sort of detective work. – Okay.
– You know, trying to understand. So, if we even suspect minutely, an ingestion of Antifreeze
we should get to the ER. – Perfect.
– Okay. – That’s exactly right. So, any question of an Antifreeze exposure it should come right to the ER. And remember with Antifreeze can be absorbed across mucus membranes. So, if you’re handling Antifreeze, a spill, you know, in your garage, or something like that,
you need to wear gloves. – Okay!
– You need to be very careful with the cleanup, because it can be absorbed across the skin to some extent.
– Okay, that’s great to know. And Darcy, can you maybe help us come up with some ways
that we can make sure that these items are
away from our children and just some general safety tips on making sure that we don’t have exposure to these poisonous items. – Sure, so, I would say
with home medications, or prescribed medications
they say child proof, those lids are not child proof. So, even though they may be difficult for the child to get off, it can certainly be done. So, if you have family visiting, or you yourself are on medications, make sure that those are stored up and out of reach of children. Even, maybe not necessarily
in a medicine cabinet where a child can climb up on the sink, and get in that medicine cabinet. But somewhere where they
clearly cannot reach. Locks on cabinets are a great idea, just to make it all that
more difficult to get into. Make sure lids are screwed on tightly. Even though household items, you know, are for the most part not super toxic, it doesn’t negate the fact that they need to be up
and away from kiddos. – Right, and you know, in terms of more generalized household items that parents may be aware
that could be dangerous, but are just gonna be around the house, like your bath bombs, or your perfumes, and things like that. How worried about poison do we need to be with those types of items, and what can we do to
keep our children safe? – Well, maybe I’ll address sort of the potential for toxicity. You know.
– Yeah! – And I would say, generally speaking, most
of these household items are not gonna result in
very serious toxicity. They can though be pretty irritating, and can occasionally create some burns to the mouth, or to the
esophagus, or something. The classic would be sort
of a household bleach, or something like that. Oven cleaner can be very, very toxic. And so there are a few things that we need to be
particularly mindful of, and as Darcy said, I think
the biggest issue here is just separating the substance from children. So, locks on cabinets,
and having these things in locations where their children simply can’t get after them. If you like, I would maybe like to make a plug for our Poison Centers, as well, in their role here,
would that be something you want me to speak to?
– Yeah, absolutely. And I’d love to hear from you when we should call the Poison Center versus when we should
immediately head to the ER. – Yeah, that’s a great question, and super important. It comes up all the time. So, first of all, our Poison Centers are a phenomenal resource, and the professionals who
are answering hotlines here are extremely knowledgeable,
and very, very skilled at doing kind of triage at home. And I think it’s testament
to their great work, that compared to the volume of exposures in children, that there are out there, if you look at the logs,
the numbers of calls that are generated to Poison Centers. And then the number of these exposures that end up in an ER, you
know, there’s relatively few that end up and come into
the ED as a percentage. And that’s because the Poison Center does such a good job of triage. As a general rule, and Darcy, I’m curious about your opinion too, I would say, if you,
there’s a few exposures that parents should know about where you just go right to the ER. And that would be button batteries, that would be ethylene glycol exposures. – That’s the Antifreeze.
– That’s the Antifreeze, thank you, that you go right in. No harm in notifying your Poison Center, but they’re gonna tell you
to just go right to ER. There’s gonna be no question. Any time your child is symptomatic, those are times when you
should probably head to the ER. So, if your child is lethargic,
so won’t interact with you. So, you’re suspicious that
they might have gotten into something, let’s say,
sedative, you know, medication, or an alcohol for example,
like hand sanitizer, even it can do that sometimes. Those are cases where, you’re
gonna either be calling 911, if you think your child
looks seriously symptomatic, or you’re gonna be immediately
bring them into the ER. So, it’s mental status changes. If your child is having trouble breathing. So, they’re in any kind
of respiratory distress, whether that’s wheezing,
or what we call stridor, which is that if you’ve
ever had a child with Croup you know what stridor sounds like, that kind of (inhales sharply) you know, sound with inspiration, those
are true medical emergencies, you should call 911, and your
child will be brought in. Or lastly if a child is
fainting or passing out, something like that, these
are true medical emergencies. Yes, ultimately the answer might be involving the Poison Center, but you need your emergency medical
services involved right away. But if there’s a question
of, boy I don’t know if my kid got into something, but I found my toddler
next to a bottle of bleach, or there’s a bleach spill on the floor. My kid splashed in it somehow, but they’re minimally or asymptomatic, that’s a great time when you
just call the Poison Center. – Really, okay.
– And they can kinda help you triage it. So, if there’s, we don’t
know if they really got into something or not,
but I’m a little worried they might have, and yet they look fine, that’s a great time to just
call your Poison Center, and they can direct you.
– Okay, that’s reassuring, I think.
– What do you think, Darcy? I, I think that’s.
– Yeah, I would totally agree. I think that the time to
call the Poison Center is in those times where maybe there’s a little bit on their lip, or they’re next to it, and you’re really not sure, but your child is acting fine. No harm, no foul in
calling the Poison Center, and them saying to you,
I think you’re okay to watch them at home, but at least now you know. But the minute your child
starts to act differently in any way, is a good indication that they need to see medical treatment. – Okay, okay.
– Yeah, yeah. – Okay.
– And these are, if your concerned about
a serious poisoning, so, you know, these are ER visits. You know, this is not generally
your pediatrician’s office, or your local Urgent Care clinic, this an ER situation, because
those dangerous poisonings, kids can get very sick, very fast, and they can really represent
real medical emergencies. We wish there were more sort of antidotes, I mentioned, you know, made
reference to one or two, but the reality is the
vast majority of care of a poisoning, whether
it’s a child or an adult, is really sort of First Aid. So, it’s our attention to the airway, their breathing, supporting
their circulation, and things like that. It’s not, unfortunately,
unlike television, kind of a miracle antidote, that’s gonna make everything right. Generally it’s good supportive
care in the hospital. – All right!
– And I would also just add to that, if I can. If you think your child
got into something, or they did get into something, and you will be taking that child to the emergency department, take whatever that toxin is with you. – Yes!
– If it is a bottle of bleach, take the bleach with you, carpet cleaner, whatever it is that you think they got into take that container with you, because that helps us in
the emergency department, it helps the Poison Center kind of be able to figure, you know, get that all figured out. So, that’s really important. A lot of times, we see kids
in the emergency department, where we know they took something, or maybe they took something, but they don’t have the
container with them, or the medicine. – Right.
– That’s really important. – Okay, that’s good to know. You know, I just wanna kinda
recap the biggest things we wanna be worrying about, where dangers might lurk, where in a house we might be finding some of these really problematic poisons. Can you kind of just
maybe walk us through, you know, where in our house. Is it the garage, is it
the parent’s bathroom? Where are some of the places where we might really need to watch our children more closely? – So, I think the garage is huge. That’s typically where people are gonna keep their Antifreeze. People maybe aren’t necessarily careless, but it’s not in their forethought when they’re working on their car, or their lawnmower’s in the garage. So, the garage I think is important. It’s not typically a thought of parents to really secure their garage, so I think that would be
important, I (voice trails off), would you?
– Yeah, I would agree. I mean, and also we forget that
our kids get in the garage. Right?
– Right! – We think about this when our kids are really little, and then our kids grow up a little bit, get more mobile, get moving
around, cruising or crawling, walking now, and all of
the sudden is the risk of exposure got a lot more real. Yeah, I think that’s right, the garage for your Antifreeze, wherever you might keep
tools, and batteries, think button batteries,
your oven cleaners are, you know, wherever you
might be keeping that. That could be potentially in some houses that could be under the
kitchen sink, for example. Your bleaches, those
are potential exposures, but I think the other thing
would then just be the bathroom, and home, again.
– And home meds. – My plug for home meds,
because I can’t say enough. When we look at the truly
dangerous ingestions in children it’s gonna be overwhelmingly home meds. – Okay.
– Yeah. – Thank you so much for your time, and the information you’ve provided. This has been really helpful. I know for me as a mom, and I’m sure for all of our moms out there. I wanna say thanks to Darcy Martin, and Dr. Luyten, and we
will see you next time.
– Hi, I’m Jeni with Denver Metro Moms Blog and it is Poison Prevention Week. Every year over 2 million