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Outdoor First Aid

Poisoned In Camp?

How to deal with common backpacking substances that are more toxic than three-day-old socks.

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Scene One: It’s the middle of the night, you’re green-gilled and retching, and your partner just happens to mention the fuzzy white mold on the salami he added to the spaghetti sauce. He says he was sure that boiling would make it safe.

Scene Two: Your fuel bottle leaked into your food bag. Everything was sealed in plastic, but the cheese still picked up a slight odor. Five days out and a week to go on light

rations, you eat the cheese at lunch. A few miles down the trail you are burping gas.

Scene Three: Because of snow and howling wind you decide to cook inside the tent. Several cups of tea and a freeze-dried dinner later, your mild headache has reached throbbing proportions. Your partner, complaining of head pain earlier, now seems irritable and confused.

Scene Four: Your child wanders into camp chewing something. In her hand is half a mushroom you can’t identify.

There you have it, four fairly easy ways to accidentally poison yourself in the backcountry (besides insect stings and snake bites, which we’ll cover in a future column). Thankfully, all four scenarios are easily avoided. Here’s what you need to know.

Food poisoning: Unfortunately, cooking does not neutralize the toxins produced by certain bacteria-especially staphylococcus-that can multiply rapidly on unrefrigerated meat. Luckily, the effects of those toxins usually dissipate after 6 to 12 hours and rarely pose a long-term threat. But the short term is most unpleasant. Symptoms, which come on 2 to 6 hours after eating the contaminated food, can include nausea, severe abdominal cramps, diarrhea, and vomiting.

Treatment is limited to water, which prevents dehydration. Be assured that your distress is temporary, even though it will feel like an eternity. You can safely continue your hike when you feel up to it.

Petrochemical poisoning: When swallowed, white gas (the fuel most commonly used in campstoves) should be treated like any corrosive, meaning you shouldn’t induce vomiting to get the poison out of your system. That’s because corrosive chemicals can do as much damage coming back up the esophagus as they did going down. Also, breathing even a tiny amount of petroleum product into your lungs while you are vomiting could bring on a dangerous case of pneumonia.

Fortunately, even if you somehow managed to swig from the fuel bottle instead of the water bottle, you should be fine if you didn’t get any in your lungs. (If you did, head to the doctor fast.) Dilution is the solution to this body pollution. Drink a liter of water. Milk is even better, if you have it. (Packing any powdered milk in your grub sack?) You’ll feel better soon enough and should continue your hike without worry.

Carbon monoxide poisoning: People who cook inside in order to stay out of the weather often zip shut their tents for the same reason. What happens is that stove and campers are soon competing for oxygen. Without plentiful oxygen, stove-fuel combustion is incomplete and the result is carbon monoxide (CO). This gas is invisible, odorless, and tasteless. In other words, you’ll never know it’s there unless you recognize the symptoms. Once inhaled it enters your bloodstream, where it bonds to the hemoglobin of your red blood cells about 200 times better than does the oxygen your blood is supposed to carry. First to feel the effects are your brain and heart, the organs most in need of oxygen. CO poisoning accounts for about half the poison deaths in the United States each year, and is one of the most serious poison threats in the wilderness.

Symptoms begin with a headache, nausea, vomiting, and lack of coordination, progressing into irritability, impaired judgment, and confusion. You’ll find it increasingly difficult to get a full breath, and you’ll grow drowsy. If you don’t get more oxygen immediately, the next stage is coma, followed by death, typically from heart failure. Contrary to a common misconception, death by carbon monoxide is not a pleasant drift into permanent slumber.

Field treatment is simple: Get fresh air. If you’ve been exposed to low levels of CO, you’ll probably recover completely in a few hours because the half-life of carbon monoxide attached to hemoglobin runs around 51/2 hours. Once you feel better, you can safely continue your hike.

If the concentration was high, however, you’re in serious trouble. You could die even once removed from the source of the gas. Rapid evacuation to a high pressure chamber and concentrations of supplemental oxygen are your only hope. Unconscious victims of CO poisoning will need to have their airway maintained during the evacuation.

It’s important to remember: At higher altitudes where the weather is often harshest and you’re more inclined to cook inside a tightly sealed tent, you’re at greater risk from not only carbon monoxide, but tent combustion, too. Mountaineers the world over cook inside their tents, but they make a point of keeping the tent well ventilated. If you must cook inside, partially unzip a window or vent.

Mushroom and plant poisonings: When it comes to eating the wrong plant or mushroom, deadly encounters are rare. Out of 85,556 documented questionable mushroom ingestions reported to the American Association of Poison Control Centers in a recent 11-year period, only 14 resulted in fatalities. Almost all the deaths were in adults who mistakenly gathered bad ‘shrooms for dinner or in hopes of a hallucinogenic high. Children are still the greatest eaters of unidentified mushrooms.

The mushroom most likely to kill? The Amanita species (also known as the Death Cap, Death Angel, and Destroying Angel) is responsible for 90 to 95 percent of all mushroom-related deaths. Typically growing under deciduous trees in the United States, Amanitas have a yellowish to white cap 11/2 to 6 inches in diameter, and a thick stalk 11/2 to 7 inches long with a large bulb at the base. The gills under the cap are usually easily visible and white to green in color. Gastrointestinal distress (severe nausea, vomiting, abdominal cramps, diarrhea) with Amanita, and with all potentially death-causing mushrooms, usually begins within 6 to 12 hours. “As a general rule,” notes the Clinical Toxicology Forum, “if symptoms develop within approximately 2 hours of ingestion, it is unlikely that the mushroom is one of the potentially fatal hepatotoxic [liver destroying] varieties.” In other words, if stomach problems surface soon after mushroom munching, the chance of dying is slim.

If you suspect someone has eaten a bad ‘shroom, or ingested anything poisonous, start treatment quickly. Even if you’re in doubt, treat. Don’t wait because each moment that passes means more poison is absorbed into the system.

If the person is still conscious, your goal is to limit the absorption of the poison from the gastrointestinal tract. There are two ways to do this in the wilderness: induce vomiting or bind the toxin with activated charcoal.

Unfortunately, by the time you realize that the person has eaten a poison, much of it will likely have traveled out of the stomach and into the bloodstream. Even so, vomiting can help get rid of what’s left, especially when done within the first hour of poison consumption. Ideally, your first-aid kit will contain a lightweight emetic (vomit inducer), most likely syrup of ipecac. Anyone older than 10 years should get 2 tablespoons with 8 to 16 ounces of water. Younger people should have 1 tablespoon with the same amount of water. Avoid facing the person because the vomiting tends to be sudden and forceful. If he hasn’t vomited in 20 minutes, repeat the dose. If you have no ipecac, try 2 tablespoons of mild soap, or the gag reflex. Lean the person forward, gently reach into his mouth with a finger, and tickle the back of his throat.

Examine the vomit. If you can find samples of the plant or mushroom, bag them and some of the vomit and carry to the hospital. If you can’t find the plant, bring the vomit anyway.

Do not induce vomiting if:

  • He’s losing consciousness.
  • He has heart problems or a disorder that leads to seizure.
  • He has swallowed corrosive acids or bases, which can increase damage as they come back up.
  • He has swallowed petroleum products, which can cause pneumonia if even a small amount is breathed into the lungs.

Better even than vomiting is binding the poison with activated charcoal, which can be administered post-vomiting. While it’s not something most campers keep in their first-aid kits, if available the usual dose is 50 to 100 grams (13/4 to 31/2 ounces) for adults, and half that for children. Swallowing the slurry of fine black powder may prove to be a chore, even though it is odorless and tasteless. To help it down, add to flavored fluids like fruit drinks.

If the person is unconscious, you’ll have to immediately evacuate him to a medical facility, during which you’ll want to keep him on his side to maintain an open airway.

In general, if you suspect someone has ingested poison, ask him about nausea and vomiting, abdominal cramps, diarrhea, loss of visual acuity, muscle cramps, or anything else unusual. What has the person put into his mouth in the past 24 hours? When? How much did he eat?

Watch for changes in the level of consciousness. Confusion, irritability, change of personality, or loss of consciousness are indicative of serious poisonings. Vital signs also are important clues indicating the seriousness of the situation, so watch for signs of shock, such as a fast heart rate with a weak pulse; quick, shallow, or labored breathing; skin that’s cool, clammy, and damp; thirst; or nausea.

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