Other-LiveIAmA 17 year old employee working on the weekends where a kid can be a kid aka Chuck E. Cheese, AMA
Mar 19th 2017 by ceckcemployee • 39 Questions • 58 Points
Hello Reddit! We are pharmacist, nurse and physician toxicologists and poison specialists at the National Capital Poison Center in Washington DC. It’s hard to imagine what people swallow, splash, or inhale by mistake, but collectively we’ve responded to more than million phone calls over the years about….you name it!
National Poison Prevention Week (March 19-25) is approaching. Take a few minutes to learn how to prevent and respond to a poison emergency. Be safe. AMA!
There are two ways to get free, confidential, expert help if a poisoning occurs:
1) Call 1-800-222-1222, or
You don’t have to memorize that contact info. Text “poison” to 484848 (don’t type the quotes) to save the contact info directly to your smart phone. Or download our vcard.
The National Capital Poison Center is a not-for-profit organization and accredited poison center. Free, expert guidance for poison emergencies – whether by telephone or online – is provided 24/7. Our services focus on the DC metro area, with a national scope for our National Battery Ingestion Hotline (202-625-3333), the webPOISONCONTROL online tool, and The Poison Post®. We are not a government agency. We depend on donations from the public.
Now for a bit of negative advertising: We hope you never need our service! So please keep your home poison safe.
Hey Redditors, thank you for all your amazing questions. We won't be taking any new questions, but will try to get to as many of the questions already asked that we can.
Have these analytics helped you to be dangerous?
It isn't all that bad :) I stamp people at kid check so I get the least complaining/people asking to fix machines
A family called us after attending a funeral where the corpse spontaneously exploded. They were worried that they might explode too. Jess Benson, Pharm.D., DABAT
I just wanted to thank you all. The other night my 4-yo daughter broke a glow-stick and it spurted in her eye. I have never heard her scream like that. And it went on and on...
We called you guys and got a very calm, cool woman on the phone who advised us to stop the saline wash we were trying, get her in the shower and force her eye open for 20 minutes. She told us what to look for and how to act and then called back 20 minutes later, as promised, to check on us.
What's your rule-of-thumb for sending people to the hospital vs. staying home and treating themselves?
I only work on the weekends and it happens prob everyday of every hour. Bunch of guests complaining about their food to a bunch of teenagers that don't get paid enough to care isn't a good time. One time I was fixing the ticket munchers aka the machines you put your tickets into and get a receipt when out of nowhere some entitled parent walks up to me and throws his tickets in my face demanding that i fix the machine and serve his child. I picked up the tickets and threw it back at him and said "get in line my boy". At that point this guy was furious and that's when the sassy manager saw this and told me to go to the gift shop and help anyone there. Nothing happened to me and the guy ended up getting escorted out by police.
Have you ever had someone call in trying to inquire which home substance would make the best poison for criminal intentions?
No, at least not at my location. The tubes and the slides were also removed in order to make room for more machines. Every morning and every afternoon we do something called coin drop where you "test" the machines and make sure they're working and clean. Pretty much just play the games.
Thanks for the AMA.
Was wondering what sort of exposure would be considered harmful to an average-sized person who happened to break a light bulb containing mercury. Also, what way could the substance enter into the body in that scenario that a person would need to be careful of?
Nah it pulls
If I ever need to call you, how would you prefer that I order the information about the poisoned victim?
Most disgusting thing I've seen is probably one time when I was loading the ice machines with ice and saw a dead fly in the ice when I was about to put it in. Needless to say I removed it and looked at every scoop I put in.
Another disgusting thing I've seen is a table full of throw up and food when a 5 year old had a little too much.
What is odorless, tasteless, dissolves instantly in liquid and is among one of the world's more deadly poisons?
Yeah I've been put in the suit before but the max amount of time that you'll ever be in it is about 20 minutes
What are some commonly overlooked areas in childproofing? Are there any items that parents don't realize are poisonous?
There are many. Button batteries are some of the most dangerous items that kids get into and they are found in so many products now -- remote controls, toys, hearing aids, key fobs and much more. These batteries can cause life-threatening injuries to the esophagus. Here's some more info: What can happen if a child swallows a button battery?
Also, rare earth magnets -- the really strong ones -- that you can find in kids' toys. If children swallow more than one, or a magnet with a metallic object, they can link up in the gut, trapping tissue between them causing the gut tissue to die.
Finally, I would caution parents and others involved in childcare to not rely too heavily on child resistant caps on medications. These caps are not "child-proof" (nothing is really). Even though they help to slow kids down, many children can open these caps at ages as young as 15 months! N Reid RN/BSN, DABAT
So there is a ton of safety information out there for new parents, can you give me some simple tips for not poisoning my kid?
Here's the condensed version.....what we tell everyone to help stay poison safe: 1. Up, up and away! Keep medications and poisonous household products out of your child’s sight and reach. Locked up is best. 2. Avoid container transfer. Some of the most devastating poisonings occur when toxic products are poured into food or beverage containers, then mistaken for food or drink. 3. Read the label and follow the directions. Misusing products has dire consequences. 4. Use child-resistant packaging. It’s not child-proof, but so much better than nothing. Sorry it’s inconvenient, but using it could save a life. 5. Keep button batteries away from children. Swallowed batteries can burn through your child’s esophagus and cause permanent injury or even death. 6. Keep laundry pods out of your child’s reach. They are as toxic as they are colorful and squishy.
If one finds themselves without access to the internet, is there an easy way to remember what poisonous substances one should induce vomiting for and which ones they should not?
We no longer recommend inducing vomiting for anything. There are a couple reasons why -- 1) we actually found that inducing vomiting does not improve clinical outcomes in poisoned patients; 2) the common emetics people use can often cause more poisoning or injury than the original substance that the person swallowed. Some emetics can cause heart problems, ruptured esophagus, or seizures!
My friend once stuck a flashlight in his mouth and turned it on to see if it would shine out his eyes. While in his mouth the battery popped and burned the back of his mouth. About 3 or 4 months after (now), he still has the chemical burns in his mouth. Is that a cause for concern?
Yes, persistent, severe symptoms are definitely cause for concern. I would have your friend call his/her physician at this point. He/she needs a medical evaluation and treatment.
"Life Goes On", We'll Have "Nothin' But a Good Time"! By the way, if you inhale too much hairspray, call Poison Control. P Soto, PharmD
What are the most common household items people swallow, splash or inhale?
Bleach is definitely a common exposure that people often accidentally swallow, splash and inhale. Although it is not pleasant, it is typically well tolerated, in small amounts. Other than bleach, bathroom cleaners are also pretty common. P Soto, PharmD
I had the good fortune of doing one of my 4th year pharmacy rotations at a poison center (not NCPC), and found it one of the most rewarding experiences I've had. Thank you for the great work you guys do!
What is the most obscure/unlikely substance you've encountered in a poisoning case?
It is wonderful to have pharmacy, nursing and medical students on rotation. We all learn from all the questions you ask us. I remember a case where a child came to the emergency room with irritability and progressive drowsiness. He eventually required intubation and mechanical ventilation. Pupils were dilated, dry skin ... the parents had given him a medicine for treatment of diarrhea. One tablet ...Lomotil. He was given naloxone and he stood up and extubated himself. Fortunately we don't see this type of exposure very much anymore. Jess Benson, Pharm.D., DABAT
Do you think the new pod detergents are helping to prevent little kids from consuming detergent? Or are kids still trying to chow down on the packets?
What do kids mostly eat that causes problems? Is it detergents? Or something else?
It's a little too soon to tell if the new packaging for the pods is helping. Pods are extremely dangerous and they have caused serious injury. When a child puts a pod in his mouth and bites down, the pod pops open and the detergent is forced into the back of their throat. The liquid from the pod goes into the lung and causes injury - some children need to be on ventilators, or breathing machines. Also the irritating liquid can injure the eye as it splashes out of the mouth. Burns are also sometimes seen in the esophagus, again because of the extreme irritation. Regular liquid detergent, while irritating, does not normally cause serious injury in small amounts that children usually swallow.
Common ingestions include household products, such as cleaning products, personal care products like make-up and lotions, and plants. These items are responsible for about half of the calls about kids. The other half include medications, such as cold and cough products and prescription medicine.
Ingestion, or eating something is probably the most common, but people can be poisoned through the skin, by inhaling fumes, and eye injuries can occur from chemicals being splashed in the eye. Poisoning can occur from injecting drugs in the vein. The most common poisonings are due to medications found in the home.
Do I really need to call poison control if my kid swallows toothpaste? Why can't we come up with a toothpaste that is edible?
Absolutely, it's always prudent to call Poison Control if your child swallows toothpaste (or anything else that he/she wasn't supposed to), but in general small amounts of fluoride-containing toothpastes (ex: less than a mouthful) in children are typically well tolerated. In these cases we usually only see some mild stomach upset or an episode of vomiting. Obviously, larger amounts of toothpaste ingested (especially Rx strength) can be problematic in children. However, there are toothpastes out there that are “safer to swallow”, that do not contain fluoride. They typically contain sorbitol, which may only cause some loose stools.
RP, PharmD, MPH, CSPI
So I was on my bed last night getting tired and downs comes the biggest spider in my life a couple feet away from me. My first instinct is oh shit, then I try and look for my Guinness world records book to kill it as it's rappeling down. Long story short, I couldn't find the book and I just stared at it while it made its way down to the side of my bed, where I lost it and still can't find it. I found some Raid bug spray and sprayed it under my bed andon the sides of it. The window was wide open.
Question: How much Raid would be needed to end up in the ER or to be on the phone with you guys?
That is a common scenario. Folks get scared by something and in their panic they use a chemical to try to kill the insect (bees are common as well as spiders). You can certainly try to look it up on webPOISONCONTROL, but if you don't feel comfortable please call us and we'll help you sort it out. You don't have to think you are seriously poisoned to make the phone call. And some people are surprised that many accidental exposures often don't cause serious injury. Sometimes when you are in panic mode it's best to talk to a specialist at poison control, because we are great at calming our callers down.
Don't know whether it's good or bad that we aren't a government agency, but we are not. We're a 501(c)(3) charitable organization. Sadly, the National Capital Poison Center is projecting a budget deficit of $2.2 million - of a total cost of just over $5 million/year. About half of our funding is from state government grants. The rest is philanthropy.
Mr. Yuk, with his green scowly face, was first introduced in 1971 by the Pittsburgh Poison Center and was used in parts of the US. There was some concern that the application of Yuk stickers to products attracted children to the products. In about 2002 there was a move to a single phone number for all 55 U.S. poison centers (1-800-222-1222) and with it a national logo was introduced - Poison Help.
Times have changed! Poison Help commercial has replaced that one!
Besides calling, is there a way people can text or chat poison control?
There are 55 poison centers covering the U.S., each with a designated service area. Some have chat capabilities, but most don't - yet. Throughout the U.S. (or internationally), if you prefer to get your poison help online, you can use the webPOISONCONTROL tool. There you enter age, substance, and amount swallowed and get case-specific automated recommendations, including a determination of whether it's safe to stay home, you need to go to the ER, or you need to call Poison Control. In most cases (73%), it's OK to stay home. We never discourage calls, but if that's not the way you like to get help, feel free to go online. Toby Litovitz, MD
Do you agree with the Bell Biv DeVoe assertion about that girl?
Yes, that girl is poison. P Soto, PharmD
I recently had an experience where someone had ingested kerosene from an unmarked container in the garage, it was mistaken for water. When I called the poison control line, they didn't offer any advice, only asked me questions like, "How do you know that it wasn't windshield wiper fluid?" (It smelled like kerosene and wasn't blue). It also seemed like they were stalling for time. I ended up hanging up and looking up information online instead (don't induce vomiting!).
Was this just an inexperienced operator? Does the phone number get traced in case of an emergency that requires authorities?
I'm sorry that you had an unsatisfactory experience calling Poison Control. I can't really speak to what the specific specialist might have been thinking or what their level of experience might be. In general, Specialists in Poison Information are registered nurses with at least 2 years of experience in the hospital, or pharmacists with a clinical background. Once you are hired by a poison center, you have to train for at least a year, and pass a national exam to become a Certified Specialist in Poison Information.
Our Poison Center utilizes a system similar to 911 to obtain phone numbers and location and we do confirm this information with the caller at the beginning of the call in case the connection drops or the patient becomes incapacitated while on the phone with us. The Poison Centers do have the capability to mobilize EMS to the patient's location if necessary.
And just to be clear, all of this personal information is kept strictly confidential by the Poison Center. N. Reid RN/BSN, DABAT
Most of us were drawn to the medical profession because we had an interest in helping people. I worked at a suicide prevention telephone service while in pharmacy school. Most of the calls were about possible poisonings. During my clinical rotations I saw many poisonings in the emergency room and admitted to the ICU. It seemed like I was drawn to clinical toxicology. Over the years I have seen many changes in poison control. One thing that has remained the same is the poison centers' ability to help people quickly and compassionately. Jess Benson
What was the hardest part of putting the app together and how do you keep track of the "logic" for all the different possible scenarios?
If you ask the toxicologists (as opposed to the software developers), we'd say the hardest part is developing the algorithms, product database and logic. Each of the 1325+ ingredient algorithms is matched to the corresponding ingredients in 49,000 products - so we have to be able to handle products with multiple ingredients, too. Each algorithm has age- or weight-based thresholds for the ingredient, a list of expected minor symptoms which may develop, a list of symptoms that require further medical evaluation, specific home treatment where appropriate, the expected onset and duration of symptoms and a risk window beyond which significant toxicity is unlikely if symptoms have not already developed. Since algorithms are also used in traditional poison centers, they also outline the justification for the threshold and provide references.
On the other hand, the developers might tell you that the greatest challenge was the overall scope and complexity of the code and the many little nuances required to accommodate variations. Specific logic is incorporated in the software to handle each formulation type, multi-ingredient products, unknown amounts, unknown weight, and the minimum possible weight for age.
It may be difficult to imagine the complexity of the engine driving this app. There are more than 50 administrative interfaces that enable tracking, linking and manipulation of products, images, barcodes (yes, you can scan the barcode of the product your kid swallowed to enter the product name), algorithms, and case data. It also includes tools for quality assurance and data analysis.
Toby Litovitz, MD
How do you account for new products that enter the market place? Do they need to disclose the ingredients to you before being allowed to be on a shelf?
Companies introducing new products are not required to disclose their ingredients. Many do voluntarily, which is a big help. But many companies are also fearful their proprietary blend of ingredients will be stolen. In these cases previous experience of the specialist at the poison center can be very helpful in determining likely ingredients and possible concerns.
What are some common poisons that often get overlooked as safe?
In children we worry about imidazoline-containing nasal sprays (contain oxymetazoline or tetrahydrozoline). Most people will not think of them as poisonous because they are over-the-counter and generally viewed as safe. Unfortunately, small amounts can produce loss of consciousness, slowed heart rate and loss of breathing. Button batteries are another example. See our reply at https://www.reddit.com/r/IAmA/comments/5zrfrq/we_are_the_national_capital_poison_center_ready/df0etyz/ We also worry about laundry pods. Jess Benson, Pharm.D., DABAT
Hi NCPC! I read a book on poison response and the vast majority of treatments seem to be ingesting medical grade activated charcoal. In a pinch, if I cut open a water filter filled with activated charcoal and took the same amount, could it be used as a somewhat effective treatment? (This is not an endorsement for people eating Brita filter charcoal instead of going to the hospital, just in a case where you're in the wilderness a few hundred miles away from civilization and just so happen to have a Brita)
Hi! Yes, that is true. People are often worried about getting their stomachs "pumped", but that isn't done very often at all anymore. Activated charcoal is still a method of decontamination that we recommend when an ingestion is recent. You're right - we don't recommend doing home treatments of activated charcoal, because if it is serious enough to require activated charcoal, we will likely want you to go into the ER. Unfortunately, the activated charcoal sold over the counter, and in water filters are probably not as "activated" as the ones available in the emergency room. Also, there are some things that charcoal cannot absorb. Some people get nauseated and vomit after drinking charcoal, which can make some situations much worse (aspiration). Overall, I would not recommend using it. P Soto, PharmD.
Tell the truth: What do you really think of parents that have to call multiple times a year for the same child that seems to have taste tested half the house?
I think children explore their environments with their mouths. This is totally normal behavior. They are quick and curious and parents are often just one step behind them when things go in the mouth. We don't judge, we want people to call -- even if it is something that seems silly. Call to be sure, don't guess. And if you are too embarrassed to call, use the webPOISONCONTROL app or online tool. N. Reid, RN/BSN, DABAT
What has been done to raise awareness of Dihydrogen Monoxide?
Dihydrogen monoxide a.k.a water is necessary for human life. However keep in mind, the poison is in the dose. If someone were to drink excessive amounts of water, it can cause electrolyte disturbances leading to vomiting, seizures, mental confusion, and yes even death. Oh, plus you can drown in it. N. Reid, RN/BSN, DABAT
Is alcohol poisoning within your purview? Secondly, if so, what kind of data do you have about alcohol poisoning (and is it made available to the public)?
Yes. You can call or use the webPOISONCONTROL site anytime about possible alcohol poisoning. The previous year's national poisoning experience is published yearly in a medical journal called Clinical Toxicology (http://dx.doi.org/10.1080/15563650.2016.1245421). This report contains statistics for all kinds of poisoning including ethanol (alcohol) poisoning. The report will under-represent the true number of people who suffer from alcohol poisoning because many people will not call their poison center when it happens. It will give you a rough idea however of how frequent these exposures are. For instance in 2015, there were 6761 calls to all U.S. poison control centers regarding possible ethanol beverage exposures. Jess Benson, Pharm.D., DABAT
I called because my cat had eaten something, but I pretended that it was my child. Did you know that I was actually calling about my cat?
So we want to stress that it’s always important to be upfront when calling Poison Center since our pets (dogs, cats, etc.) have different metabolisms than humans, and some things that are completely safe for humans can be very toxic to dogs and cats. For example, certain foods that humans can safely enjoy such as: grapes, raisins, onions, shallots, garlic, coffee, and even chocolate can be toxic even in small amounts to our pets!
RP, PharmD, MPH, Certified Specialist in Poison Information