Common Medical Emergencies

1
Chapter 13

• Common Medical Emergencies

2
Objectives (1 of 5)

• Identify the signs and symptoms of the acute
  abdomen and the necessity for immediate transport
  of patients with these symptoms.
• Identify the patient taking diabetic medications
  with altered mental status and the implications
  of a history of diabetes.

3
Objectives (2 of 5)

• State the steps in the emergency care of the
  patient taking diabetic medicine with an altered
  mental status and a history of diabetes.
• Recognize the patient experiencing an allergic
  reaction.

4
Objectives (3 of 5)

• Describe the emergency care of the patient with
  an allergic reaction.
• Describe the mechanisms of allergic response and
  the implications for airway management.
• List the signs and symptoms associated with
  poisoning.

5
Objectives (4 of 5)

• Describe the steps in the emergency care for the
  patient with suspected poisoning.
• Perform a rapid gentle assessment of the abdomen.
• Demonstrate the steps in the emergency care for
  the patient taking diabetic medicine with an
  altered mental status and a history of diabetes.

6
Objectives (5 of 5)

• Demonstrate the emergency care of the patient
  experiencing an allergic reaction.
• Demonstrate the steps in the emergency care for
  the patient with suspected poisoning

7
Physiology of the Abdomen (1 of 2)
The Acute Abdomen

• Acute abdomen
• Sudden onset of abdominal pain
• Peritoneum
• Thin membrane lining the entire abdomen
• Colic
• Severe, intermittent cramping pain

8
Physiology of the Abdomen (2 of 2)
The Acute Abdomen

• Referred pain
• Perceived pain at a distant point of the body
  caused by irritation of the visceral peritoneum
• Peritonitis
• Irritation of the peritoneum caused by illness or
  injury

9
Signs and Symptoms of Acute Abdomen (1 of 3)
The Acute Abdomen

• Abdominal pain and/or tenderness
• Quiet patient guarding the abdomen (shock)
• Rapid and shallow breathing
• Referred (distant) pain
• Anorexia, nausea, vomiting

10
Signs and Symptoms of Acute Abdomen (2 of 3)
The Acute Abdomen

• Loss of bowel sounds
• Tense, often distended abdomen
• Sudden constipation or bloody diarrhea
• Tachycardia
• Hypotension
• Fever

11
Signs and Symptoms of Acute Abdomen (3 of 3)
The Acute Abdomen

• Rebound tenderness
• Indigestion/heartburn
• Colic (severe painful spasms)
• Difficulty swallowing
• Jaundice

12
Examining the Abdomen
The Acute Abdomen

• Explain what you are about to do.
• Position the patient supine with legs drawn up
  and knees flexed.
• Observe the patient.
• Gently palpate the abdomen.
• Determine if the patient can relax the abdominal
  wall on command.
• Determine if abdomen is tender when palpated.

13
Causes of Acute Abdomen
The Acute Abdomen

• Substances lying in or adjacent to the abdominal
  cavity
• Other common causes
• Appendicitis
• Perforated gastric ulcer
• Cholecystitis
• Diverticulitis

14
Uterus and Ovaries
The Acute Abdomen

• Always consider a gynecological problem with
  women having abdominal pain.
• Causes of pain
• Menstrual cycle
• Pelvic inflammatory disease
• Ectopic pregnancy

15
Other Organ Systems
The Acute Abdomen

• Aneurysm
• Weakness in aorta
• Pneumonia
• May cause ileus and abdominal pain
• Hernia
• Protrusion through a hole in the body wall

16
Emergency Medical Care (1 of 2)
The Acute Abdomen

• Do not delay transport.
• Do not attempt to diagnose.
• Clear and maintain the airway.
• Anticipate vomiting.
• Administer high-flow oxygen.
• Give nothing by mouth.

17
Emergency Medical Care (2 of 2)
The Acute Abdomen

• Document all pertinent information.
• Anticipate the development of hypovolemic shock.
• Make the patient comfortable.
• Monitor vital signs.

18
Defining Diabetes (1 of 2)
Diabetic Emergencies

• Diabetes mellitus
• Metabolic disorder in which the body cannot
  metabolize glucose
• Usually due to a lack of insulin
• Glucose
• One of the basic sugars in the body
• Along with oxygen, it is a primary fuel for
  cellular metabolism

19
Defining Diabetes (2 of 2)
Diabetic Emergencies

• Insulin
• Hormone produced by the pancreas
• Enables glucose to enter the cells
• Without insulin, cells starve
• Hormone
• Chemical substance produced by a gland
• Has special regulatory effects on other body
  organs and tissues

20
Type I Diabetes
Diabetic Emergencies

• Insulin-dependent diabetes
• Patient does not produce any insulin
• Insulin injected daily
• Onset usually in childhood

21
Type II Diabetes
Diabetic Emergencies

• Noninsulin-dependent diabetes
• Patient produces inadequate amounts of insulin
• Disease may be controlled by diet or oral
  hypoglycemics

22
Role of Glucose and Insulin
Diabetic Emergencies

• Glucose is the major source of energy for the
  body.
• Constant supply of glucose needed for the brain.
• Insulin acts as the key for glucose to enter
  cells.

23
Hyperglycemia
Diabetic Emergencies

• Lack of insulin causes glucose to build up in
  blood in extremely high levels.
• Kidneys excrete glucose.
• This requires a large amount of water (3 Ps).
• Without glucose, body uses fat for fuel.
• Ketones are formed.
• Ketones can produce diabetic ketoacidosis.

24
Signs and Symptoms of Diabetic Ketoacidosis
Diabetic Emergencies

• Vomiting
• Abdominal pain
• Kussmaul respirations
• Unconsciousness

25
Blood Glucose Monitors
Diabetic Emergencies

• Test strips
• Normal range 80-120 mg/dL
• Glucometer

26
Diabetic Coma (Hyperglycemia)
Diabetic Emergencies
27
Signs of Diabetic Coma
Diabetic Emergencies

• Kussmaul respirations
• Dehydration
• Fruity breath odor
• Rapid, weak pulse
• Normal or slightly low blood pressure
• Varying degrees of unresponsiveness

28
Insulin Shock (Hypoglycemia)
Diabetic Emergencies
29
Signs of Insulin Shock
Diabetic Emergencies

• Altered mental status
• Aggressive or confused behavior
• Hunger
• Fainting, seizure, or coma
• Weakness on one side of the body

• Normal or rapid respirations
• Pale, moist skin
• Sweating
• Dizziness, headache
• Rapid pulse
• Normal to low blood pressure

30
Diabetes and Alcohol Abuse
Diabetic Emergencies

• Patients may appear intoxicated.
• Suspect hypoglycemia with any altered mental
  status.
• Be alert to the similarity in symptoms of acute
  alcohol intoxication and diabetic emergencies.

31
Emergency Medical Care (1 of 2)
Diabetic Emergencies

• Ask a patient with known diabetes
• Do you take insulin or any pills to lower blood
  sugar?
• Have you taken your usual dose of insulin (or
  pills) today?
• Have you eaten normally today?
• Have you had any illness, unusual amount of
  activity, or stress today?

32
Emergency Medical Care (2 of 2)
Diabetic Emergencies

• Perform initial assessment.
• Obtain baseline vital signs and SAMPLE history.
• Check for emergency medical identification
  symbol.
• Always do a full, careful assessment.
• Ask patient or family about last meal or insulin
  dose.
• DO NOT administer anything to an unconscious
  patient.

33
Administering Oral Glucose(1 of 2)
Diabetic Emergencies

• Names
• Glutose
• Insta-Glucose
• Dose equals one tube
• Glucose should be given to a patient with
  diabetes and a decreased level of consciousness.
• DO NOT give glucose to a patient with the
  inability to swallow or who is unconscious.

34
Administering Oral Glucose (2 of 2)
Diabetic Emergencies
35
Complications of Diabetes
Diabetic Emergencies

• Heart disease
• Visual disturbances
• Renal failure
• Stroke
• Ulcers
• Infections of the feet and toes
• Seizures
• Altered mental status

36
Seizures
Diabetic Emergencies

• Consider hypoglycemia as the cause.
• Use appropriate BLS measures for airway
  management.
• Arrange for prompt transport.

37
Altered Mental Status
Diabetic Emergencies

• Altered mental status is often caused by
  complications of diabetes.
• Ensure that airway is clear.
• Be prepared to ventilate and suction.
• Arrange for prompt transport.

38
Allergic Reactions
Allergic Reactions and Envenomations

• Allergic reaction
• Exaggerated immune response to any substance
• Histamines and leukotrienes
• Chemicals released by the immune system

39
Anaphylaxis
Allergic Reactions and Envenomations

• Extreme allergic reaction
• Involves multiple organs
• Can rapidly result in death
• Most common signs
• Wheezing
• Urticaria (hives)

40
Urticaria
Allergic Reactions and Envenomations
41
Five General Allergen Categories
Allergic Reactions and Envenomations

• Insect bites and stings
• Medications
• Plants
• Food
• Chemicals

42
Insect Bites and Stings
Allergic Reactions and Envenomations

• Death from insect stings outnumber those from
  snake bites.
• Venom is injected through stinging organ.
• Some insects and ants can sting repeatedly.

43
Signs and Symptoms
Allergic Reactions and Envenomations

• Sudden pain, swelling, and redness at site
• Itching and sometimes a wheal
• Sometimes dramatic swelling

44
Removing Stingers
Allergic Reactions and Envenomations
45
Anaphylactic Reactions to Stings
Allergic Reactions and Envenomations

• 5 of all people are allergic to bee, hornet,
  yellow jacket, and wasp stings.
• Anaphylaxis accounts for approximately 200 deaths
  a year.
• Most deaths occur within half an hour of being
  stung.

46
Signs and Symptoms of Allergic Reaction
Allergic Reactions and Envenomations

• Chest tightness and coughing
• Dyspnea
• Anxiety
• Abdominal cramps
• Hypotension

• Itching and burning
• Widespread urticaria
• Wheals
• Swelling of the lips and tongue
• Bronchospasm and wheezing

47
Patient Assessment
Allergic Reactions and Envenomations

• Allergic symptoms are almost as varied as
  allergens themselves.
• Assessment should include evaluations of
• Respiratory system
• Circulatory system
• Mental status
• Skin

48
Emergency Medical Care (1 of 2)
Allergic Reactions and Envenomations

• Give oxygen.
• Perform a focused history and physical
  examination.
• Find out if the patient has a history of
  allergies.
• Obtain baseline vital signs and a SAMPLE history.

49
Emergency Medical Care (2 of 2)
Allergic Reactions and Envenomations

• Inform medical control.
• Find out if the patient has a prescribed
  auto-injector.
• Be prepared to use standard airway procedures.
• Assist the patient with the auto-injector if
  permitted.

50
Using an Auto-Injector
Allergic Reactions and Envenomations

• Receive order from medical direction.
• Follow BSI precautions.
• Make sure the prescription is for the patient.
• Make sure the medication is not discolored or
  expired.

51
Administering an Auto-Injector
Allergic Reactions and Envenomations

• Remove the safety cap.
• Place tip of the injector against the lateral
  side of the patients thigh.
• Push the injector firmly and hold until all of
  the medication is injected.
• Remove the injector.
• Record the time and dose.
• Reassess and record vital signs every 2 minutes.

52
Auto-Injector
Allergic Reactions and Envenomations
53
Epinephrine Side Effects
Allergic Reactions and Envenomations

• Tachycardia
• Pallor
• Dizziness
• Chest pain
• Headache
• Nausea
• Vomiting

54
Black Widow
Allergic Reactions and Envenomations

• Found in all states except Alaska
• Venom poisonous to nerve tissue
• Requires patient transport as soon as possible

55
Brown Recluse
Allergic Reactions and Envenomations

• Mostly in Southern and Central US
• Venom causes local tissue damage
• Requires patient transport as soon as possible

56
Snake Bites
Allergic Reactions and Envenomations

• 40,000 to 50,000 reported snake bites in the US
  annually.
• 7,000 bites in the US come from poisonous snakes.
• Death from snake bites is rare.
• About 15 deaths occur each year in the US.

57
Four Types of Poisonous Snakes in the US
Allergic Reactions and Envenomations
Rattlesnake
Cottonmouth
Copperhead
Coral snake
58
Pit Vipers
Allergic Reactions and Envenomations

• Rattlesnakes, copperheads, and cotton mouths
• Store poison in pits behind nostrils
• Inject poison to victim through fangs

59
Signs and Symptoms of aPit Viper Bite
Allergic Reactions and Envenomations

• Severe burning at the bite site
• Swelling and bluish discoloration
• Bleeding at various distant sites
• Other signs may or may not include
• Weakness Fainting
• Sweating Shock

60
Caring for Pit Viper Bites (1 of 2)
Allergic Reactions and Envenomations

• Calm the patient.
• Locate bite and cleanse the area.
• Do not apply ice.
• Splint area to minimize movement.
• Watch out for vomiting caused by anxiety.
• Do not give anything by mouth.

61
Caring for Pit Viper Bites (2 of 2)
Allergic Reactions and Envenomations

• If the patient is bitten on the trunk, lay the
  patient supine and arrange for prompt transport.
• Monitor patients vital signs.
• Mark the swollen area with a pen.
• Care for shock if signs and symptoms develop.
• Arrange for snake to be brought to the hospital
  if it has been killed.

62
Coral Snakes
Allergic Reactions and Envenomations

• Small snake with red, yellow, and black bands
• Red on yellow will kill a fellow, red on black,
  venom will lack.
• Injects venom with teeth, using a chewing motion
  that leaves puncture wounds
• Causes paralysis of the nervous system

63
Caring for Coral Snake Bites (1 of 2)
Allergic Reactions and Envenomations

• Quiet and reassure the patient.
• Flush the area with 1 to 2 quarts of warm, soapy
  water.
• Do not apply ice.
• Splint the extremity.
• Check and monitor baseline vital signs.

64
Caring for Coral Snake Bites (2 of 2)
Allergic Reactions and Envenomations

• Keep the patient warm and elevate the lower
  extremities to help prevent shock.
• Give supplemental oxygen if needed.
• Arrange for prompt transport. Give advance notice
  to EMTs of coral snake bite.
• Give the patient nothing by mouth.

65
Scorpion Stings
Allergic Reactions and Envenomations

• Venom gland and stinger found in the tail end.
• Mostly found in southwestern US
• With one exception, the Centruroides
  sculpturatus, most stings are only painful.
• Provide emergency care and arrange for transport.

66
Tick Bites (1 of 3)
Allergic Reactions and Envenomations

• Ticks attach themselves to the skin.
• Bite is not painful, but potential exposure to
  infecting organisms is dangerous.
• Ticks commonly carry Rocky Mountain spotted fever
  or Lyme disease.

67
Tick Bites (2 of 3)
Allergic Reactions and Envenomations

• Rocky Mountain spotted fever develops 7 to 10
  days after bite.
• Symptoms include
• Nausea, vomiting
• Headache
• Weakness
• Paralysis
• Possible cardiorespiratory collapse

68
Tick Bites (3 of 3)
Allergic Reactions and Envenomations

• Lyme disease is the second fastest growing
  infectious disease next to AIDS in US
• Lyme disease symptoms may begin 3 days after the
  bite.
• Symptoms include
• Rash
• Painful swelling of the joints

69
Caring for a Tick Bite
Allergic Reactions and Envenomations

• Do not attempt to suffocate or burn tick.
• Use fine tweezers to grasp tick by the body and
  pull it straight out.
• Cover the area with disinfectant and save the
  tick for identification.
• Provide any necessary supportive emergency care
  and arrange for transport.

70
Dog Bites and Rabies (1 of 2)
Allergic Reactions and Envenomations

• All dog bites should be considered infected until
  proven otherwise.
• Place a dry, sterile dressing over the wound and
  arrange for prompt transport.
• Rabies, an acute viral infection to the central
  nervous system, is a major concern.

71
Dog Bites and Rabies (2 of 2)
Allergic Reactions and Envenomations

• Rabies can be treated with a series of vaccine
  injections.
• A bitten patient can avoid shots only if the dog
  can be identified and tested for rabies.
• Remember scene safety the dog may still be loose
  when you arrive on the scene.

72
Caring for Human Bites
Allergic Reactions and Envenomations

• Remember, human bites that penetrate the skin can
  be serious injuries.
• Promptly immobilize the area.
• Apply a dry, sterile dressing.
• Arrange for transport.

73
Coelenterates
Allergic Reactions and Envenomations

• Responsible for more envenomations than any other
  marine life animal
• Has stinging cells called nematocysts
• Results in very painful, reddish lesions
• Symptoms include headache, dizziness, muscle
  cramps, and fainting.

74
Caring for Stings
Allergic Reactions and Envenomations

• Limit further discharge by minimizing patient
  movement.
• Inactivate nematocysts by applying alcohol.
• Remove the remaining tentacles by scraping them
  off.
• Arrange for transport.

75
Substance Abuse and Poisoning
Poison vs. Substance Abuse

• Poison
• Any substance whose chemical action can damage
  body structures or impair body functions.
• Substance Abuse
• The knowing misuse of any substance to produce a
  desired effect.

76
Identifying the Patient and the Poison
Substance Abuse and Poisoning

• If you suspect poisoning, ask the patient the
  following questions
• What substance did you take?
• When did you take it or (become exposed to it)?
• How much did you ingest?
• What actions have been taken?
• How much do you weigh?

77
Determining the Natureof the Poison
Substance Abuse and Poisoning

• Give suspicious materials, containers, vomitus to
  EMS.
• Provide key information on
• Name and concentration of the drug
• Specific ingredients
• Number of pills originally in bottle
• Name of manufacturer
• Dose that was prescribed

78
Poison Control Centers
Substance Abuse and Poisoning

• Information on most substances
• Information on emergency treatments and antidotes.

79
Ingested Poison
Substance Abuse and Poisoning

• Poison enters the body by mouth.
• Accounts for 80 of poisonings
• May be accidental or deliberate
• Activated charcoal will bind to poison in stomach
  and carry it out of the body.
• Assess ABCs.

80
Activated Charcoal
Substance Abuse and Poisoning
81
Inhaled Poisons
Substance Abuse and Poisoning

• Wide range of effects
• Some inhaled agents cause progressive lung
  damage.
• Move to fresh air immediately, they may require
  supplemental O2.
• All patients require immediate transport.

82
Injected Poisons
Substance Abuse and Poisoning

• Usually result of drug overdose
• Impossible to remove or dilute poison once
  injected
• Arrange for prompt transport

83
Absorbed Poisons
Substance Abuse and Poisoning

• Many substances will damage the skin, mucous
  membranes, or eyes.
• Substance should be removed from patient as
  rapidly as possible.
• If substance is in the eyes, they should be
  irrigated.
• Do not irrigate with water if substance is
  reactive, i.e. sodium or phosphorus.

84
Emergency Medical Care
Substance Abuse and Poisoning

• External decontamination is important.
• Care focuses on support assessing and
  maintaining ABCs.
• You may be permitted to give activated charcoal
  for ingested poisons per your local protocol.

85
Specific Poisons
Substance Abuse and Poisoning

• Tolerance
• Need for increased amount of drug to have same
  desired effect
• Addiction
• Overwhelming desire or need to continue using an
  agent

86
Alcohol (1 of 3)
Substance Abuse and Poisoning

• Most commonly abused drug in the US
• Kills more than 200,000 people a year
• Alcohol is a powerful CNS depressant.
• Acts as a sedative and hypnotic
• A person who appears intoxicated may have a
  medical problem.

87
Alcohol (2 of 3)
Substance Abuse and Poisoning

• Intoxicated patients should be transported and
  seen by a physician.
• If patient shows signs of serious CNS depression,
  provide respiratory support.
• A patient with alcohol withdrawal may experience
  delirium tremens (DTs).

88
Alcohol (3 of 3)
Substance Abuse and Poisoning

• Patients with DTs may experience
• Agitation and restlessness
• Fever
• Sweating
• Confusion and/or disorientation
• Delusions and/or hallucinations
• Seizures

89
Opioids (1 of 2)
Substance Abuse and Poisoning

• Drugs containing opium
• Most of these, such as codeine, Darvon,
  Oxycontin, and Percocet, have medicinal purposes.
• The exception is heroin, which is illegal.
• Opioids are CNS depressants causing severe
  respiratory distress.

90
Opioids (2 of 2)
Substance Abuse and Poisoning

• Care includes supporting airway and breathing.
• You may try to wake patients by talking loudly or
  shaking them gently.
• Always give supplemental oxygen and prepare for
  vomiting.

91
Sedative-Hypnotic Drugs
Substance Abuse and Poisoning

• These drugs are CNS depressants and alter level
  of consciousness.
• Patients may have severe respiratory depression
  and even coma.
• The main concern is respiratory depression and
  airway clearance, ventilatory support, and
  transport.

92
Abused Inhalants (1 of 2)
Substance Abuse and Poisoning

• Common household products inhaled by teenagers
  for a high
• Effects range from mild drowsiness to coma
• May often cause seizures

93
Abused Inhalants (2 of 2)
Substance Abuse and Poisoning

• Patient is at high risk for sudden cardiac
  arrest.
• Try to keep patient from struggling or exerting
  self.
• Give oxygen and use a stretcher to move patient.
• Prompt transport is essential.

94
Sympathomimetics
Substance Abuse and Poisoning

• CNS stimulants cause hypertension, tachycardia,
  and dilated pupils.
• Amphetamines and methamphetamines are commonly
  taken by mouth.
• Cocaine can be taken in many different ways.
• Can lead to seizures and cardiac disorders
• Be aware of personal safety.

95
Marijuana
Substance Abuse and Poisoning

• Smoked by 20 million people daily in the US
• Produces euphoria, relaxation, and drowsiness
• Impairs short-term memory and ability to work
• Transport to hospital is rarely needed.
• Marijuana can be used as vehicle for other drugs,
  ie, can be coated with PCP or crack.

96
Hallucinogens (1 of 2)
Substance Abuse and Poisoning

• Alter an individuals sense of perception
• LSD and PCP are potent hallucinogens.
• Sometimes, people experience a bad trip.
• Patients typically are hypertensive, tachycardic,
  anxious, and paranoid.

97
Hallucinogens (2 of 2)
Substance Abuse and Poisoning

• Use a calm, professional manner and provide
  emotional support.
• Only restrain if danger of injury exists.
• Watch the patient carefully during evacuation and
  while awaiting EMS.

98
Anticholinergics
Substance Abuse and Poisoning

• Hot as a hare, blind as a bat, dry as a bone,
  red as a beet, and mad as a hatter
• Block the parasympathetic nerves
• Patient may go from normal to seizure to death
  within 30 minutes.
• Arrange for ALS transport.

99
Cholinergic Agents
Substance Abuse and Poisoning

• Commonly used as nerve agents for warfare
• Overstimulate body functions controlled by the
  parasympathetic nervous system
• Organophosphate insecticide or wild mushrooms are
  also cholinergic agents.

100
Signs and Symptoms of Cholinergic Poisoning
Substance Abuse and Poisoning

• D Defecation
• U Urination
• M Miosis
• B Bronchorrhea
• E Emesis
• L Lacrimation
• S Salivation

• S Salivation
• L Lacrimation
• U Urination
• D Defecation
• G GI irritation
• E Eye constriction

101
Care for Cholinergic Poisoning
Substance Abuse and Poisoning

• Main concern is to avoid exposure
• May require field decontamination
• Priority after decontamination is to decrease the
  secretions in the mouth and trachea.
• Provide airway support.
• May be treated as a HazMat incident

102
Aspirin Overdose
Substance Abuse and Poisoning

• Signs and symptoms
• Nausea/vomiting
• Hyperventilation
• Ringing in ears
• Confusion
• Seizures
• Arrange for prompt transport to the hospital.

103
Acetaminophen Overdose
Substance Abuse and Poisoning

• Overdosing is common.
• Generally not very toxic
• Symptoms may not appear until it is too late.
• Liver failure may not be apparent for a full
  week.
• Gathering information at the scene is very
  important.

104
Other Alcohols
Substance Abuse and Poisoning

• Methyl alcohol and ethylene glycol are more toxic
  than ethyl alcohol.
• May be taken by people with chronic alcoholism
  who cannot obtain drinking alcohol
• More often taken by someone attempting suicide
• Immediate transport is essential.

105
Food Poisoning
Substance Abuse and Poisoning

• Salmonella bacterium causes severe GI symptoms
  within 72 hours.
• Staphylococcus is a common bacteria that grows in
  foods kept too long.
• Botulism often results from improperly canned
  foods.

106
Caring for Food Poisoning
Substance Abuse and Poisoning

• Try to obtain as much history as possible.
• Arrange for prompt transport.
• If two or more persons have the same illness,
  give some of the suspected food to EMS, if
  possible.

107
Plant Poisoning
Substance Abuse and Poisoning

• Several thousand cases of plant poisonings occur
  each year.
• If you suspect plant poisoning
• Assess the patients airway and vital signs.
• Notify poison control center.
• Give the plant to EMS to take to the hospital.
• Arrange for prompt transport.