Emergency Care and First Aid (Safety in the Healthcare Facility) (Nursing) Part 6

Poisoning

Any substance that threatens a person’s health when it is absorbed or comes into contact with the body is defined as a poison. Poisons are in such common substances as household cleaning agents, insecticides, antifreeze, furniture polish, kerosene, and nail polish. Accidental poisoning is a particular danger for children. In Practice: Nursing Care Guidelines 43-7 outlines first-aid care for poisoning. In Practice: Important Medications 43-2 lists common antidotes for poisoning.

In any case of poisoning or drug overdose, call the nearest Poison Control Center (or 1-800-222-1222) immediately. They will advise you what to do; in nearly all cases, the victim should be transported to an ED for treatment. The recommendations for treatment have changed recently, and gastric lavage (“pumping the stomach”) is not often used. Induced vomiting is not recommended.

The National Poison Control Center organization gives the following tips for prevention of poisoning:

•    Keep all potential poisons locked up or high and out of sight.

•    Keep all poisons in their original containers.

•    Know the current weights of all children younger than 6 years.

•    Do not take medications while children are watching— they may copy you.

•    Never refer to medication as “candy,” and do not use funshaped medications (even vitamins).

•    Syrup of ipecac (an emetic, which causes vomiting) is no longer recommended for the home or day-care provider’s medicine cabinet.

•    Keep activated charcoal in the home medicine cabinet if the home is far away from an ED.

•    Always call the local Poison Control Center for any questions or incidents.

•    Keep the number of the Poison Control Center by each phone in the house.

IN PRACTICE :NURSING CARE GUIDELINES 43-7

GIVING FIRST AID IN POISONING OR OVERDOSE

♦    Call for help: 911. Rationale: Treatment for poisoning depends on the poison ingested. Expert assistance is needed.

♦    After calling 911, contact the nearest Poison Control Center In some EMS areas, 9 1 1 dispatchers can connect the call to the Poison Control Center and monitor the call. Rationale: The Poison Control Center can instruct the caller in proper treatment. Usually, the person needs to be transported to an emergency department. Vomiting is not induced.

♦ Attempt to identify the poison. Question the person, if possible. Save all vomitus, urine, or stools and the remains of food or drugs that may have been responsible. Look for medication bottles or other containers. Bring all these materials to the medical facility with the person. Rationale: This information is necessary to determine the nature and amount of poison or drug taken.

Key Concept The treatment of choice in nearly all poisoning or overdose situations is activated charcoal.

An emetic is no longer recommended because:

♦    Research shows that the outcome of serious overdose or poisoning has not been altered by induced vomiting.

♦    Ipecac can be abused by persons with an eating disorder such as bulimia.

♦    A serious potential for aspiration exists during vomiting, particularly if the person does not have a gag reflex or is sedated, inebriated, having seizures, in severe shock, or unconscious.

♦    Vomiting after ingestion of a caustic substance, such as gasoline, will cause more damage because of the second exposure of the throat and lungs to the substance when the person vomits.

Gastric lavage is seldom used, except in cases of certain drugs, such as a large dose of aspirin (which tends to clump), or in an overdose of drugs, such as lithium, iron, or calcium channel blockers. Always follow the recommendations of the Poison Control Center.

Medication Poisoning

All medications are potentially poisonous, but many do not have such effects because they are given in small doses. Accidental drug poisoning may result from misreading a label or taking medicine from an unlabeled bottle or in the dark. Older persons may take extra doses of medications because they may forget that they have already taken them.

♦    Use the sense of smell to detect the odor of alcohol or other chemicals on the person’s breath. Rationale: Many drugs are more dangerous when combined with alcohol.

♦    In cases of suspected overdose, ask questions of the person and the family Was this a suicide attempt or an accident? Was there a suicide note? Was the person depressed or despondent? How many pills or how much alcohol was taken? Rationale: This information will be important to the medical team in planning emergency treatment and continuing medical care.

♦    Give supportive care. Keep the person warm. Use artificial ventilation if the person is having difficulty breathing. Maintain the heartbeat. If possible, keep the person awake. Follow basic life support procedures if CPR is needed. Rationale: Poisoning or overdose is a medical emergency. Maintain the person in the most stable condition possible until arrival at the healthcare facility.

♦    Follow the instructions of the Poison Control Center Rationale: They are the experts in treatment of poisoning or overdose.

♦    Do not give anything to eat or drink or any medications without specific instructions to do so. Rationale: This could be very dangerous and could cause additional complications.

♦ Remember the acronym SIRES (Stabilize victim, Identify poison, Reverse effects, Eliminate poison, Support vital functions). Rationale: This acronym will help to guide your actions.

A drug overdose may be accidental or intentional (e.g., a suicide attempt). Care in a suicide attempt is discussed.

Food Poisoning

Food poisoning is almost always caused by eating contaminated food. Bacteria’s normal action on food causes decomposition, which forms toxins (poisonous substances).

IN PRACTICE :IMPORTANT MEDICATIONS 43-2

FOR POISONING AND DRUG OVERDOSE

The following medications are commonly used for treating poisoning or overdose:

♦    All-purpose antidote: activated charcoal (Actidose-Aqua, CharcoCaps)

♦    Acetaminophen overdose: acetylcysteine (Mucomyst)

When caring for the person receiving any of these medications,keep in mind the following:

♦    Never combine these medications.

♦    Be sure that activated charcoal is available to all first-aid personnel and in the home medicine cabinet if help will not be readily available.

♦    Assess the first bowel movement after activated charcoal is given. It will appear black. Watch for constipation; bowel obstruction may occur.

♦    Do not give syrup of ipecac.

Another cause of food poisoning is the accidental eating of poisonous fruits, berries, or vegetables (e.g., toadstools or poisonous mushrooms). Symptoms of food poisoning include abdominal pain, nausea, vomiting, and diarrhea. Onset is acute (within a few hours after eating the contaminated food). The sooner the symptoms occur, the more serious the poisoning is. Symptoms usually disappear in 1 to 2 days, after the person has excreted the toxins.

A severe form of food poisoning, called botulism, is caused by the organism Clostridium botulinum. About half of the cases of botulism result in death. Home-canned foods that have been improperly sterilized or have lost their seal are a common cause. Symptoms, which are progressive, include weakness, headache, paralysis of the eye and throat muscles, and finally, respiratory paralysis. Specific antitoxins are effective if given early. Rescue breathing may be required until EMS personnel arrive. They will maintain the person with the AMBU-bag during transport. The person may need to be maintained via endotracheal tube on a mechanical ventilator until the antitoxin takes effect and spontaneous respirations resume.

Nursing Alert Warn clients never to use a home-canned or commercially canned item if the top is bulging, if there is dark leakage around the seams, or if there is any discoloration in the contents of jarred foods. If there is any doubt, throw it out!

Psychiatric Emergencies

Psychiatric emergencies affect people of all ages and can occur at any time. A person requires medical attention when severe anxiety results in hallucinations, paranoia, confusion, or suicidal threats or gestures. Anxiety or “panic attack” may cause the person’s heart to race or his or her respirations to become rapid. Sometimes the person’s fingers and hands become numb and tingly. The person may feel incapable of functioning. Assess the person for suicidal tendencies and potential risk for harming self or others. The nurse working in home care or community-based nursing may be the first and only healthcare person to come in contact with the client. Recognizing the symptoms of a psychiatric emergency is important. Call for medical assistance when any of these factors are present in an individual:

•    Threat to harm self or others

•    Suicidal thoughts, especially if the person has a specific plan (e.g., weapons, pills, and so forth) or even if the person does not have a plan

•    Refusal to talk further when a psychiatric emergency is suspected

•    History of prior suicide attempts

•    Severe depression

•    Intoxication or drug abuse, combined with suicidal or violent thoughts or actions

•    Self-injurious behavior (e.g., burning or cutting oneself)

•    Out-of-control or bizarre behavior, causing major disturbances in the community

•    Evidence of self-harm (e.g., empty pill bottles, unresponsiveness, suicide attempt)

•    Evidence of not caring for one’s self, such as not eating, not sleeping, living in a trash-strewn house, or not taking prescribed medications

•    Reports of any of the above by family or neighbors

Assist emotionally disturbed people by remaining calm. Show them respect and make no assumptions or judgments. Ask questions that allow him or her to explain the situation. Avoid questions that elicit yes or no answers; encourage the person to talk. Help generate a positive plan of action. Express a desire to help. Communicate on the client’s level. Listen attentively. Obtain medical assistance as soon as possible. The police can assist in taking the person to the hospital if necessary.

Key Concept When dealing with an emotionally disturbed person, remain calm and speak softly slowly and clearly Maintain a nonthreatening posture and tone of voice. Do not allow the person to get between you and the door— maintain an "escape route” for yourself. Prevent the person from injuring himself, herself, or anyone else. Seek assistance as soon as possible.

KEY POINTS

•    Nurses are with clients much of the time in the healthcare facility. Therefore, the nurse may be in the position to recognize and alert the appropriate staff to deal with cardiopulmonary arrest and other emergencies.

•    Nurses must use Standard Precautions when administering first aid (to whatever extent possible).

•    In emergencies, nurses and nursing students function only at their level of first-aid training. Quick evaluation of the scene and planning for action are crucial.

•    Calling 911 will summon the EMS system in almost all areas of the United States and Canada. The nurse must know how to summon assistance in an emergency.

•    When assessing an emergency, the most important consideration is to make sure the person is breathing and that his or her heart is beating.

•    Be sure to treat the injured person for shock.

•    Do not move an injured person, unless the situation is life threatening. Take precautions to prevent further injury.

•    All healthcare workers, including nurses, should know how to perform CPR and remove an airway obstruction in an emergency. Maintain current CPR certification.

•    The nurse may be called on to provide first-aid assistance in a community. Each nurse has the responsibility to be knowledgeable in basic first-aid techniques.

•    Chest injuries can result in inadequate air exchange and are immediately life threatening. Ensure that the chest wall is intact. Plug any open wound of the chest. Do not remove any penetrating objects.

•    Be aware of the possibility of injury from excessive heat or cold. Take prompt action in life-threatening situations.

•    A person who is having a heart attack is often in denial. EMS personnel may need to be very persuasive to get the victim to appropriate medical care.

•    The first-aid person must be knowledgeable in methods used to stop bleeding.

•    Anaphylaxis is a medical emergency that requires immediate treatment.

•    Follow the instructions of the Poison Control Center in the event of poisoning or overdose.

•    Remain calm when dealing with an emotionally upset client. Be alert for the possibility of suicide.