1. EMERGENCY NURSING CARE Toxicological Emergencies By Geraldine M. Harris, BSN, RN-C Prepared for NGR 6711: Creative Teaching

2. OBJECTIVES Upon completion of this lecture, the learner will be able to: Describe what is a toxicological emergency. Identify specific types of toxicological agents. Explain how to handle toxicological emergencies utilizing the nursing process. Describe the symptoms and treatment of overdoses involving alcohol, cocaine, amphetamines, inhalants, salicylates, acetaminophen, sedatives, hypnotics, digoxin, and acid/alkali burns. 3. WHAT IS ATOXICOLOGICAL EMERGENCY Toxicological emergencies involve acute poisonings, overdoses or intake of abuse/illegal substances, over-the-counter medications and prescription drugs. According to the American Association of Poison Control Centers, about 2.5 million cases of poison exposure was reported in 2009 (Badillo, Hovesth & Schaffer, 2013). Toxicological emergency visits are due to use of remedies such as antihistamines, anti- diarrheal, prescription drugs such as digoxin, inhalants and illicit street drugs (cocaine, PCP, GHB). Emergency care involves rapid identification of the substances used with treatment is directed towards preventing/decreasing absorption and symptoms. 4. TOXICOLOGICAL EMERGENCIES Exposures can be occupational, environmental, recreational, or therapeutic. Exposures occur through inhalation, ingestion, injection, or contact with skin and mucous membranes. Antidotes are available for a variety of substances.An antidote is physiological antagonist that reverses the signs and symptoms of poisoning (Badillo, Hovseth, & Schaffer, 2013). 5. NURSING PROCESS Assessment Subjective/Objective/Psychosocial Differential Nursing Diagnoses Planning and Interventions Evaluation and Ongoing Monitoring Documentation 6. SPECIFICTOXICOLOGICAL EMERGENCIES Alcohol Use Opiate Use Cocaine Amphetamines Inhalants Carbon Monoxide Poisoning Salicylate Poisoning Acetaminophen Poisoning Sedative, Hypnotic & Barbituate Poisoning Acid and Alkali Burns Cyanide Poisoning Digoxin Toxicity 7. ASSESSMENT Begin with primary assessment: airway, breathing, circulation, disability (A, B,C, Ds). Resuscitation if necessary. History of Present Illness- information regarding use/abuse/ingestion. Route of exposure, reason for exposure, Past Medical History- current meds, hospitalizations. Psychological/social/environmental factors suicide, addictions Objective Data: General appearance, level of consciousness, vital signs, odors, auscultation of heart/breath/abdominal sounds. Diagnostics: Drug levels, glucose, serum/urine toxicology, CBC, CMP,ABG, Chest xray 8. ANALYSIS: DIFFERENTIAL DIAGNOSES Anxiety/fear Ineffective coping Risk for injury/falls Risk for poisoning Risk for self/other-directed violence Disturbed sensory/perception: visual, auditory, kinesthetic Risk for impaired gas exchange Risk for ineffective airway clearance Risk for seizures 9. PLANNING, IMPLEMENTATION AND INTERVENTIONS Priorities of Care: Maintain airway, breathing, circulation, disability Provide supplemental oxygen as needed Obtain intravenous access Administer pharmacological therapy as ordered Allow loved ones to remain with patient if supportive Educate patients and significant others Notify Poison Control for reporting and treatment recommendations. 10. PLANNING, IMPLEMENTATION AND INTERVENTIONS Poison control center experts help clinicians to assess patients and can suggest management practices. The center uses POISINDEX and other toxicological databases, which are updated regularly. Notifications help them to track patients and gather demographic and statistical information 11. INTERVENTIONS Gastrointestinal Decontamination Activated Charcoal Substances NOT absorbed by Activated Charcoal : Caustics, heavy metals (lead, zinc, mercury), hydrocarbons, iron preparations, lithium, toxic alcohols. Gastric Lavage- indicated if substances were consumed within 1 hour Cathartics magnesium sulfate, magnesiun citrate, sorbitol Whole Bowel Irrigation GoLYTELY, CoLyte orally or gastric tube Hemodialysis Charcoal Hemoperfusion- filtering blood through a cartridge containing activated charcoal. 12. EVALUATION AND DOCUMENTATION Continuously monitor and treat as indicated Monitor treatment responses and modify care plan as necessary Document patient response accurately (positive and negative) 13. AGE-RELATED CONSIDERATIONS Pediatrics Decreased renal clearance of children