Page 619 - ACCCN's Critical Care Nursing

596 S P E C I A LT Y P R A C T I C E I N C R I T I C A L C A R E

assessment and management of presentations (see
Chapter 17). TABLE 22.6 Acronyms outlining potential causes of
altered level of consciousness
OVERDOSE AND POISONING Acronym Cause Acronym Cause

Poisoning is a common clinical presentation in Australia T Trauma A Alcohol and
and New Zealand, accounting for 1–5% of admissions to other toxins
public hospitals. 103-105 Up to 25% of successful suicides I Infection E Endocrine
105
are due to poisoning. Current clinical management Encephalopathy
with supportive and/or symptomatic control has resulted P Psychogenic Electrolyte
in death rates as low as 0.5% for overdose admissions to Porphyria abnormality
105
hospitals. New Zealand has a similar poisoning pattern S Seizure I Insulin/diabetes
to Australia but much higher rates of admission and a Syncope
106
lower mortality rate than many countries. Common Space-occupying O Oxygen: hypoxia
of any cause
self-poisoning ED presentations include prescribed drugs, lesion Opiates
illicit drugs and ingestion of common dangerous sub-
stances (e.g. detergents, cleansers, psychotropic agents, U Uraemia
analgesics, insecticides, paracetamol, aspirin). 107
A range of artificial and naturally-occurring substances
can produce acute poisonings. The toxicity of a substance
depends on numerous factors, such as dose, route resuscitation may require removal of the toxin, counterac-
of exposure, and the victim’s preexisting conditions. tion of the poisoning by an antidote if available, and the
108-110
Poisoning, whether intentional or unintentional, can treatment or support of symptoms.
occur at any time, and may involve single or multiple Note that many drugs such as paracetamol may have
substances. 107-109 limited initial effects but serious, potentially fatal conse-
The vast amount of knowledge required on all poisons quences if not treated in a timely manner. 104,109,110 Once
prompted the development of poison control informa- ascertained that a patient does not have an immediate,
tion centres to provide specific information and guidance life-endangering problem, attention is directed towards a
for healthcare providers and the general public, on the more thorough assessment and identification of the toxin
management of a poisoned patient; to collect statistics on involved. Accurate history is often the most significant aid
toxic substances; and to educate the public on the preven- in directing care. If a history is unobtainable or uncertain,
108
tion or recognition of toxic exposures. Other initiatives there are several general guidelines available for dealing
to limit the incidence and severity of acute poisoning with a patient who has an altered mental state or con-
107,108,110
include the control of drugs, specific information on sciousness level (see Table 22.6).
labels, the introduction of blister packs and enforced Poisoning should always be considered for a patient
safety standards such as childproof caps. 108-110 with a sudden-onset, acute illness. If there is a strong
suspicion of poisoning, attempt to compare the patient’s
presentation with the suspected toxin and the likelihood
of exposure. Age and gender influence the types of pre-
sentation. Accidental poisonings are the most common
Practice Tip cause of medical emergencies in the paediatric patient
population. Childhood ingestions tend to be accidental
Australian Poisons Information: 131126
and to involve a single substance. Boys are more likely
Poisons Information New Zealand: 0800 POISON (0800 764766) to be the victims of poisoning than girls. Adult inten-
tional poisonings occur more often with adults, and
are more likely to involve multiple substances. 105-107
Women attempt suicide with poisons more often than
men, but men have a higher mortality rate. 105-107 Poison-
ASSESSMENT, MONITORING ings in the aged population are often complicated by
AND DIAGNOSTICS co-existing medical conditions, which may exaggerate
A poisoned patient may present with a wide range of the effects or impair the excretion of the substances
clinical features – from no symptoms through to a life- involved.
threatening condition or the potential to deteriorate
rapidly; patients should therefore always be assessed Previous History
immediately. Triage decisions are based on the potential Patients with existing medical conditions often have mul-
for rapid deterioration and the need for urgent interven- tiple medications that could be either intentionally or
tion. Resuscitation may be necessary before any further unintentionally ingested. Use of multiple drugs may
definitive care can be commenced. 107,109,110 Priorities cause untoward reactions. A patient with a history of
include assessment and maintenance of an airway, depression may attempt suicide with psychotropic
104
adequate ventilation and circulation. Successful drugs. 105-107 A quick onset and acute illness or condition