This is the act of giving immediate intervention by the Paediatric nurse/nurse to a child who has been exposed to a toxic/dangerous substance by means of swallowing, touching, inhaling, injecting or absorbing.
Aims
· Provide antidote therapy
· Provide basic resuscitation
· Promote excretion of toxins
· Prevent/treat complications
· Provide supportive therapy
· Counsel/educate caregiver/child on prevention of poisoning
· Allay fear and anxiety
Types
· Corrosive compound
· Medication/drug-related poisoning
· Petroleum compound
· Plants/Organisms
Requirements
a. Emergency tray containing the following:
· Padded spatula
· Nasal prongs/oxygen mask
· Ambu bag/self inflating mask
· IV cannula and giving set (age appropriate)
· IV fluid (warm normal saline)
· Syringes and needles (various sizes
· NG tube (various sizes)
· Urethral catheter (various sizes)
· Paediatric stethoscope
· Water soluble lubricant
· Emergency medications e.g. atropine
· Glucometer and strips
· Pulse oximeter
· Sterile and disposable gloves
· Sterile swabs
b. Suction apparatus with catheters
c. Oxygen cylinder/source
d. Vital signs tray
e. Drip stand
f. Other appropriate PPEs
g. Infusion pumps/infusion flow meter
h. Activated charcoal
i. CPR monitor
j. Receiver for used swabs
k. Protective bed clothing
Steps
1. Receive child into the emergency couch
2. Introduce self quickly to child and caregiver
3. Determine the nature and time of poisoning
4. Call for resuscitation tray and assistance
5. Perform five moments of hand hygiene as and when required
6. Assess airway, breathing and circulation
7. Clear airway if necessary
8. Remove contaminated clothing
9. Administer oxygen, intubate and provide ventilatory support if necessary
10. Obtain weight on admission
11. Provide IV access and set up required fluid
12. Pass urethral catheter to monitor fluid intake and output
13. Maintain nil per os for all cases of poisoning
14. Perform gastric lavage within one to two hours of ingestion of non-corrosive substances using warm saline and activated charcoal
15. Perform eye irrigation using normal saline if contaminant has affected the eye
16. Administer prescribed medications:
· Atropine
· Adrenalin
· Anticonvulsants
· Antipyretic
· Antibiotics
· Analgesic
· Coagulant (Tranexamic acid, vitamin K)
17. Assess and treat for shock
18. Assess level of consciousness
19. Assess blood sugar level and manage appropriately
20. Explain procedure to child and caregiver
21. Observe for seizures
22. Prepare child for blood/plasma transfusion if needed
23. Monitor vital signs (TPR, BP, O2 Saturation and pain) fifteen (15) to thirty (30) minutes for the next two (2) hours
24. Document all procedures, findings and observations in the appropriate charts (manual or electronic)
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