Expert consensus on emergency nursing of poisoned patients(2024)

doi:10.3877/cma.j.issn.2095-9133.2024.03.001

Chinese Journal of Hygiene Rescue(Electronic Edition) ›› 2024, Vol. 10 ›› Issue (03): 129-139. doi: 10.3877/cma.j.issn.2095-9133.2024.03.001

• Expert Consensuse •

Expert consensus on emergency nursing of poisoned patients(2024)

Wen He¹, Ying Wang², Xiaopan Wang³^,^†(), Yuzhi Gong⁴, Bilong Feng⁵, Dan Tian⁶, Kaili Dai⁷, Chuanren Ling⁸, Xing Tang⁹, Ran Dong¹⁰, Qingping Huang¹¹, Hanlan Jiang¹², Jie Xiao¹³, Junhui Zhang¹⁴, Qing Guo¹⁵, Xiaohong Zhang¹⁶, Guanxing Yuan¹⁷

^1. Emergency Department, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan 430010, China
^2. Nursing Department, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
^3. Nursing Department, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan 430010, China
^4. Nursing Department, Liyuan Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, China
^5. Nursing Department, Zhongnan hospital of Wuhan University, Wuhan 430071, China
^6. Emergency Department, Wuhan University People's Hospital, Wuhan 430060, China
^7. Emergency Department, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
^8. Emergency Department, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China
^9. Emergency Department, the Third Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou 310005, China
^10. Emergency Department, Hubei Maternal and Child Health Hospital, Wuhan 430064, China
^11. Emergency Department, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
^12. Emergency Department, Wuhan Children's Hospital, Wuhan 430015, China
^13. Emergency Department, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan 430030, China
^14. Emergency Department, Liyuan Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, China
^15. Emergency Department, Yichang Central People's Hospital, Yichang 443008, China
^16. Emergency Department, Xiangyang Central Hospital, Xiangyang 441021, China
^17. Emergency Department, Wuhan Asian Heart General Hospital, Wuhan 430056, China

Received:2024-04-15 Online:2024-06-18 Published:2024-09-29
Contact: Xiaopan Wang

Abstract

Abstract:

Poisoning can endanger the lives of patients. Because its overall incidence is low and it is not familiar to the majority of medical staff, it brings many challenges to emergency medical staff. It is necessary to adopt a structured and thoughtful treatment approach to poisoned patients. Understanding the nuances of toxicological history and physical examination and standardizing the first contact of poisoned patients can help manage these patients. To this end, the Hubei Province Alliance on Poisoning and Occupational Diseases organized a number of domestic medical institutions to draft this expert consensus based on the academic and clinical experience of relevant experts, and applied it in practical terms with some nursing experts with rich experience in poisoning treatment. Finally, it was submitted to this consensus expert committee for discussion and approval to reach a consensus on emergency care for poisoned patients. This article aims to help emergency nursing staff make practical and feasible assessment and management of poisoned patients.

Key words: Poisoning, Emergency care, Nursing

Wen He, Ying Wang, Xiaopan Wang, Yuzhi Gong, Bilong Feng, Dan Tian, Kaili Dai, Chuanren Ling, Xing Tang, Ran Dong, Qingping Huang, Hanlan Jiang, Jie Xiao, Junhui Zhang, Qing Guo, Xiaohong Zhang, Guanxing Yuan. Expert consensus on emergency nursing of poisoned patients(2024)[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2024, 10(03): 129-139.

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References 67

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适应证	禁忌证
患者符合洗胃的指征（表1）；	患者不符合洗胃的任何指征（表1）；
洗胃的益处大于风险	患者已经丧失或可能丧失气道保护反射，但未插管。（插管后，如有其他指征，可进行洗胃）；
	在未进行气管插管的情况下，摄入了误吸可能性较高的毒物；
	摄入碱性腐蚀剂；
	摄入异物（如药包）；
	患者因潜在病变、近期手术或其他疾病而有大出血或胃肠道穿孔的风险，使用洗胃可能会进一步加重病情；
	摄入的毒物形式过大，无法进入洗胃管腔内（如许多缓释制剂）

适应证	禁忌证
患者符合洗胃的指征（表1）；	患者不符合洗胃的任何指征（表1）；
洗胃的益处大于风险	患者已经丧失或可能丧失气道保护反射，但未插管。（插管后，如有其他指征，可进行洗胃）；
	在未进行气管插管的情况下，摄入了误吸可能性较高的毒物；
	摄入碱性腐蚀剂；
	摄入异物（如药包）；
	患者因潜在病变、近期手术或其他疾病而有大出血或胃肠道穿孔的风险，使用洗胃可能会进一步加重病情；
	摄入的毒物形式过大，无法进入洗胃管腔内（如许多缓释制剂）

适应证	禁忌证
患者不符合洗胃标准或洗胃可能有害；	已知活性炭不能吸附的毒物；
摄入物可能有毒，但活性炭可以很好地吸附；	气道保护性反射消失或预期消失，患者没有插管；
摄入的毒物在可被活性炭吸附的时间范围内，或存在临床因素，表明并非所有毒物都已被全身吸收；	与摄入腐蚀性物质的情况一样，很可能发生胃肠道穿孔；
摄入的毒物在可被活性炭吸附的时间范围内，或存在临床因素，表明并非所有毒物都已被全身吸收；	治疗很可能会增加吸入的风险和严重程度；
只要没有绝对禁忌证，无论摄入时间长短，有可能危及生命的中毒患者	确定将行内镜检查（腐蚀剂）

适应证	禁忌证
患者不符合洗胃标准或洗胃可能有害；	已知活性炭不能吸附的毒物；
摄入物可能有毒，但活性炭可以很好地吸附；	气道保护性反射消失或预期消失，患者没有插管；
摄入的毒物在可被活性炭吸附的时间范围内，或存在临床因素，表明并非所有毒物都已被全身吸收；	与摄入腐蚀性物质的情况一样，很可能发生胃肠道穿孔；
摄入的毒物在可被活性炭吸附的时间范围内，或存在临床因素，表明并非所有毒物都已被全身吸收；	治疗很可能会增加吸入的风险和严重程度；
只要没有绝对禁忌证，无论摄入时间长短，有可能危及生命的中毒患者	确定将行内镜检查（腐蚀剂）

适应证	禁忌证
摄入致命剧毒鹅膏、胺碘酮、阿米替林、卡马西平、秋水仙碱、右旋丙氧芬、洋地黄毒甙、地高辛、丙吡胺、度硫平、度洛西汀、敌草快、赭黄裸伞、拉莫三嗪、纳多洛尔、苯巴比妥、保泰松、苯妥英、吡罗昔康、喹硫平、奎宁、索他洛尔、茶碱、丙戊酸、维拉帕米、长春瑞滨；	任何单剂量活性炭禁忌证；存在回肠或其他导致肠蠕动减弱的原因
摄入大量经过肠肝循环或肠道再循环并被活性炭吸附的、危及生命的毒物；
摄入大量缓慢释放的毒物或已知会形成凝块或结块的毒物

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适应证	禁忌证
摄入缓释和控释药物可能中毒；	未插管患者的气道保护性反射消失或预期消失；
在无法采用其他消化道净化方法或这些方法无效的情况下，摄入一定量的活性炭无法吸附的毒物；	消化道受损，有回肠梗阻、消化道严重出血或血液动力学不稳定的迹象，可能会影响消化道蠕动；
从携带毒品的体内取出毒品包	持续呕吐；
	可卡因包有渗漏迹象（手术取出的指征）

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