Emergency nursing care of acute carbon monoxide poisoning

  Carbon monoxide is a colorless and odorless toxic gas. After being inhaled into the lungs through the respiratory tract, it will combine with hemoglobin in the blood to form carboxyhemoglobin. Carbon monoxide has a strong affinity, which is 300 times that of oxygen, while the dissociation rate of carboxyhemoglobin is relatively slow, which is more than 3000 times different from the dissociation rate of total oxygen hemoglobin. When the human body inhales more carbon monoxide, the carbon monoxide in the plasma will squeeze out the oxygen and hemoglobin in the blood, causing the hemoglobin to lose its ability to carry oxygen, causing tissue suffocation. When carbon monoxide is poisoned, the first organs that are damaged are the brain and heart. Therefore, timely and correct rescue is the key to treatment.
  First aid measures
  1. On-site disposal. The site of carbon monoxide poisoning is more dangerous, and the patient should be immediately moved into a safe environment with fresh air. If the patient’s room is in a closed state, the window should be opened immediately for ventilation. First of all, make sure that the patient’s breathing is unobstructed, and pay attention to keeping the patient warm. Patients who have cardiac arrest should undergo cardiopulmonary resuscitation immediately.
  2. Correct the patient’s hypoxic state. The most serious symptom of carbon monoxide poisoning is hypoxemia, so patients should be given the correct oxygen therapy during treatment. Mild patients can inhale oxygen through a catheter or a mask, and moderate or severe patients should give patients a high flow of oxygen, set at 10 liters per minute. Pay attention to the oxygen inhalation time, the patient should not inhale oxygen for more than 24 hours, otherwise oxygen poisoning will occur.
  3. Hyperbaric oxygen therapy. Hyperbaric oxygen therapy is an effective method for carbon monoxide poisoning at this stage, and it is also one of the first clinical methods. Hyperbaric oxygen therapy can effectively reduce patient mortality and reduce patient complications. The use of hyperbaric oxygen to improve the patient’s hypoxic condition, and effectively reduce the patient’s intracranial pressure, cerebral edema and other complications, is of great significance in preventing patients from serious brain injury.
  4. Prevent patients from brain edema. Patients with carbon monoxide poisoning are prone to brain edema. In addition to oxygen therapy for such patients, intravenous access should be established in accordance with the doctor’s advice, and the patients should be treated with dexamethasone and mannitol. Patients with conditions can input fresh bright blood, which can effectively improve hypoxia. Observe closely the vital signs of patients, and apply drugs that promote the recovery of brain cell function for treatment.
  5. Other symptomatic treatment. If the patient suffers from respiratory failure, respiratory stimulants can be used for treatment, and patients with high fever can be treated with physical cooling or medication. Patients with frequent seizures can inject diazepam according to the situation. Naloxone and Xingnaojing can also be used to prevent and control infections in patients.
  Nursing measures
  1. Monitoring of vital signs. The monitoring of vital signs is very important for patients, especially those who have fallen into a coma. It is necessary to strictly monitor the patient’s breathing rate and rhythm. The early stage patients of carbon monoxide have tidal breathing, the middle stage patients have faster and deeper breathing, and there are snoring sounds, and the late stage patients have irregular breathing intervals. Determine the degree of poisoning according to the patient’s condition, observe the changes of the patient’s pupils, and prevent the patient from developing brain edema or even herniation.
  2. Keep the patient’s airway open. Patients with carbon monoxide poisoning often have symptoms of nausea and vomiting, so it is necessary to closely observe whether the respiratory tract of the patient is in a smooth state. If the patient has vomiting, immediately lie on the head and suck out the foreign body to prevent the patient’s respiratory tract from being blocked by sucking backwards. Observe whether the patient has the phenomenon of falling behind the base of the tongue, if it occurs, quickly pull the tongue out. During the nursing period, the patient should be undressed, a pillow should be placed on the neck, and the head should be tilted back as much as possible.
  3. Establish venous access. Adjust the balance of water and electrolyte in the patient’s body through fluids. It is necessary to control the speed of the infusion to avoid aggravating the heart load due to the excessive speed. Diuretic and dehydration can be treated according to the patient’s condition. Pay attention to whether the patient has emphysema, notify the doctor in time if there is an emergency, and adjust the treatment plan.
  4. Treatment of urinary retention. Some patients will experience urinary retention after poisoning, often severe restlessness, and dullness when percusing the bladder. The nursing staff should follow the doctor’s order to catheterize the urine. When inserting the urinary catheter, pay attention to the operation process as slowly as possible to prevent damage to the patient’s urethra. After carbon monoxide poisoning, the mucosa is in an ischemic state, and bleeding is prone to occur. The patient should not exceed 1000 ml during the first urine release to avoid sudden decompression leading to hematuria.
  5. Observe and prevent cerebral edema. After carbon monoxide poisoning, some patients develop intracranial hypertension and cerebral edema. It is necessary to monitor the basic conditions of the patient’s body temperature, pulse, blood pressure, etc., and determine whether the intracranial pressure increases and cerebral edema occurs according to the patient’s condition. Cold therapy can be used to prevent cerebral edema. Ice trough cold therapy can reduce brain tissue metabolism, reduce its oxygen consumption, improve brain cell tolerance, and slow down or control the development of brain damage.