See or hear this? Suspect exposure
See or hear this? Suspect exposure
History is key
After ED nurses received an emergency medical services call of an "asthma attack" in a pregnant woman, suddenly multiple patients arrived in respiratory distress. It turned out that someone had sprayed pepper spray in a nightclub.
"The doors were blocked and people panicked, resulting in many victims who were trampled," says Theresa Patrick, RN, BSN, clinical resource nurse for the ED at University of North Carolina — Chapel Hill.
A few minutes later, ED nurses started experiencing burning eyes and throat irritation and coughing. "Nobody knew the pepper spray was released, so no decontamination was done," she recalls. "If this had been a more toxic chemical release, many of the staff and EMS would have been exposed and could have died." The lesson, says Patrick: "History is the key in knowing how to protect others from exposure."
Most of the time, workers in industrial plants know exactly what they have been exposed to, "so pay attention to their stories," says Joan Somes, PhD, MSN, RN, CEN, FAEN, ED educator at St. Joseph's Hospital in St. Paul, MN.
If patients do not mention chemical exposure, however, you still should suspect this if they present with respiratory problems. "These are a good clue: Patients may wheeze, cough, or present with stridor, an indication of bronchospasm," says Somes.
However, patients may not know themselves that they have been exposed, so take note of a pattern of similar symptoms. Be suspicious if several people from the same area — a shopping mall or workplace, for example — present with trouble breathing, watery or burning eyes, skin rash, or irritation. Your questions at triage should be geared toward identifying route of exposure, says Patrick. Ask patients: Did you smell anything funny? Did you see any fumes or feel something splash on your skin? "Find out if the patient changed clothes or showered," says Patrick.
The patients might be so ill that they are unable to tell you what they were exposed to, but the plant manager, first responders, or other workers might be able to provide information, says Somes. "Many will have the MSDS sheets [material safety data sheets] out and ready to send with the patient," she says. "We have had companies fax them to the ED, so we were aware of the best and safest method to proceed."
Somes once cared for a cardiac arrest patient who she later found out was off gassing hydrogen cyanide from his clothing. Burning eyes, running noses, wheezing, and a pungent odor noticed by people walking into the ED prompted a call to the poison control center.
"Those in the department no longer could smell the chemical as our olfactory senses were totally overloaded," says Somes. "Our patient, and the staff, did much better after we removed the patient's clothing and contaminated sheets from the room. All too often with the very sick patient, we cut the clothing open but leave them laying in the 'soup' underneath them."
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