# Poisoning Emergency Nursing Management

> Nursing notes on poisoning management: decontamination rules, activated charcoal, antidotes, organophosphate care, medico-legal duties and prevention.

- Canonical URL: https://prepelephant.com/topics/allied/nursing/poisoning-nursing-management
- Exam / course: Allied Health · Subject: Nursing
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Poisoning Emergency Nursing Management", PrepElephant, https://prepelephant.com/topics/allied/nursing/poisoning-nursing-management

## Direct answer

Poisoning management starts with airway, breathing and circulation before any antidote, followed by identifying the substance, time and amount, and selective decontamination — induced vomiting is never used. Activated charcoal at 1 g per kg within an hour binds many drugs but not alcohols, corrosives, hydrocarbons or iron; gastric lavage is confined to early, life-threatening ingestions with a protected airway and is contraindicated with corrosives. The nurse runs the specifics: antidotes from atropine and pralidoxime for organophosphates to N-acetylcysteine for paracetamol, seizure and suicide precautions, personal protection during decontamination, and preservation of samples because every deliberate poisoning is a medico-legal case.

## What you must remember

- Assessment firsts: level of consciousness, pupils, vital signs, breath odour (garlic in organophosphorus, bitter almond in cyanide), skin decontamination and glucose in every unconscious patient.
- Gastric lavage, where indicated, uses a large-bore tube with a cuffed airway in the unconscious, within the first hour for best yield; whole-bowel irrigation with polyethylene glycol solution serves sustained-release and iron ingestions.
- Organophosphorus compounds, the commonest Indian agricultural poisonings, give the DUMBBELLS picture — diarrhoea, urination, miosis, bronchorrhoea and bronchospasm, bradycardia, excitation of skeletal muscle then weakness, lacrimation, salivation and sweating.
- Atropine is titrated to endpoints (chest clear of secretions, pulse above 80, pupils mid-dilated, dry axillae), then infusion to maintain; pralidoxime reactivates cholinesterase before ageing; watch for the intermediate syndrome of neck and respiratory weakness at 48 to 96 hours.
- Antidote pairs worth rote memory: paracetamol-N-acetylcysteine; opioids-naloxone (repeat dosing, short half-life); benzodiazepines-flumazenil (seizure risk); methanol or ethylene glycol-fomepizole or ethanol with dialysis; iron-desferrioxamine; warfarin and anticoagulant rodenticides-vitamin K1; methaemoglobinaemia-methylene blue; cyanide-hydroxocobalamin or nitrite-thiosulphate; isoniazid-induced seizures-pyridoxine.
- Snake envenomation is monitored with the 20-minute whole blood clotting test, the limb immobilised at heart level, and polyvalent anti-snake venom infused with adrenaline ready for reactions — never a tourniquet or incision.
- Deliberate self-poisoning is never left alone: one-to-one observation, ligature-free environment, belongings searched, and psychiatric assessment before any discharge.
- Medico-legal duty: preserve vomitus, gastric washings, the container and blood samples in sealed labelled packets; inform the police as required; record times verbatim; staff wear gloves and gowns because skin-contaminated patients poison their carers.

## A worked organophosphate ingestion

A 30-year-old farmer arrives within the hour of drinking an unknown insecticide, drenched in sweat, pinpoint pupils, frothing at the mouth, with a pulse of 52 and audible chest fullness. The team gowns and gloves, strips and washes the contaminated skin, suctions the airway, gives oxygen and secures intravenous access, while the vomitus container is sealed and labelled. Atropine 2 to 4 mg intravenously is given and repeated every few minutes toward the endpoints — lungs clearing, pulse above 80, axillae dry — after which an infusion maintains atropinisation; a loading dose of pralidoxime follows on order, timed early before the enzyme ages. Breath sounds, secretions and saturation are charted quarter-hourly, and the family is questioned for the exact compound, since the container's label drives prognosis and counselling. By day two he improves; on day three, neck flexion weakness and shallow breathing appear — the intermediate syndrome — requiring ventilator readiness, not more atropine. Before discharge comes the mental-health assessment, and prevention closes the loop: locked pesticide storage away from food and the district's suicide-prevention helpline for the family.

## Where students slip

Vomiting induction survives in answer choices and must be rejected every time, as must milk for corrosives and neutralisation chemistry. Charcoal is over-applied to stems involving kerosene or acid, where it has no role. Atropinisation endpoints are remembered as pupil size alone — secretions and heart rate come first, and pupils may never fully dilate in recovery. Naloxone items are answered as single-dose cures, ignoring re-sedation. The medico-legal duties — sample preservation and police intimation — are treated as optional paperwork, though they carry as many marks as the antidotes.

## Frequently asked questions

### Why is vomiting never induced in poisoning?

Because corrosives re-injure the oesophagus on the way up and hydrocarbons aspirate violently; removal, when needed, is by charcoal or controlled lavage with a protected airway.

### When is activated charcoal useful, and when not?

Within about an hour of ingesting most drugs at 1 g per kg; it fails to bind alcohols, acids, alkalis, hydrocarbons, iron, lithium and cyanide.

### What marks successful atropinisation in organophosphate poisoning?

Chest clear of secretions, heart rate above 80, dry axillae and (less reliably) mid-dilated pupils — endpoints for titrating boluses and then infusion.

### Why can naloxone require repeated dosing?

Its half-life is shorter than most opioids, so re-sedation and respiratory depression return; monitoring continues and doses repeat as needed.

### What are the nurse's medico-legal duties in poisoning?

Preserve vomitus, gastric wash and containers in sealed labelled samples, inform police as required, record exact times and observations, and accompany every deliberate overdose with psychiatric assessment before discharge.