Communication with the patient

Introduction

This report is based on a patient that was brought on into George Mukhari casualty on the 1st of July 2009. It was a male patient who had ingested milk, cooking oil and PARAFFIN. The patient was 24 yrs old. Verbal communication with the patient was limited, a SAMPLE history wasn't possible. Patient's Gcs was 14(eye opening to voice). Skin was warm and dry. No diaphoresis. Pupils were 2mm left and right. Patient was vomiting at home and in casualty, he also passed urine whilst in casualty. My focus in this report is therefore paraffin poisoning and the symptoms and complications showed by patients. The main problem was poisoning. Treatment, normal symptoms, physiology as well as my experiences will be discussed

Analysis

The unintentional intake of paraffin normally presents with a range of symptoms, these symptoms are dependant on the amount ingested [1], and whether some had gone through the trachea into the lungs or not. The medical presentation is dependent relatively on the period past ingestion.

Symptoms are fever [1], coughing, pneumonitis and pulmonary edema; in your central nervous system depression [1] and coma Fever is also a common CNS complication, which could be due to the presence of a foreign matter in the pulmonary system

The patient on who this case study was done clearly displayed the classic symptoms, vomiting; he vomited at home and in casualty.

The symptoms that the patient exhibited in the CNS are depression in the form of a decreased GCS. Patient probably ingested a small amount of paraffin hence he didn't have all the classic symptoms such as edema or pneumonia.

The only inconsistent symptom that the patient presented with was, the skin was warm and dry and not diaphoretic to indicate fever.

There's no set protocol for dealing with paraffin poisoning in the pre- hospital setting. The best treatment would be to first of all perform an accurate focused assessment thereafter, maintain airway if the patient's GCS is below 8 with either an LMA combitube, and if advanced airways are not necessary just give the patient oxygen via non rebreather. Initiate i.v access with a ringers lactate; give fluids according to blood pressure. "Passage of stomach tube may produce gagging and retching" [2]

The patient was given oxygen and given i.v ringers but no fluid challenges, and placed lateral as to avoid aspiration. The patient didn't show any obvious response to treatment, although after the o2 we did at least expect an increase in the patent's GCS. This didn't occur. Since there was no N.G tube placed, what I realized was that I should've recommended to the doctor to think about placing a NG tube for gastric lavage. In future I as a practitioner will be do a more depth assessment and focus on history. If it has been longer than 30 mins [2] form ingestion I will be cautious with the N.G tube.

Critical thinking

This experience signified that assessment of patients is vital, and always think about the implications that the complication of a procedure will have on the patient's all round clinical appearance. Placing the patient lateral, giving him oxygen, and initiating I.V access were part of my treatment that was efficient. The reason for its efficiency was that it was performed correctly, and was indicated in terms of the patent's clinical appearance. I didn't sincerely learn much about myself in this situation. When it comes to other individuals what I gathered was that not all practitioners are perfect and being human allows us to make mistakes and make bad decisions but not necessarily just letting it pass but leaving us with the prospect to gain more knowledge.

The in effective part of my treatment was perhaps the part that wasn't done such as the N.G tube, or a more detailed assessment. The ability not to pass judgment played a vital role, in respects of both the patient and practitioner.

My thoughts on winding up are that just patient's will not always present with all the necessary symptoms to come to diagnosis and that everyone is susceptible to error.

Decision making

Next time I will further assess the patient further.

As a matter of fact what I've actually learnt is that sticking to set guidelines will generally have a good outcome. Always keep in mind the complications or adverse effects of any aspects of patient care that you render .Doing reflective reports give the practitioner a systematic approach to further learning.

References

1. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2123701 -

2. PORT OF THE SUBCOMMITTEE ON ACCIDENTAL POISONING

CO-OPERATIVE KEROSENE POISONING STUDY

EvaIuaf@onof Gastric Lavage and Other Factors in the Treatment Of Accidental Ingestion of Petroleum Distillate Products

Pg14; Pg 9; Pg 13

Source: www.chestjournal.org/content/47/4/local/front-matter.pdf -

3. Kerosene poisoning in childhood. PDF: A 6-year prospective study at the Princess Rahmat Teaching Hospital

Ali M. Shotar

Department of legal medicine, toxicology and forensic science, Jordan University of Science and Technology, School of Medicine, Irbid, Jordan.

Correspondence to Source http://www.ncbi.nlm.nih.gov/pubmed/16380681

4. Paraffin poisoning in children what can we do differently?

National School of Public Health, University of Limpopo (Medunsa Campus), Pretoria, South Africa Du Plooy WJ, PhD (Pharmacology)

Department of Pharmacology and Therapeutics, University of Limpopo (Medunsa Campus), Pretoria, South Africa Ogunbanjo GA, MBBS, MFGP (SA), M Fam Med (Medunsa), FACRRM, FACTM, FAFP (SA)

Department of Family Medicine and Primary Health Care, University of Limpopo (Medunsa Campus), Pretoria, South Africa

Correspondence: Ntambwe Malangu, National School of Public Health, University of Limpopo (Medunsa Campus)

Source: http://www.safpj.co.za/index.php/safpj/article/viewArticle/162

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