Question

Chp 26 you have checked the medications Record (MAR) for MARgAnet MARKs meet the patients, in Volume 12 and prepAREP her next dose of antibiotic for Ivindministration, The MAR also indicates that she is Recieving Morphine for pain and that her Last dose was given IHR Ago when you enter the Room, you find her Apparently sleeping. You are not able to awaken her to verify her identity, What do you suspect is happening, and how should you

Answer 1

From the clinical scenario it appears that it is a case of Morphine overdose,it could be accidental or intentional.
This is a clinical emergency and I would respond as follows:

1. Call for help : Shout loudly or pull emergency buzzer to get other nurses and doctors in the room

2. Assess patient in the order A - B - C :

Airway: make sure patient has an open airway, if not assist patient by chin lift and jaw thrust; clean airway of any saliva etc using suction

Breathing: start patient on oxygen via non-rebreathing mask at 15 litres/minute, monitor SpO2 , if patient is not breathing enough then start bag mask ventilation, head up position to prevent aspiration

Circulation: feel for pulse, check blood pressure(BP), if BP is low then consider IV cannulation and intravenous fluids

3. If patient doesnot gain consciousness consider specific antidote Naloxone to reverse opioid action

4. Some patients may need admission to Intensive Care for better recovery

5. At all times constant communication has to be ensured between doctors and nurses for better results

6. Once patient is stabilised a critical event has to be filed to find the reasons of opioid poisoning and prevent the same in future