Case of corrosive poisoning with pneumonia

Sivagami. C

ANS, Department of Nursing, Kauvery Hospital, Salem, Tamil Nadu

Case Presentation

17 years aged female came to ER with history of consumption of corrosive (Kerosene) 20ml – 25ml. On admission she was having mild tachycardia & tachypnea SpO2 – 90 in room air. RR – 30/min. Baseline investigation done, She was dyspneic, started on O2 2litre and immediately shifted to ICU

Evolution

Patient having SpO2 – 90 with 2litre O2 HR – 120/mts RR – 36 she was on NIV support in view of respiratory distress
She was having repeated fever spikes – cultures taken and antibiotics started
Pulmonologist opinion was obtained and same day evening bronchoscopy was done and bronchial cultures done
Patient was electively intubated due to worsening of respiratory distress

USG showed

Minimal free fluid in pelvis
Bilateral mild pleural effusion with collapse consolidation in both lower lobe

Echo showed

Normal chambers/Trivial MR
Mild TR, No PAH (RVSP – 22 mmHg)
Normal LV, EF – 72

CT chest showed

Sub segmental consolidation at right upper and middle lobes with multiple internal cavitations air fluid level and surrounding ground glassing – Necrotizing pneumonia with early abscess formation.

Multiple small peripheral nodules with cavitations in both lungs more in right side likely septic emboli.

Bilateral collapse of lower lobe

Nursing Care Management

Sterile suction & ET care
Maintain a clear & potent airway
Prevent aspiration & further injection
Provide adequate nutrition & hydration
Pain management & comfort
Counselling (Reduce anxiety & emotional support)
Monitor the PR & breath sounds early defection at respiratory distress
Mobilization
Physiotherapy
Monitor the sign at chest pain, fever, hypotension – early defection & prevent complications
Adequate IVF & electrolytes replacement – Hydration
2^nd hourly positing
Back care

Bronchial cytology: Neutrophil predominant smears

Peripheral Smear

Microcytic hypo chromic anemia with neutrophilic leukocytosis and thrombocytosis

7-9^th day – Plan for extubation, slowly, we did, CPAP trial F102, day by day decreased
10^th day – Patient was extubated successfully
11^th day – After stabilization patient was shifted to single room and 2litre O2
13^th day – USG showed – Bilateral pleural effusion
14^th day – Pleural tapping done (200ml) removed
15^th day – She was on observation
18^th day – She was discharged

Diet Advise

Oral soft diet
High protein diet
Avoid spicy & Oil diet

Discharge Advice: Review after 5 days

Drugs	Dose	Frequency	Duration
Tab. Pan DSR	40mg	1-0-1	5 days
Tab. Levoflox	500mg	1-0-0	5 days
Cap. Clindamycin	300mg	1-1-1	5 days

Case of corrosive poisoning with pneumonia

Case of corrosive poisoning with pneumonia

Sivagami. C

Nightingale Journals