Indiana Poison Center Nursing Position

Gwenn is a Senior Partner and Team Leader at the Indiana Poison Center at Methodist Hospital. When you call the Poison  Center, you talk to Gwenn.

“My mom was an ER nurse and she was an inspiration to me. I enjoy helping people and being able to tell a parent that their child is going to be OK.”

Gwenn has five children who are her primary passion. She loves to read, collects books by some rather obscure authors, and enjoys embroidery and classic Broadway musicals.

You can read more about where Gwenn works at Clarian's ACallToChange.org website: Find Nursing Position in Indiana.

I just finished a 12-hour shift. Maybe it’s the cold, cold weather, maybe it’s the post-holiday let-down, maybe it’s the phase of the moon… but there were an unusual amount of suicide attempts for the day shift today. Most intentional ingestions happen on evenings and nights.

(All details below changed to protect confidentiality.)

I talked to two concerned moms with distraught daughters. One was a 13-year old girl who took 10 Ibuprofen after her boyfriend broke up with her. The other was a 24-year old lady with a history of bipolar disorder and post-partum depression who took a double-dose of her Elavil®, “but wanted to take the whole bottle.” Fortunately, mom had wrestled the bottle away. I also spoke with the ER nurse caring for an 18-year old girl “whose parents are out of the picture” and who was brought in by her live-in boyfriend after they had an altercation. She had drunk half a bottle of Nyquil® and taken four tablets of Benadryl® – because she “wanted to go to sleep.”

Now, none of these sound like very serious ingestions to most people – they aren’t ingestions of hundreds of pills, they aren’t particularly toxic substances in the amounts ingested, and none of the patients were having significant symptoms when we were called. Still, each patient was referred to the ER for (or the ER was advised to provide) a thorough medical evaluation – on the general theory that a person who is upset enough to intentionally take an overdose can’t be relied upon to be the most accurate historian. Psychiatric evaluation was also recommended.

At some point you may encounter a friend, relative or acquaintance that has made a suicidal gesture. The circumstances (a teenage romance, the baby blues, a squabble with a boyfriend) may not seem very significant to you. The exposure itself may not seem particularly toxic. Of course, we recommend that you call Indiana Poison Center and let us help you determine what to do in each circumstance.

I encourage you to treat these events EXTREMELY SERIOUSLY for these reasons:

1. Although the “motive” may seem “insignificant” in your eyes, if the patient has judged it to be an adequate reason for an attempt, disastrous results may occur.
2. You don’t really know what has been ingested or the quantity involved and you shouldn’t wait to find out what may develop.
3. If initial suicidal attempts are ignored or minimized, subsequent attempts may be more aggressive.

What happened with these three young ladies? All three were medically evaluated and medically cleared. All were evaluated by the respective Crisis Teams at their facilities. Two were admitted for in-patient psychiatric care and one was referred back to her current therapist for on-going out-patient therapy. Were these ER evaluations worthwhile? Absolutely. They were a very effective method to establish physical stability and acquire an entry to the mental health system.

Someone may call on you for help. Be sure you are listening.

Gwenn

To be a registered nurse at Clarian, visit Registered Nurse Job Opportunities.

Oh the joys of the holiday season! The sweet smells of baking and evergreens, the glittering lights, candles, ornaments and tinsel, the crackling of wrapping paper, the glow of a cheerful fire, the lovely sounds of voices raised in song and laughter …… and the multitude of opportunities for poisoning abounding everywhere!

Here’s just a smattering of common exposures & their general risks:

• Bubble lights – not a problem unless you drink more than one
• Tiny glass bulbs – not a problem if you crunch one
• Poinsettias – NOT toxic! If you eat the entire plant, you’ll vomit
• Jerusalem cherry – toxic
• Christmas cactus – not toxic
• Flocking – not toxic
• Tinsel – a problem for cats
• Chocolate – a problem for dogs
• Christmas ornaments – foreign bodies / choke hazards; ancient ornaments may have lead-based paint
• Candles – “dry” wax is not toxic; Liquid candles or “wet” wax are aspiration risks
• Oil lamps – aspiration risks
• Plug in air fresheners – aspiration risks
• Left over alcoholic drinks – hypoglycemic risks for kids
• Cigarettes and cigarette butts – toxic
• Silica gel (the desiccant in purses, stereos, new shoes) – not toxic, choke hazard
• Button or disc batteries – toxic! Child will need an immediate X-Ray to locate the battery’s position; further treatment depends upon where the battery is.

Have a wonderful, joyous holiday time! Keep those little ones – and everyone else – safe. If you think an exposure has occurred, call the Indiana Poison Center at 1-800-222-1222 – we’ll be there 24/7, just like the rest of the hospital world, ready and waiting to help you if you need us.

Gwenn

To be a registered nurse at Clarian, visit Registered Nursing Opportunities Indiana.

“Indiana Poison Center, this is Gwenn RN, how may I help you?”

“My son just ate Santa Claus!” wailed the caller. “What am I going to do?”

Unique ingestions happen around the holidays. This one was perhaps more unique than is typical.

“Ma’am? Could you explain that a little more thoroughly for me? What do you mean, he ATE Santa?”

Turned out “Santa” was an antique glass ornament, handed down through the family, and mom had unfortunately hung it on a lower branch on the Christmas tree. Her 18 month old son had promptly grabbed the shiny object and bit off it’s head. The baby was fine, had no cuts in his mouth, and was able to drink juice without any problem. The tiny fragments of thin old glass would pass through his GI tract without problem, so only a little instruction on diet adjustment and observation during the next week was necessary.

How mom was going to explain this to Grandma was a whole other story, one that I couldn’t assist her with.

Gwenn

To be a registered nurse at Clarian, visit Nursing Jobs Indianapolis.

At Indiana Poison Center our staff are called Specialists in Poison Information, conveniently abbreviated as SPIs. Sometimes I think our Registered Nurse jobs should actually be known as real Spies, since we spend so much time digging out hidden information ...

Indiana Poison Center, this is Gwenn RN, how may I help you?

“This is Kate, the school nurse from Happy Valley Elementary. Several of our parents have seen this e-mail that is circulating about alcohol based hand sanitizer and the dangers involved if children should lick the hand sanitizer off of their hands. The parents want us to switch to alcohol-free hand sanitizer. Can you tell me anything about this?”

Well, I can tell you that as long as your students weigh more than 30 pounds and are licking less than a teaspoon of hand sanitizer from their hands, they are going to be perfectly fine. Ethanol based hand sanitizers typically contain 62% ethanol, and ingestion of a teaspoon or less in a 2 year old, 30 pound child is not enough to be a problem. If you have kindergarten aged children and above, they should weigh more than 30 pounds, so they should be fine. I’d be glad to e-mail you our news release on hand sanitizer – you’re not the only school nurse being besieged by parents who have read this mis-information and are worried about it!

“Hi, this is Dr House from Memorial Community ER. I have a guy here who says he shot up heroin, but he sure doesn’t act like it. He’s agitated, tachycardic and hypertensive. I remember seeing something about heroin that was contaminated ... Can you fill me in on that?”

Sure, Epi-X had an alert out on heroin that is contaminated with clenbuterol. It resulted in symptoms like you describe – agitation, tremors, hypertension, tachycardia – plus hypokalemia and hyperglycemia. Treatment is basically symptomatic and supportive care – benzodiazepines and temperature control, plus correction of the electrolytes. Would you like me to fax you the alert?”

A weeping mom: “I just gave my baby some Motrin and some cold medicine - Then my sister-in-law told me that ibuprofen and cold meds could kill him! She saw it on the internet! Should I take him to the Emergency Room?”

No, ma’am, you don’t need to take him to the hospital, he’s going to be perfectly fine. I’ve seen that internet entry too and it’s not true at all. It’s what we call an urban legend, or what they used to call an old wives’ tale. Ibuprofen, which is what’s in Motrin, and Dextromethorphan, which is the cough ingredient they’re concerned about, are not toxic together. Both are safe when used as directed, together or separately. I’ve checked several drug interaction sites and they have no drug interactions, and I’ve also checked some reputable web-sites that investigate web rumors like this and they say there’s no support for this one.

Gwenn

To be a registered nurse at Clarian, visit Nursing Jobs Indianapolis.

Indiana Poison Center, this is Gwenn RN, how may I help you?

8:00 am “My 20 month old, 19 pound daughter just took the medicine we had laid out for my 12 year old son. That’s Concerta® 36 mg, 2 tablets. Will she be OK?”

“Well, she’s going to need to come into the Emergency Room and be monitored for awhile. This is a pretty strong medication and it can affect her heart and her neurological status. But I think with appropriate care she’ll be just fine. What hospital will you take her to?”

08:05 am I called report to Community Memorial ER about the child who ingested the Concerta®. Talked to Kylie RN and suggested Activated Charcoal PO, EKG monitor, benzodiazepines if symptomatic, monitor for at least 6-8 hours for this SR product.

08:07 am “My 2 year old son just drank some cologne! He’s spitting and carrying on something awful! What should I do?”

Cologne has a lot of alcohol in it and it tastes horrible. However, a little bit of it’s not going to harm him. Wipe his mouth out with a clean wet cloth and start him on some juice or Koolaid, then bring the bottle back to the phone …

08:32 am I’m 79 years old and I do NOT have dementia. But I think I just took a double dose of my Tylenol Arthritis Extra Strength. I usually take 2 tablets 3 times a day, at 7 am, 3 pm, and 11 pm. But I got up early this am and took my Tylenol at 7 am and I think I took it again just now!”

One time a double dose of Tylenol®, even Tylenol Arthritis Extra Strength®, should not harm you. But you will need to restrict the total amount of Tylenol® that you take for the day, so you don’t take too much for the 24 hour period. I suggest you skip your 3 pm dose and resume your dose at 11pm, OK? Or you can check with your Doctor’s office and see what they say.

08:44 am This is Officer Mitch Jones calling from Happyvale Police Dept. and I want to identify a pill confiscated at a traffic stop. There has been no exposure. It’s a round yellow tablet with the imprint TL 177.

This is cyclobenzaprine, common name Flexeril; it is a prescription but not a Scheduled drug.

0851 am This is Deb RN calling from Memorial General ER. These parents just brought in a 7 month old who chewed on a paint brush that had been dipped in oil based paint, wrapped in tin foil, and stored in the refrigerator. He is coughing and spitting. He seems to be oxygenating OK, as his color is good and his biox is 98% on RA.

OK, oil based paint is a concern because it is a Hydrocarbon and if even a few drops are aspirated into the lungs, it can cause a nasty hydrocarbon pneumonitis. Treatment is basically symptomatic – O2, RT treatments, CXR, biox, ABGs – the usual. Real rarely these kids will require mechanical ventilation. Antibiotics only if there are signs of a secondary infection and no need for steroids…

Gwenn

To be a registered nurse at Clarian, visit Registered Nurse Career Job Search.

Vicky, a school nurse called. A special-needs student, a little boy aged 8, had eaten a good portion of a toy. “Well, not the toy itself. It’s this special kind of “Real-Life Reptile” and he chewed a hole in the tail and ate a bunch of these little white beads …. what we want to know is if those beads are toxic or not?”

First I established that the little boy, Ricky, was generally healthy and having no obvious problems at this time. He had been given a glass of water to drink and was doing so without problem. They estimated the amount of beads he had ingested as ¼ cup….

"Do you have the original packaging on the toy, and does it say non-toxic?"

"Oh no, we never keep all that stuff."

"Then do you know the manufacturer’s name or number?"

"Only what it says on the tag..."

Turned out the tag said the product was a "Real-Life Reptile" made by Boinky Ball Toys (all names changed to protect the innocent), but nothing more. The particular reptile he had ingested was a "Fast & Friendly Gecko," blue-green with bulging orange eyes and red toes.

I did a quick search on our Poisindex© system – neither the toy nor the manufacturer was listed.

Then I did a quick Google© search – and voila! Boinky Ball Toys was listed, and so was our little reptile friend... unfortunately there was no information on the contents and their potential risks if ingested.

I advised Vicky that I doubted this was a toxic exposure, as toys are generally made with non-toxic components, because kids do tend to nibble on them. I suggested that I take her number, and that I would call the company and track down the actual ingredients, just to be sure. Meanwhile she would closely monitor little Ricky. She was agreeable with that approach.

I called Boinky Ball Toys and spoke to Tiffany in their Customer Service department. Eventually I got her to understand that I wasn’t interested in placing an order but I needed to speak with someone in charge of product development, to find out what the product was made of. Then I spoke to Shelly, who said I needed to talk to Dave, "but he’s in a meeting right now, may I have him call you?" I explained, yet again, that we had a child that had EATEN their toy and we needed to know sooner, rather than later, what the toy was composed of. Shelly promised to interrupt Dave’s meeting.

A few minutes later, Dave called back. He had obtained the MSDS on the toy and was pleased to report that the white pellets were vulcanized plastic and totally non-toxic. I thanked him for his time and called Vicky back.

"Good news, it’s just plastic, completely non-toxic," I told her. "The only risk would be a concern for obstruction, but that’s unlikely since the format that Ricky swallowed was all tiny pellets." Still I recommended that he be fed a high fiber, high fluid diet for a few days and that he be watched for any signs of an acute abdomen. Of course, if he developed any symptoms, he should be checked by his FMD and that the physician needed to be informed of this exposure.

When Indiana Poison Center opened it’s doors, in 1977, nurses used a microfiche to look up general topics and made a general guess as to their contents. When I joined IPC in 1988, they had recently moved to a computerized database, Poisindex©, which tries to list every possible substance and it’s ingredients, with general directions on managing each. Since the early 2000s, with the advent of the internet, we’ve turned more and more to Google© and other search engines to help us find things that have yet to hit the database. But often technology is still not enough and it comes down to basic research and personal interaction to find the information that we need.

Was all that necessary? Well, I could have slept pretty well that night, knowing that the chance was 99.9% that Ricky’s ingestion was non-toxic... but I’d rather take the extra time, make the extra calls, and make 100% certain there was NO risk – treating that child like my child. So that’s what I did.

Gwenn

To be a registered nurse at Clarian, visit RN Job Opportunities Indiana.

All morning long the phone has been ringing and everyone I’ve spoken to has apologized for calling me. “I’m sorry for bothering you.” “I’m sure this is nothing, but … ” “This is a stupid question.” “I feel really silly bothering you with this …”

And all morning long my response has been some version of “There are no stupid questions,” “It’s no bother at all,” “I’m here to help you,” or “That’s why we’re here.”

It reminds me of an old song, but I can’t for the life of me remember what it is ...

One of the major challenges in working at Indiana Poison Center is persuading the public to call us right away, and not to wait for symptoms to develop. Despite all of our attempts at educating the public, a great majority of callers still worries about “bothering” us with trivial calls. So we go on attempting to educate, one at a time, that there are NO trivial calls and we welcome ALL calls. The best policy when it comes to poison control is better safe than sorry.

I don’t expect the average parent to be able to recognize or determine when a toxic exposure has occurred. I do expect them to realize when a non-food substance has been ingested, sprayed into the eyes, inhaled, or spilled on the skin, and to call for help right away. MY job is to help you determine how serious it is.

I don’t expect a parent to know which will be a problem: ear drops or eye drops (it's eye drops), Advil infant drops or Tylenol infant drops (Tylenol), Grandma’s beta-blocker or her ACE-I (BB), or pansies or petunias (neither). Figuring out what is toxic is a complicated process. It involves more than just the substance, but also includes the patient’s age, weight, PMH, current condition and other pertinent factors.

So, our conversation continues. Most of the time the exposure turns out to be a trivial event. Occasionally it is a serious situation and we send that child to the nearest ER. But even the calls that are not emergencies are important – they give me a chance to interact with the parent, to do some teaching regarding normal childhood development and poison proofing, to discuss when it is appropriate to call the PCC (always!) and to send them some educational literature about the PCC.

So the moral of the story is – ALWAYS CALL US. We’re here to help!

And thanks to Google, I found the song I was thinking of. It’s by Conway Twitty and the words are:
     That’s my job
     That’s what I do
     Everything I do is because of you
     To keep you safe, you see ……
     That’s my job.

Gwenn

To be a registered nurse at Clarian, visit Registered Nursing Opportunities Indiana.

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