ActionStat: Attempted suicide

Nursing, Apr 2003 by McGlotten, Sandra

YOU'RE MAKING end-of-shift rounds when you discover that one of your patients, Morton Long, 40, isn't in his bed. To your horror, you find him with a sheet around his neck, hanging from the shower curtain rod. You call a code and rush to support him.

What's the situation?

Mr. Long was admitted to your medical/ surgical unit for treatment of ascites and cirrhosis of the liver. On admission he was alert and cooperative, although his speech was slow, his tone low, and he avoided eye contact. He reported a history of alcohol and substance abuse and a family history of depression. He said he was feeling down because he'd recently lost his job and his wife had left him, moving his children to another state.

Mr. Long's admission vital signs were BP, 110/60; temperature, 98.6 deg F (37 deg C); pulse, 100; and respirations, 22. His skin was warm and dry, his abdomen was distended, and you noted 1 edema of his legs.

Whats your assessment?

Mr. Long gave several clues that he was depressed and might attempt suicide: During his admission interview he talked about his substance abuse history (frequently a precursor to suicide attempts), family history of depression, job loss, and recent separation from his family. Any one of these can be a red flag to alert you to serious depression.

What must you do inmediately?

After calling a code, you attempt to get Mr. Long's weight off his neck by lifting his body. When the code team arrives, one person will stabilize Mr. Long's head and neck while you and another person support his body and a fourth person removes the sheet from his neck. You lower him onto a backboard and open his airway, using a jaw-thrust maneuver.

He's unresponsive and isn't breathing, but you palpate a carotid pulse. You begin rescue breathing, and he starts to breathe on his own.

The team members complete their evaluation and intervenlions and say that Mr. Long is clinically stable.

What should be done later?

Mr. Long is transferred to a monitored bed and watched for cartiac arrhythmias and delayed pulmonary complications related to edema of laryngeal structunes. He'll have X-rays of his cervical spine taken before cervical spine stabilization is removed, and he'll need a computed tomography scan of the head if he's not awake, alert, and oriented. Lab work will be done to rule out physiologic causes of Mr. Long's depression. Mr. Long may need to be seen by an ear-nose-throat specialist or trauma surgeon to check for laryngeal or carotid artery injuries.

Mr. Long will be placed under constant one-to-one observation until a psychiatric consultation can be arranged. He'll be encouraged then to discuss what led to the suicide attempt. (If you work in a hospital that has an inpatient psychiatric unit, suggest transferring Mr. Long there after he's stable.)

Be alert for signs that a patient may be depressed and contemplating suicide. Screening tools such as the Beck Depression Inventory can be used at admission to screen patients with risk factors. Follow your facility's procedures for suicide precautions and for referring patients to mental health professionals who can determine a patient's suicide risk and the appropriate level of suicide precautions.

BY SANDRA McGLOTTEN, RNC, BSN

Nurse-Educator Albert Einstein Healthcare Network Philadelphia, Pa.