Emergency Medicine – Approach to Poisoning: By Stella Yiu M.D.
Here is the approach to the poisoned patient.
There are two separate arms: diagnosis and treatment. Each consists of multiple steps.
In practice these occur simultaneously. But here first we will discuss the diagnosis and
then treatment. Diagnosis consists of three main steps. Step 1: History: Key elements are: what was
the toxin and what time they were ingested or used. Step 2: Physical examination: Pay attention
to vital signs – temperature, heart rate, respiratory rate, and blood pressure. Look
at the size of pupils, skin and level of consciousness. Piecing together these signs might clue us
in to a particular toxidrome. Step 3: Diagnostic tests: A few selected blood
tests that will help us in the poisoned patient. An EKG is helpful. Treatment consists of five main steps. Step 1: ABC stabilization: Ensure the patient
has a patent airway. Give oxygen if oxygen saturation is low. Give intravenous fluids
for hypotension. Step 2: Blood sugar and opioid reversal: Check
blood glucose. Give dextrose if it is low. If suspicious of an opioid overdose give an
opioid antidote. Step 3: Decontamination: Get rid of toxins
by different means. Irrigate if it is on the skin. For ingested toxins we can remove the
toxins from the GI tract and blood. Step 4: Antidote: Once you figure out what
the poison is we give specific treatment or antidote usually in conjunction with the poison
center. Step 5: Supportive treatment: If there is
no specific antidote, we treat the patient’s symptoms.
Remember that in the poisoned patient we treat and diagnose at the same time. For diagnosis
we need names of toxins, pay attention to the examination and selected diagnostic tests.
For treatment we ensure that ABC is addressed, reverse low sugar, and opioid, decontaminate
and have specific and supportive treatment.