Transient airway compromise (e.g., isolated GHB toxicity, post-ictal period): Consider basic airway maneuvers alone with close airway monitoring.↑ Risk of aspiration: e.g., excessive vomiting.Severely depressed mental status or coma.Consider early intubation for patients expected to deteriorate with:.Uncontrollable seizures: Abort convulsive activity and perform RSI.Perform intubation as soon as possible.Caustic or inhalation injury: high risk of difficult airway.↑ Risk of aspiration or bronchial obstruction.The combination of hypotension and bradycardia suggests the ingestion of beta blockers, calcium channel blockers, digoxin, guanfacine, or clonidine. Once the patient has been stabilized, continue the toxicological risk assessment.Īnticipate and prepare for changes in hemodynamic and mental status, as toxins are metabolized gradually.Determine if GI decontamination, enhanced elimination techniques, and/or specific antidotes are required during or after stabilization.Evaluate for classic toxidromes as well as for signs and symptoms of specific poisonings.Exposure: Look for clues for the underlying toxin and perform surface decontamination.Disability: Treat alterations in glucose metabolism and/or toxic seizures.Circulation: Check ECG to identify and treat cardiotoxic substance exposure.Breathing: Consider the effect of the toxin on the respiratory drive.Airway: Anticipate airway loss due to impending obstruction or depressed mental status and consider prophylactic airway protection.Stabilize the patient using a modified ABCDE approach that includes toxicology-specific considerations, for example:.The monitoring and disposition requirements and the risk of complications can be estimated through a careful toxicological risk assessment and reassessment. For most serious toxic exposures, specific treatment strategies are required that include decontamination methods to reduce absorption (e.g., activated charcoal), enhanced elimination therapies (e.g., hemodialysis), or specific antidotes (e.g., naloxone for opioid toxicity, or N-acetylcysteine for acetaminophen toxicity). Frequent reevaluation of the patient is essential, since the pharmacokinetics of a substance are altered in situations of overdose, and the clinical presentation can be dynamic as the substance is metabolized. Many patients can be managed with supportive care alone and careful monitoring. The risk assessment depends on patient characteristics such as age and comorbidities, as well as characteristics of the exposure, including type, route, dosage, timing, and whether the exposure was intentional or unintentional, and typically involves consultation with a toxicologist or regional poison control center (in the United States, Poison Control is available 24/7 at 1-80). Successful management of poisoned patients involves adapting the ABCDE approach to include toxicological considerations (including expedient recognition of various classic toxidromes), performing a toxicology-focused history and physical examination, and tailoring management based on an individualized risk assessment of each patient. Although fewer than 1% of poisonings are fatal, acute poisoning can be a challenging medical emergency. This article provides a general approach to patients with known or suspected acute poisoning from exposure to a wide variety of potentially toxic substances, including medications, recreational drugs, and common household products.

Poison antidote chart