General Management of Poisoning

Understanding of the general principles of poisoning and its management.

Principles of management of poisoning:

"Recognition-Resus-RSI-DEAD"¹

• Recognition
  • Degree of emergency
  • Getting senior help
  • Application of 100% oxygen early

• Resuscitation
  • A: Control in any patient with significantly impaired conscious state
  • B: Oxygen if not previously applied. Mechanical ventilation if required.
  • C: Intravenous access is always required. Central venous access may be required.
  • D: Glucose level. Control seizures.
  • E: Control hypothermia

• Risk assessment
  • History including timing, amount, co-administered drugs, current patient status.
• Supportive care
• Investigations
  • ECG
  • Invasive monitoring may be required if haemodynamics are unstable.
  • Drug levels

• Decontamination
  • Activated charcoal may be appropriate if recent ingestion (<1 hour) and the airway is secured
• Enhanced Elimination
  • Used in severe poisoning when supportive care is likely to be inadequate. Includes:
    • Urinary alkalinisation
    • Filtration
• Antidotes
  • E.g. naloxone for opiates
• Disposition

Footnotes

LITFL has a fantastic section on the approach to the poisoned patient if you want more information.

References

1. Nickson, C. Approach to the Acute Poisoning. LITFL.
2. Leslie RA, Johnson EK, Goodwin APL. Dr Podcast Scripts for the Primary FRCA. Cambridge University Press. 2011.