2. The Call
Ambulance is transporting a 16 year
old girl found unresponsive at home.
Moans to light pain stimuli.
Color pink. HR 60 RR12 BP 110 / 50
spo2 93% on room air.
Parents saw her last night at 2400
when she came home after going out
with friends
ETA – 10 min
3. "All substances are
poisons; there is none
that is not a poison. The
right dose differentiates a
poison from a remedy."
Paracelsus (1493–1541)
4. Toxic exposures are a common
cause of ED visits
2008 – ED saw 2,000 people /
day from poisoning
Estimated annual poisonings or
drug overdoses = 4.5 million
2/3 of toxic exposures reported
involve children
ENO
5. Management
Provide continuous respiratory and hemodynamic support
Patient safety
Evaluate the potential for toxicosis
Intervene to reduce toxin absorption and promote its excretion
Provide substance-specific therapy, including antidote
administration
6. What Questions do you need to
ask?
Discuss with neighbor and determine at least 4 important
questions
12. Toxidrome Clues
Anticholinergic: Blind as a bat, mad as a hatter, red as a
beet and dry as a bone
Cholinergic: DUMBELS- defication, urination, miosis,
bronchospasm, emesis, lacrimation, sedation
Alcohol: hypothermia
Barbiturates: barb blisters
Pulmonary edema: aspirated hydrocarbon, ethyl glycol, ASA,
Gum discoloration: lead arsenic, Vitamin A
20. Activated Charcoal
GI decontamination is the preferred treatment
Prevents entry into enterohepatic circulation
Effective alone or in combination with other
therapy
Thoughts on administration?
23. Whole Bowel Irrigation
When not bound to charcoal
For sustained release or enteric
coated
Toxic substances such as balloons etc
Give PEG solution (goLytely or clolyte solution)
What time did the exposure take place?Is the exposure – acute or chronic What access does the patient have access to Who might know more?How great / how many / how much Remember that some drugs have delayed toxic effectsWhat has been doneIdeation – Intentional / Accidental
Utilize toxidrome vasoactive handout
Mallory weiss tears, propulsion of the particles past the pyloric spincter, aspiration
Syrup of ipecac was once a mainstay of therapy in poisoned patients in the emergency department and at home. The American Academy of Pediatrics10 no longer recommends the use of syrup of ipecac, and the American Association of Poison Control Centers11 recommends its use only in rare circumstances because it: Causes protracted vomiting•Is implicated in Mallory-Weiss tears and electrolyte imbalances•Delays the administration of activated charcoalHowever, patients may have already taken syrup of ipecac before arriving in the emergency department.
In most toxic ingestions, activated charcoal administration is the preferred means of gastrointestinal decontamination. Charcoal is activated by exposing it to high temperatures that dramatically increase its surface area. Activated charcoal has an extensive network of interconnecting pores that can bind with and trap chemicals within minutes of contact, preventing their absorption and toxicity. Binding also prevents absorption into the enterohepatic circulation. Studies suggest that, in terms of preventing toxin absorption, activated charcoal administration alone is as effective as—or more effective than—activated charcoal administration after emesis induction or gastric lavage.15In most toxic ingestions, activated charcoal administration is the preferred means of gastrointestinal decontamination. Charcoal is activated by exposing it to high temperatures that dramatically increase its surface area. Activated charcoal has an extensive network of interconnecting pores that can bind with and trap chemicals within minutes of contact, preventing their absorption and toxicity. Binding also prevents absorption into the enterohepatic circulation. Studies suggest that, in terms of preventing toxin absorption, activated charcoal administration alone is as effective as—or more effective than—activated charcoal administration after emesis induction or gastric lavage.15In most toxic ingestions, activated charcoal administration is the preferred means of gastrointestinal decontamination. Charcoal is activated by exposing it to high temperatures that dramatically increase its surface area. Activated charcoal has an extensive network of interconnecting pores that can bind with and trap chemicals within minutes of contact, preventing their absorption and toxicity. Binding also prevents absorption into the enterohepatic circulation. Studies suggest that, in terms of preventing toxin absorption, activated charcoal administration alone is as effective as—or more effective than—activated charcoal administration after emesis induction or gastric lavage.15
