Mark Little builds a framework for the clinical approach to patients with suspected poisoning or envenomation. Particularly useful in a country where everything is trying to kill you.

1. Could it be a poison?
Mark Little Cairns Hospital

2. “...Polypharmacy OD...”

3. Deliberate self poisoning - up to 5% of ED
presentations
• Australian life time risk:
• MALE: 2500 / 100 000
• FEMALE: 4430 / 100 000
• Highest: Females 15 - 24 yrs
• Boyce B J Clin Pharm 2003

4. NSW PIC Report 2012

5. Paracelsus (1493 - 1541)
“All things are poison and nothing is without poison, only the
dose permits something not to be poisonous”

6. Aim:
An approach to the patient that may be
poisoned

7. Not all poisonings are human
WA PIC Report 2004

8. Resuscitation

12. Approach to a
poisoning arrest
• Continue CPR and
resuscitation for prolonged
periods
• Tachyarrythmias may need
correction of electrolyte and
acid base abnormalities
• Use of antidotes
• Non standard drug therapies
• Seek urgent advice from
toxicologist

13. Resuscitation
COMA
If under 40 yrs age: 80% chance your diagnosis is
a toxicology one

14. Quetiapine:
No 1 cause of DSP coma needing intubation
in Australia.

17. NSW PIC Report 2012

18. Screening Test

19. Screening Test

20. Risk Assessment

21. Drug(s)
Dose
Symptoms and Signs
Pre morbid state
Time since ingestion

22. The neat thing about an overdose case is if
you have a good risk assessment the
clinical course is entirely predictable

23. History:
Often forgotten
Attention to detail

24. Ask the patient

28. NSW PIC Report 2012

34. Don’t forget
complementary &
alternative medications
(CAMS)

37. Poppy Seed

38. Examine the patient

39. Observations

40. Pupils Size?

43. Open i Beta

44. Risk assessment

52. ED Short Stay Units

55. Children are small adults

56. NSW PIC report 2011

58. If they ingest anything, children will ingest
one or two tablets

59. Common paediatric exposures
2009 US PIC data

60. One or two tabs can
kill

61. Amphetamines
Calcium Channel Blockers SR
Chloroquine & OH Chloroquine
Duloxene Opioids
Propanolol Sulphonylureas
Theophylline TCA

62. Have they been poisoned by a venomous
creature?

65. Some present with sudden collapse or
seizures

66. Thanks to Bart Currie

67. Children who
suddenly become
unwell
Thanks to Bart Currie

68. Of course not all cases are straight forward

71. Conclusion
An approach to the poisoned patient

72. Questions?