2. Outline
• Overview
• Toxicologic history and physical exam
• Common toxidromes
• Management of the undifferentiated
poisoned patient
3. Toxicology
• the study of chemicals and how they
affect humans
• nearly any substance has the ability to be
poisonous if taken in great enough
quantity
6. Medications Dangerous to Children in 1
or 2 doses
• Beta blockers
• Calcium channel
blockers
• Glyburide
• Oil of Wintergreen
(methyl salicylate)
• TCA
• Camphor
• Clonidine and the
imidazolines
• Opioids
• Lomotil
• Toxic alcohols
7. Approach to the Poisoned
Patient
• Supportive care is the cornerstone of
treatment of poisoned patients
• Your attention to this will do more good
for your patient than any other single
intervention
8. Approach (cont’d)
• ABC’s-stabilize as needed
• Oxygen, monitor, IV, glucose level,
narcan?
• Hx-what, how much, when?
• Px-general exam, toxidromes
• Labs-drug levels, drug screen?
• Charcoal within 1 hour
• Antidote if available
9. The Toxicology History
• Gather information from all sources
possible
• pill bottles
• time of ingestion (good luck!)
• amount ingested
• types of ingestions/co-ingestions
13. Odors in the Overdose History
Bitter almonds Cyanide
Carrots Water Hemlock
Fruity
EtOH, acetone, isopropyl
alc.
Glue Toluene, solvents
Shoe polish Nitrobenzine
14. Skin, Mucous Membranes
• dry mouth or lots of secretions?
• skin warm and flushed or diaphoretic?
• any rash?
• cyanosis?
15. Neuro Exam
• GCS helpful at giving a global
assessment of LOC, but can be
misleading
• always look at the pupils
• any evidence of a post-ictal state?
18. Substances that can cause seizures
• Tricyclics
• Isoniazid
• Cocaine, amphetamines
• Salicylates (Aspirin)
• Anticholinergics
• Organophosphates (insecticides)
19. Respiratory
• crackles and wheezes may indicate
organophosphate poisoning!
• stridor and immediate respiratory distress
may point to a caustic ingestion
20. Radiology
• Radiopaque items
• “C” chloral hydrate
• “H” heavy metals
• “I” iron
• “P” phenothiazines
• “S” slow release(enteric coated)
• X-ray affect TX only in iron O.D.
21. Toxidrome
• a constellation of signs or symptoms that
are associated with a toxin
• most patients will not exhibit all aspects of
the toxidrome
• mixed ingestions complicate the picture
32. Ipecac
• There are really no indications for the use
of ipecac syrup to induce vomiting
33. Gastric Lavage
• Questionable effectiveness
• No evidence of improved patient outcome
• Risk of serious complications ~3%
34. Activated Charcoal
• Binds toxins to its surface and being non-absorbable allows
charcoal-toxin complex to be excreted via the GI tract
• Toxic if aspirated
• do not give if decreased LOC or greater than 1 hour
from ingestion
• Not bound by charcoal:
• Iron, lithium, cyanide, strong acids and bases,
ethanol, methanol, ethylene glycol
• Ions/Acids/Bases/Alcohols
35. Whole Bowel Irrigation
• Polyethylene glycol electrolyte solution (PEG,
GoLytely)
• Useful for large ingestions of substances:
• Not bound by charcoal
• Late presentation after overdose
• Extended release preparations
• Need a nasogastric tube
• 1-2 L/hr for adults and 0.5 L/hr for peds
