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KEY CONCEPTS

KEY CONCEPTS

  • image Poisoning can result from exposure to excessive doses of any chemical, with medicines being responsible for most childhood and adult poisonings.

  • image The total number and rate of poisonings have been increasing, but preventive measures, such as child-resistant containers, have reduced mortality in young children.

  • image Immediate first aid may reduce the development of serious poisoning, and consultation with a poison control center may indicate the need for further therapy.

  • image The use of ipecac syrup, gastric lavage, whole bowel irrigation, and cathartics has fallen out of favor as routine therapies, whereas activated charcoal remains useful for gastric decontamination of appropriate patients.

  • image Antidotes can prevent or reduce the toxicity of certain poisons, but symptomatic and supportive care is essential for all patients.

  • image Acute acetaminophen poisoning produces severe liver injury and occasionally kidney failure. A determination of serum acetaminophen concentration may indicate whether there is risk of hepatotoxicity and the need for acetylcysteine therapy.

  • image Anticholinesterase insecticides may produce life-threatening respiratory distress and paralysis by all routes of exposure and can be treated with symptomatic care, atropine, and pralidoxime.

  • image An overdose of calcium channel antagonists will produce severe hypotension and bradycardia and can be treated with supportive care, calcium, and insulin with supplemental dextrose.

  • image Poisoning with iron-containing drugs produces vomiting, gross gastrointestinal bleeding, shock, metabolic acidosis, and coma, and can be treated with supportive care and deferoxamine.

  • image Acute opioid poisoning and overdose can produce life-threatening respiratory depression that can be treated with assisted ventilation and naloxone.

  • image Chemicals can be used for mass poisonings by acts of terrorism and warfare and typically produce life-threatening effects within minutes to hours, which warrant emergency preparedness at healthcare facilities and communities.

PATIENT CARE PROCESS

Patient Care Process for Prehospital Care of Acute Poisonings

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Collect (from patient, caregiver, or bystander)

  • Patient symptoms (eg, none, minor, life-threatening)

  • Time of exposure

  • Type of exposure (eg, ingestion, inhalation, injection, skin contact, eye contact)

  • Substance(s) involved in the exposure

  • Patient characteristics (eg, age, sex, weight)

  • Circumstances of the exposure (eg, unintentional, substance abuse, self-harm)

  • Patient health history (healthy, acute and chronic illnesses, pregnancy, recent hospitalization, substance use disorder)

  • Prescription and nonprescription medications, dietary supplements, household products and chemicals in the vicinity

  • Objective information

    • Estimate of the number of tablets or volume missing and possibly consumed

    • Exact name of the product and strength

Assess

  • Presence of emergent symptoms (eg, unresponsiveness, seizures, shortness-of-breath, slowed or shallow breathing or if the exposure is likely to produce these symptoms within 1 hour)

  • Presence of potential high-risk factors (eg, child-resistant container, signal words (Poison, Caution, Danger) on the product label; debilitated, elderly; suspected suicidal or homicidal intent; suspected child or elder abuse; substance abuse) (see Tables e7-1 and e7-4)

  • Ability/willingness to contact a poison control center or call 9-1-1

  • Ability/willingness to provide first aid (see Table e7-8) and naloxone if needed and available (see Table e7-13)

Plan*

  • If emergent symptoms are present, call 9-1-1 for ...

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