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Key Points

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  • A thorough history of present illness including information gathered from available friends, family, and emergency medical service personnel can be invaluable in the management of poisoned patients.

  • Perform a comprehensive physical exam including a full set of vital signs to help classify the patient's clinical presentation into a particular toxidrome.

  • Always focus on supportive measures first in the clinical management of poisoned patients.

  • Consult your regional poison center (1-800-222-1222) to ensure the appropriate management of poisoned patients.

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Introduction

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More than 2 million toxic exposures and poisonings are reported to U.S. regional poison centers annually. Consequently, all emergency physicians should possess a basic fundamental comprehension of emergency toxicology and a sound clinical approach for managing the poisoned patient. Depending on the absolute dose and/or duration of exposure, all substances have the potential for harm. Factors including the absorption, distribution, and elimination rate of the inciting agent help determine its overall toxicity. In poisoned patients, the pharmacokinetic features of the toxin (eg, circulating half-life) can be markedly prolonged secondary to extended absorption times and the saturation of metabolizing enzymes. These toxicokinetic principles often result in an unpredictable onset of symptoms and overall duration of toxicity.

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The initial goal in managing a poisoned patient is to provide excellent supportive care. Contact your regional poison center (1-800-222-1222) early in the management of your patient as they can provide invaluable support. To aid in making the diagnosis, attempt to classify the patient's clinical presentation into a specific toxidrome (a syndrome complex that characterizes certain classes of poisonings) (Table 54-1). Only by following the preceding guidelines will certain patients be suitable for decontamination measures and possibly focused antidotal care.

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Table Graphic Jump Location
Table 54-1.

Common toxidromes.

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