Emergency Treatment of Poisoned Patient

The first principle in the management of the poisoned patient is to treat the patient, not the poison. Many substances such as carbon monoxide and drugs are poisonous only in higher concentrations or dosages. And others such as cleaners are dangerous only if ingested. Children can be sensitive to even small amounts of certain drugs and chemicals.

Airway, breathing, and circulation are assessed and addressed initially along with any other immediately life-threatening toxic effect. Acid-base and electrolyte balance along with acetaminophen and salicylate levels in the blood are assessed. Intravenous access is obtained and the patient is placed on a cardiac monitor.

If you come across any event of possible poisoning, call Poison Help at 800-222-1222 in the United States or your regional poison control center.

Poison control centers are excellent resources for poisoning information and, in many situations, they may advise in-home observation.

Here is the step-wise approach followed for the treatment of a poisoned patient:

●DECONTAMINATION

Once the patient is stabilized, the assessment for decontamination can occur. This may include flushing of the eyes with saline or tepid water to a neutral pH, rinsing of the skin for dermal exposure as well as administration of GI decontamination with gastric lavage, activated charcoal, or whole bowel irrigation.

●ELIMINATION ENHANCEMENT

HEMODIALYSIS: Elimination of some toxins may be enhanced by hemodialyses such as methanol, ethylene glycol, salicylate, theophylline, phenobarbital, and lithium

URINARY ALKALINIZATION: Increasing the urine pH with intravenous sodium bicarbonate transforms the drug into an ionized form and prevents reabsorption.

MULTI-DOSE ACTIVATED CHARCOAL: This therapy enhances the elimination of certain drugs like digoxin, phenobarbital, valproic acid, etc. Medications traverse from the areas of high concentration to low concentration to be absorbed by the charcoal present. Bowel sounds must be present prior to each activated charcoal dose to ensure movement of the GI tract and prevent obstruction.

CLINICAL TOXICOLOGY