Here is the approach to the poisoned patient.
There are two separate arms: diagnosis and
treatment.
Each consists of multiple steps.
In practice these occur simultaneously.
But here first we will discuss the diagnosis
and then treatment.
Diagnosis consists of three main steps.
Step 1: History: Key elements are: what was
the toxin and what time they were ingested
or used.
Step 2: Physical examination: Pay attention
to vital signs - temperature, heart rate,
respiratory rate, and blood pressure.
Look at the size of pupils, skin and level
of consciousness.
Piecing together these signs might clue us
in to a particular toxidrome.
Step 3: Diagnostic tests: A few selected blood
tests that will help us in the poisoned patient.
An EKG is helpful.
Treatment consists of five main steps.
Step 1: ABC stabilization: Ensure the patient
has a patent airway.
Give oxygen if oxygen saturation is low.
Give intravenous fluids for hypotension.
Step 2: Blood sugar and opioid reversal: Check
blood glucose.
Give dextrose if it is low.
If suspicious of an opioid overdose give an
opioid antidote.
Step 3: Decontamination: Get rid of toxins
by different means.
Irrigate if it is on the skin.
For ingested toxins we can remove the toxins
from the GI tract and blood.
Step 4: Antidote: Once you figure out what
the poison is we give specific treatment or
antidote usually in conjunction with the poison
center.
Step 5: Supportive treatment: If there is
no specific antidote, we treat the patient’s
symptoms.
Remember that in the poisoned patient we treat
and diagnose at the same time.
For diagnosis we need names of toxins, pay
attention to the examination and selected
diagnostic tests.
For treatment we ensure that ABC is addressed,
reverse low sugar, and opioid, decontaminate
and have specific and supportive treatment.
