• WHY IMPORTANT?
• WHAT TO DO?
• WHAT IS GOING ON?
• DECONTAMINATION OR NOT?
IS THERE AN ANTIDOTE?
WHY IS THIS IMPORTANT?
2-5 million overdoses a year in the US, 5-10 % all ED visits, 55 adult ICU admissions
1-2% mortalit y rate in hospitalized patients
WHAT TO DO? CALL POISON CONTROL, BE SYSTEMATIC!!!
• ABC’s : airway protection, ACLS as needed
• Quick exam: vitals, mental status (up or down), pupils, cardiac monitor and ecg
• History: usually unreliable or unattainable, try to elicit type and time of ingestion, ask family, friends,
witnesses and paramedics for information.
• PE: to assist you in identification of toxidrome
• General: diaphoresis, lacrimation, salivation,
• Pulm: bronchoconstriction, crackles
• GI/GU: incontinence, diarrhea, urinary retention, bowel sounds,
• Skin: dry, flushed, sweaty
• MS: rigidity, myoclonus, choreoathetosis,
• CNS: nystagmus, seizures, tremor, reflexes, clonus
electrolytes, LFT’s, ABG, ASA and tylenol levels are most useful.
• Urine toxicology rapid immunoassay screen for drugs of abuse (screen takes 1 hour, confirmation 6
hours) not too helpful in initial evaluation.
• Serum send out screens for 100’s of drugs (takes 2 days, needs lab medicine resident approval), not
helpful initial evaluation, however, may be instructive in unclear and complicated cases not fitting
any of the below toxidromes.
WHAT IS GOING ON? TRY TO IDENTIFY THE TOXIDROME
Agitation, paranoia, mydriasis,
hypertension, tachypnea, tremors,
seizures, diaphoresis, seizures
theophylline, caffeine, beta-
agonist, thyroid hormone
Agitation, paranoia, delirium,
hallucinations, coma, mydriasis,
tachypnea, hypertension, dry
flushed skin, dry mucous
membranes, decreased bowel
sounds, urinary reten