Emergency Medicine - Approach to Poisoning: By Stella Yiu M.D.

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Emergency Medicine – Approach to Poisoning: What You Need to Know
Whiteboard Animation Transcript
with Stella Yiu, MD
https://medskl.com/Module/Index/approach-to-poisoning

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.

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