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What information is important in the history to define a toxidrome?
What are the key areas of focus for the physical examination in the unknown poison/overdosed patient?
What are common toxidromes to consider?
What are the effective decontamination procedures to consider?
How do you determine appropriate disposition of the poisoned/overdosed patient?
When should you be concerned about delayed toxicity?
What is the role of a poison center and poison information specialist?
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Nearly 2.5 million human exposures were reported in 2007 to U.S. poison control centers. The majority of these exposures involved analgesics, sedative-hypnotics, and antipsychotics. Substances more frequently involved in fatalities of adults include sedative/hypnotics/antipsychotics, opioids, antidepressants, acetaminophen in combination, cardiovascular drugs, stimulants, and street drugs. As this database is dependent upon calls to the poison center, the incidence of poisonings by overdose and deaths due to overdose and exposures are likely underestimated, since not all exposures are reported.
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Of cases reported to the poison center, approximately 1.8 million (73%) are managed at the site of exposure, 15% are treated and released from the health care facility, but 5.7% are admitted for medical care. Many of these patients will be managed and stabilized by hospitalists. A systematic approach to overdosed and poisoned patients is needed to provide effective and efficient care. In most cases the basic stabilization measures involving airway, breathing, and circulation will have occurred in the emergency department. However, continued supportive care is required until each patient is medically stable ...