The General Approach to the Poisoned Patient

Jill Theobald MD PhD Medical Toxicology Fellow

Toxikon Consortium Emergency Physician

But really its everywhere

How to approach the poisoned patient

is for Airway

is for Breathing

is for Cardiovascular

is for Disability

Decontamination

Do give charcoal Dilution is the solution to pollution

Dextrose

Is for directed therapy

The most important directed therapy is…

is for EKG

Its not just the ST segments…

The intervals are important!

is also for Enhanced Elimination

is for Fever

The most important letter of the alphabet…

What does every potentially poisoned patient need?

A GOOD PHYSICAL EXAM

CBC CMP

Acetaminophen Salicylate Alcohol Urine EKG

A quick word about Urine Drug Screens

They are fraught with misinterpretation!

False Positives Amphetamines:

Labetalol Bupropion Sertraline

PCP:

Venlafaxine Ibuprofen

Dextromethorphan

False Negatives Opiates

Benzodiazepines

So what can you believe?

I have this tooth ache and all I wanted to do was sleep…

What? When? How much? Why? Other meds/herbals?

PMH Social history Allergies Previous episodes Anything else

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