Toxicology
Summary: <br> Poison Control Hotline: 1-800-222-1222<br> <br> <br> <br> Step 1: Evaluate the Airway<br> <br> <br> <br> * General principles* “If they can’t speak, they can’t control their airway”* “If GCS is <8, intubate”* In the real world, it’s a clinical judgement call<br> <br> <br> <br> Step 2: Toxicology History<br> <br> <br> <br> * What did they take? * How much did they take?* Why did they take it?* When did they take it? <br> <br> <br> <br> Step 3: Toxicology Exam<br> <br> <br> <br> * Vital signs* Pupils* Skin<br> <br> <br> <br> Step 4: Medication List<br> <br> <br> <br> * Make note of all bottles with patient* Make EXTRA note if any pills seem to be missing* Bonus points if you bring your attending a med list<br> <br> <br> <br> Step 5: Common Toxicology Tests<br> <br> <br> <br> * Assessing for damage* Electrolytes* Liver function test* EKG* Pregnancy* Assessing for co-ingestion* Serum acetaminophen* Serum salicylate* Serum alcohol* Urine drug screen<br> <br> <br> <br> The “Big 5” Toxidromes<br> <br> <br> <br> * Anticholinergic* Increased vitals* Big pupils* Dry skin* Treatment – Physostigmine (rarely given)* Cholinergic* Decreased vitals* Small pupils* Moist skin* Treatment – Atropine* Opioid* Decreased vitals* Small pupils* Dry skin* Treatment – Naloxone* Sedative/Hypnotic* Decreased vitals* Normal pupils* Dry skin* Treatment – Flumazenil (rarely given)* Sympathomimetics* Increased vitals* Big pupils* Moist skin* Treatment – Benzodiazepines<br> <br> <br> <br> Additional Reading<br> <br> <br> <br> * NBME Shelf Review – Ophthalmology and Toxicology <a href="http://www.emclerkship.com/nbme-shelf-review-5/">(EM Clerkship)</a>* Toxidromes <a href="https://adminem.com/poc/toxidromes/">(Admin EM)</a><br> <br> <br> <br> <br>
