Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ GENERAL APPROACH TO THE POISONED PATIENT ++ See Table 31-1. ++Table Graphic Jump LocationTable 31-1General Approach to the Poisoned PatientView Table||Download (.pdf) Table 31-1 General Approach to the Poisoned Patient History Exposure, timing, amount, formulation, symptoms Intent of exposure: often related to age of the patient Young children: Unintentional, exploratory exposures; rarely child abuse by poisoning Adolescents: Self-harm by intentional overdose; illicit drug use Assess vital signs and perform complete physical exam Key components: Mental status, pupils, mucous membranes, skin, bowel sounds, bladder size Identify the presence of a toxidrome (see Table 30–2). Diagnostics Bedside blood glucose testing, electrocardiography; exposure-specific testing based on history and clinical presentation Determine acetaminophen concentration in all patients with intentional overdose. Management Airway, breathing, circulation Exposure-specific; consider decontamination and antidote therapy. Consult the Poison Control Center (1-800-222-1222) Psychiatric evaluation for all intentional ingestions +++ TOXIDROMES ++ See Table 31-2. Describe the combination of signs and symptoms that are seen with certain toxins When approaching a poisoned patient, use toxidromes for proper assessment and development of a differential diagnosis; though actual clinical manifestations may vary. ++Table Graphic Jump LocationTable 31-2Common ToxidromesView Table||Download (.pdf) Table 31-2 Common Toxidromes Drug Class Vital Signs: HR/BP/RR/T Mental status Pupils Skin Bowel sounds Comments Anticholinergics (i.e., antihistamines) Increased HR, BP, T; RR variable Delirium Dilated Dry/flushed Decreased “Blind as a bat, mad as a hatter, red as a beet, hot as Hades, full as a flask, dry as a bone, and the heart runs alone.” Cholinergics (i.e., organophosphates) Variable Depressed Constricted Diaphoresis Increased Salivation, lacrimation, urination, defecation, bronchorrhea, bronchospasm, fasciculations, paralysis Sedative-hypnotics (i.e., benzodiazepines) or ethanol Normal or decreased Depressed Variable Normal Decreased Opioids (i.e., heroin) Decreased Depressed Constricted Normal Decreased Sympathomimetics (i.e., amphetamines, cocaine) Increased Agitated Dilated Diaphoresis Normal/increased Seizures BP = blood pressure; HR = heart rate; RR = respiratory rate; T = temperature +++ DECONTAMINATION AND ENHANCED ELIMINATION: ACTIVATED CHARCOAL ++ Decreases absorption of some drugs in the stomach; however, not routinely recommended unless a potentially toxic amount of poison has been ingested Should be used soon as soon as possible after ingestion Technique: Activated charcoal given orally or by nasogastric (NG) tube at dose of 1 g/kg (maximum, 100 g); repeat dose 0.5–1 g/kg every 4–6 hours, if necessary (see entry for multiple-dose activated charcoal) ✓ Ideally should achieve ratio of at least 10 g charcoal per gram of drug ingested Does not bind metals (iron, lithium, lead) or common electrolytes, mineral acids or bases, alcohols, cyanide, solvents, and water-insoluble compounds such as hydrocarbon Poses aspiration risk, especially among patients who vomit or receive charcoal via NG tube Contraindicated in caustic or hydrocarbon ingestion and in patients without protected airway (altered mental status or unconscious) +++ GASTRIC LAVAGE/GASTRIC EMPTYING ++ Gastric lavage still ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.