Abstract

ACUTE POISONING: MANAGEMENT OF THE POISONED PATIENT

Feba Mariyam Mathew*, Rani Manju, Pheba Susan Thomas and Santhosh M. Mathews

ABSTRACT

Acutely poisoned patients are commonly encountered in Emergency Centres. Acute poisoning (accidental or intentional) requires accurate assessment and prompt therapy. The necessity to prevent cross contamination during the initial evaluation should be emphasized. Early identification of the involved toxin/s is crucial and the majority can be identified by a thorough history and physical examination. An ABC-approach should be followed ensuring a protected airway, adequate ventilation and hemodynamic stability. Supportive and symptomatic care remains the cornerstone of treatment. A stepwise approach can be followed to decrease the bioavailability of toxins. Indications, contra-indications, risks and dosage regimens are described for decontamination procedures including both termination of topical exposures and decreasing exposure to ingested toxins. Aspects of general management are reviewed including immediate interventions, investigations, gastrointestinal decontamination techniques, use of antidotes, methods to increase poison elimination and psychological assessment. More common and serious poisonings caused by paracetamol, salicylates, opioids, tricyclic antidepressants, selective serotonin reuptake inhibitors, benzodiazepines, non-steroidal anti-inflammatory drugs and cocaine are discussed in detail. Specific aspects of common paediatric poisonings are reviewed. The aim of this commissioned review is to establish concise guidelines for the initial management of the acutely poisoned patient in the Emergency Centre.

Keywords: Acute poisoning, Poison, Emergency management.