Poison Control Hotline: 1-800-222-1222

Step 1: Evaluate the Airway

* 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

Step 2: Toxicology History

* What did they take? * How much did they take?* Why did they take it?* When did they take it?

Step 3: Toxicology Exam

* Vital signs* Pupils* Skin

Step 4: Medication List

* 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

Step 5: Common Toxicology Tests

* Assessing for damage* Electrolytes* Liver function test* EKG* Pregnancy* Assessing for co-ingestion* Serum acetaminophen* Serum salicylate* Serum alcohol* Urine drug screen

The “Big 5” Toxidromes

* 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

Additional Reading

* NBME Shelf Review – Ophthalmology and Toxicology (EM Clerkship)* Toxidromes (Admin EM)