The General Approach to the Poisoned Patient Jill Theobald MD PhD Medical Toxicology Fellow Toxikon Consortium Emergency Physician
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
Get the level!