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