Management of the poisoned patient

Abstract 

Poisoning is caused by deliberate or accidental exposure to potentially harmful substances. There are 1800 deaths per annum from poisoning in England and Wales and at least 100,000 admissions. Poisoning can be broken down into three phases preclinical, toxicity and resolution, and can present at any stage, frequently before toxicity begins. Management involves stabilizing the patient whilst obtaining as much detail as possible from the history. An ABC approach, with modifications to take account of the toxicities, is recommended. Particular attention must be paid to alternative diagnoses and the interaction of co-morbidities with the toxicity. Care is usually supportive with the addition of specific therapies for specific poisons. The use of Toxbase and the National Poisons Information Service is essential. Admission to critical care is required not only when there is a specific treatment required or invasive respiratory or haemodynamic monitoring and support but also for careful observation of patients who may deteriorate. Addressing the issues that lead to the poisoning is important during the recovery phase.

Keywords: collapse, deliberate self-harm, poisoning, toxbase, toxicity