Emergency Medicine - Approach to Poisoning: By Stella Yiu M.D.

Summary

This video provides a comprehensive approach to diagnosing and treating poisoned patients. It highlights two key areas: diagnosis and treatment. Diagnosis involves three main steps: taking a history of toxin exposure, performing a physical exam to identify signs of toxidromes, and conducting diagnostic tests like blood work and EKG. Treatment consists of five main steps: stabilizing the patient’s airway and vitals, managing blood sugar and opioid reversal, decontaminating the body, administering antidotes when available, and providing supportive care. The script emphasizes the simultaneous nature of diagnosis and treatment in the management of poisoned patients.

Takeaways

• 😀 Diagnosis of poisoning involves three main steps: history, physical examination, and diagnostic tests.
• 😀 History includes identifying the toxin and the time of exposure.
• 😀 Physical examination focuses on vital signs (temperature, heart rate, respiratory rate, blood pressure), pupil size, skin condition, and consciousness level.
• 😀 Diagnostic tests such as selected blood tests and an EKG are crucial for identifying the toxin.
• 😀 Treatment for poisoning follows five main steps: ABC stabilization, blood sugar and opioid reversal, decontamination, antidote administration, and supportive treatment.
• 😀 ABC stabilization ensures the patient has a clear airway, adequate oxygen saturation, and intravenous fluids if hypotension is present.
• 😀 Blood sugar levels should be checked and corrected if low; opioid overdoses require an opioid antidote.
• 😀 Decontamination involves removing toxins from the skin or GI tract, depending on the exposure method.
• 😀 Antidotes should be administered once the specific poison is identified, often in consultation with a poison center.
• 😀 Supportive treatment is given if there is no antidote, focusing on symptom management.
• 😀 The approach to poisoned patients involves simultaneous diagnosis and treatment, emphasizing the importance of timely intervention.

Q & A

What are the two main arms of managing a poisoned patient?

The two main arms are diagnosis and treatment, which typically occur simultaneously in practice.

What is the first step in diagnosing a poisoned patient?

The first step is taking a thorough history, which includes identifying the toxin involved and the time of ingestion or exposure.

What should be included in the physical examination of a poisoned patient?

Key elements include monitoring vital signs (temperature, heart rate, respiratory rate, and blood pressure), assessing pupil size, skin condition, and the patient's level of consciousness.

Why is it important to assess vital signs in a poisoned patient?

Vital signs help in identifying abnormal patterns that may indicate a specific toxidrome, which can guide the diagnosis and treatment plan.

What diagnostic tests are recommended for poisoned patients?

Selected blood tests and an EKG are recommended to evaluate the patient's condition and assist in diagnosing the toxicity.

What is the first step in the treatment of a poisoned patient?

The first step in treatment is ABC stabilization, which involves ensuring a patent airway, administering oxygen if needed, and providing intravenous fluids for hypotension.

How is low blood sugar addressed in poisoned patients?

Blood glucose levels should be checked, and if low, dextrose should be administered.

What should be done if an opioid overdose is suspected in a poisoned patient?

If an opioid overdose is suspected, an opioid antidote should be administered.

How is decontamination handled in poisoned patients?

Decontamination involves irrigating the skin if toxins are present on it, and for ingested toxins, the toxins can be removed from the gastrointestinal tract and bloodstream.

What is the role of antidotes in the treatment of poisoned patients?

Antidotes are administered once the specific toxin is identified, usually in conjunction with a poison center for guidance.

What should be done if no specific antidote is available for the poison?

If no specific antidote is available, supportive treatment should be provided to manage the patient's symptoms.

How should diagnosis and treatment be approached in a poisoned patient?

Diagnosis and treatment should be approached simultaneously. Diagnosis focuses on identifying the toxin, examining the patient, and conducting tests, while treatment includes stabilization, reversal of opioid overdose and low blood sugar, decontamination, and supportive care.