Page 53 - 2026 SMOG

TOXIC INGESTION
POISON CONTROL NUMBER (IN US): 1-800-222-1222
WEBSITE: https://www.poison.org
Signs and Symptoms Differential Diagnosis
• Mental status changes • Cyclic Antidepressants
• Hypotension/hypertension • Acetaminophen
• Respiratory depression • Depressants
• Tachycardia/arrythmias • Stimulants
• Seizure • Anticholinergic
• Cardiac medications
• Solvents/cleaners
ADULT PEDIATRIC
• Blood sugar <70mg/dL: AMS PROTOCOL • Blood Sugar <70mg/dL:
˚ D50 25g in 500mL NS • D25 2mL/kg IV
OR
OR
˚ Glucagon 1mg IM ˚ Glucagon 0.5mg IM (<20kg); 1mg IM
• Blood sugar >70mg/dL: (>20kg)
˚ Activated Charcoal 25–100g PO • Blood Sugar >70mg/dL:
(If alert and <1hr from ingestion)
• Activated Charcoal: refer to DRUG CARD
• Beta-blocker overdose: • Beta Blocker Overdose:
˚ Glucagon 2–10mg IV; may repeat bolus after ˚ Infants and Children
10–15min if no response
Glucagon 0.5mg/kg IV; may repeat after
■
• Opiates: 10–15min if no response
˚ Naloxone 0.4–2mg IV/IO/IN ˚ Adolescent
Glucagon 5–10mg IV
Watch for Respiratory Depression
■
■
• Tricyclic antidepressant: • Opiates:
˚ 12-lead ˚ <20kg: Naloxone 0.1mg/kg IV/IO/IN
˚ QRS >100 or hypotensive ˚ >20kg: Naloxone 0.4–2mg IV/IO/IN
˚
AIRWAY PROTOCOL
Sodium Bicarbonate 1–2mEq/kg
■
• Organophosphate: • Tricyclic antidepressant:
˚ Atropine 2mg IV/IM q5 + 2-PAM ˚ 12-lead
˚ 600mg IV/IM ˚ QRS >100 or hypotensive?
OR
Sodium Bicarbonate 1–2mEq/kg
■
˚ Atropine 20mg in 250mL NS; titrate to dry • Organophosphate:
˚
respiratory secretions
Atropine 0.05–0.1mg/kg q5–10min
• Seizure • Seizure:
˚ Midazolam 5mg IV; 10mg IM ˚ Lorazepam 0.1mg/kg IV; may repeat in
5–10min (max dose 4mg/dose)
Notes, Cautions, Warnings
• Anticholinergic: altered mental status, hyperthermia, mydriasis, flushing, anhidrosis, full bladder
˚ Follow Tricyclic dosing
Lorazepam for agitation and seizures
˚
• Beta blockers: watch for hypoglycemia
• Calcium channel blockers: watch for hyperglycemia
• Cyclic antidepressant signs: hypotension, depressed mental status, respiratory depression, and cardiac
arrhythmias.
• Opioid signs: depressed mental status, pinpoint pupils, N/V, respiratory depression, hypotension
• Organophosphate signs: salivation, lacrimation, urination, diarrhea, emesis, altered mental status
Reference: CPD ID #69, 93, 101 (CBRN Series)
2026 Standard Medical Operating Guidelines (SMOG) • 45