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Medical

TOXIC INGESTIONS

Signs and Symptoms: Differential Diagnosis:
• Mental Status Changes • Cyclic Antidepressants • Organophosphate/Carbamate
• Hypo/Hypertension • Acetaminophen • Medical Cause
• Respiratory Depression • Depressants (hyperthyroidism)
• Tachycardia/ /Arrhythmias • Stimulants
• Seizure • Anticholinergic
• Cardiac Medications
• Solvents/Cleaners
Continued from: Universal Patient Care Guideline If possible,
Tactical Evacuation Guideline O2 (if Hypoxemic) Contact Poison Control Center or Medical
IV/IO Guideline Control if toxin known or for treatment advice
Cardiac Monitor (ASAP) In US: 1-800-222-1222
Altered Mental Status Guideline Supportive care is keystone in management
(50% Dextrose 25g in 500mL NS IV or YES Blood Sugar <60? of toxic ingestions:
Glucagon 1mg IM if no IV) • Continuous monitoring, supplemental O2/
NO airway support, IVF resuscitation
IV Bolus pprn n
r
Beta Blocker Overdose:
TriCyclic Overdose: Activated Charcoal 1g/kg PO (If AV Block (especially, 1 st Degree),
QRS >100 = Predictive of seizures alert/protecting airway and time Bradycardia, and Hypotension: Consider
QRS >160 = Predictive of VT of ingestion <1hr) giving: Glucagon 3-10mg IV/IM Bolus
followed by 3-5mg/hr infusion

Opiates TriCyclic Antidepressant Organophosphate/Carbamate Other
(Respiratory
Depression) 12 Lead EKG Atropine 2mg IV/IO q5min 12-lead EKG
(No max dose: give until
improving with ↓ secretions)
Naloxone 0.4-2mg QRS >100ms or Hypotensive? 2-PAM 600mg IV/IM Hypotension, Seizures,
IV/IO (Atropine + 2-PAM = Mark 1 Kit) Ventricular Dysrhythmias,
Sodium Bicarbonate 1mEq/kg Altered Mental Status, Chest
May repeat to maintain QRS <100 Pain
Airway Guideline Start Maintenance Infusion: If in Seizure give:
100-150mEq (2-3 amps) in 1L D5/NS
@ 100-200mL/hr IV Midazolam 2.5-5mg IV/IM x 2 Appropriate Guideline
Seizure Guideline
Continuous Monitoring, reassess q5 min
Pearls:
• Anticholinergic: Altered mental status (mad as a hatter), Hyperthermia (hot as a hare), mydriasis (blind as a bat), Flushing (red as a
beet), anhidrosis (dry as a bone), Full Bladder (full as a flask).
o Treat as with Tricyclic overdose pathway (including EKG and Sodium Bicarb for prolonged QRS and/or arrhythmias)
o LORAZEPAM for agitation and seizures and Hyperthermia Guideline if hyperthermic
• Beta Blocker: Hypoglycemia.
• Calcium Channel Blocker: HypERglycemia.
• Cyclic Antidepressant: Hypotension, depressed mental status, respiratory depression, cardiac arrhythmias.
• Opioid: Depressed mental status, pinpoint pupils, N/V, respiratory depression, hypotension possible.
• Organophosphate/Carbamate (Cholinergic): Salivation, lacrimation, urination, diarrhea, emesis, altered mental status.
• Sympathomimetic/Stimulant (Methamphetamine/Cocaine): Altered mental status, tachycardia, diaphoresis, mydriasis, and
hyperthermia. Treat with Benzodiazepine (LORAZEPAM) and prn cooling or Hyperthermia Guideline.
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