TREATMENT
- Ensure safety of the patient and minimize/stop exposure e.g. wash off/clean skin with water and soap
- Monitor and stabilize all vitals (blood pressure, heart rate, respiratory rate, oxygen saturation AND temperature)
Airway and breathing (often impaired in
unconscious patient)
- Ensure the airway is cleared and maintained
- Insert an airway cannula if necessary
- Position patient semiprone to minimise risk of inhalation of vomit
- Assist ventilation if necessary
- Administer oxygen if necessary
Blood pressure
Hypotension is common in severe poisoning with CNS depressants. A systolic BP <70 mmHg may cause irreversible brain or renal damage
- Carry the patient’s head down on the stretcher and nurse in this position in the ambulance
- Set up an IV normal saline line
- Fluid depletion without hypotension is common after prolonged coma and after aspirin poisoning due to vomiting, sweating and hyperpnoea
- Hypertension is less common but may be associated with sympathomimetic poisoning e.g. amphetamines, cocaine, pseudoephedrine
Heart
- Cardiac conduction defects and arrhythmias may occur in acute poisoning especially with tricyclic antidepressants, but the defects usually respond
to correction of any hypoxia or acidosis
Body temperature
- Hypothermia may develop in patients with prolonged unconciousness especially after overdose of barbiturates or phenothiazines e.g.,
chlorpromazine, trifluoperazine - Hypothermia may be missed unless temperature is monitored
- Treat by covering the patient with a blanket
- Hyperthermia may occur with anticholinergics and sympathomimetics
- Treat by tepid sponging and antipyretics if appropriate
Convulsions
- Diazepam 10 mg rectally repeated if necessary
Child: 0.5 mg/kg per dose (1.5-2.5 mg if <1 month,
5 mg if 1 month-2 years, 5-10 mg if 2-12 years)
Or diazepam 5- 10 mg slow IV repeated if necessary max 30 mgChild: 200 micrograms (0.2 mg)/kg max 10 mg
Other considerations
- Counsel patient and families concerning poisoning
- A psychiatric evaluation is necessary if poisoning was intentional
- If environmental or ccupational exposure, follow up to assess if other people have been affected and take appropriate measures