Module 9 – Summary and Additional Resources

9.1 Key Takeaways

• Address airway, breathing, circulation first when managing poisoned patients
• Look for vital sign abnormalities and physical exam clues to identify toxic syndromes
• Use diagnostic tests judiciously based on clinical presentation
• Provide supportive care, GI decontamination, and enhanced elimination as appropriate
• Administer antidotes tailored to the clinical syndrome
• Determine need for admission versus discharge home with follow-up
• Involve poison experts early when treating complex presentations

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9.2 Key References Utilized

1. Goldfrank LR, et al. Goldfrank’s Toxicologic Emergencies. 11th ed. New York, NY: McGraw-Hill; 2019.

2. Hoffman RS, Howland MA, Lewin NA, Nelson LS, Goldfrank LR. Goldfrank’s Toxicologic Emergencies. 10th ed. New York, NY: McGraw-Hill; 2015.

3. Gravelyn TR, Weg JG. Respiratory rate as an indicator of acute respiratory dysfunction. JAMA. 1980;244(10):1123-1125.

4. Dart RC, Borron SW, Caravati EM, et al. Expert consensus guidelines for stocking of antidotes in hospitals that provide emergency care. Ann Emerg Med. 2009;54(3):386-394.e1.

5. Ghannoum M, Gosselin S. Enhanced poison elimination in critical care. Adv Chronic Kidney Dis. 2013;20(2):138-146. 

6. McGuigan MA. Guideline for the out-of-hospital management of human exposures to minimally toxic substances. J Toxicol Clin Toxicol. 2003;41(7):907-917.

7. Karjalainen J, Viitasalo M. Fever and cardiac rhythm. Arch Intern Med. 1986;146(6):1169-1171.

8. Mofenson HC, Greensher J. The unknown poison. Pediatrics. 1974;54(3):336-342.

9. Brett AS, Rothschild N, Gray R, Hayes TM, Rodriquez M. Predicting the clinical course in intentional drug overdose. Implications for the use of the intensive care unit. Arch Intern Med. 1987;147(1):133-137.

10. Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS. Goldfrank’s Toxicologic Emergencies. 9th ed. New York, NY: McGraw-Hill; 2011.

11. Jones AL, Proudfoot AT. Hypoxia and hypotension in acetaminophen poisoning. J Toxicol Clin Toxicol. 2001;39(6):541-553.

12. Chyka PA, Seger D, Krenzelok EP, Vale JA. Position paper: single-dose activated charcoal. Clin Toxicol (Phila). 2005;43(2):61-87.

13. Kulig K, Bar-Or D, Cantrill SV, Rosen P, Rumack BH. Management of acutely poisoned patients without gastric emptying. Ann Emerg Med. 1985;14(6):562-567.

14. Benson BE, Hoppu K, Troutman WG, et al. Position paper update: gastric lavage for gastrointestinal decontamination. Clin Toxicol (Phila). 2013;51(3):140-146.

15. Proudfoot AT, Krenzelok EP, Vale JA. Position Paper on urine alkalinization. J Toxicol Clin Toxicol. 2004;42(1):1-26.

16. Ghannoum M, Hoffman RS, Mowry JB, Lavergne V. Trends in toxicological exposures in the United States from 2000 to 2012. Clin Toxicol (Phila). 2014;52(10):1092-1098.

17. Mowry JB, Spyker DA, Brooks DE, McMillan N, Schauben JL. 2014 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 32nd Annual Report. Clin Toxicol (Phila). 2015;53(10):962-1147.

18. Wang GS, Buchanan JA. Toxicologic Emergencies. Emerg Med Clin North Am. 2018;36(4):869-886.

19. Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med. 2005;352(11):1112-1120.