Initial Evaluation and Management of the Poisoned Patient.

Principles in the management of poisoned patient
One of the most important aspects in the management of poisoning or a toxic exposure is knowing what to do and in what order to do it; and knowing if the toxic agent can be easily removed, neutralized or eliminated and what is the specific antidote available.
Causes Of Poison-Related Death
1. Respiratory failure
2. Circulatory failure
3. Systemic hypoxemia
4. Convulsion
5. Other organ damage

Clinical evaluation of the poisoned patient:
The first step is to provide the patient with good supportive care which focuses on six major areas:
(1) resuscitation and stabilization (physical examination):
a- Check breathing: the patient may need oxygen or start mechanical ventilation .
b- Check blood pressure; shock is treated with fluid challenge and if necessary vasopressor agents.
c- Check sinus rhythm and if the patient comatose or experiencing seizures or tremors and if underlying any medical problems such as liver or renal diseases.
(2) History of poisoning:
An accurate history should include identification of the poison, amount and time of ingestion or length of contact, emergency first aid treatment already administered and the patient psychological profile. Information obtained from relatives or friend because the patient may be unconscious.
(3) appropriate decontamination of the gastrointestinal tract, skin, and eyes.
(4) use of laboratory tests, electrocardiograms, and so on.
(5) administration of specific antidotes, if indicated; and
(6) utilization of enhanced elimination techniques for selected toxins.

Methods to reduce or prevent absorption (gastrointestinal decontamination):