Emergency care for poisoning

Primary Care Algorithm and Condition Assessment

Upon contact with a patient suspected of intoxication, a medical professional must first ensure their own safety: assess potential environmental risks and strictly use personal protective equipment. Next, the algorithm is based on stopping the toxin's exposure and collecting critically important data:

• Assessment of vital functions: continuous monitoring of baseline parameters (respiratory rate, heart rate, blood pressure, thermometry) is performed. In parallel, an active search for specific symptom complexes — toxidromes — is conducted.
• Toxicological history taking: it is necessary to record as accurately as possible the type of toxic substance, the estimated dose, the route and duration of exposure, and the exact time of the incident.
• Preservation of physical evidence: for subsequent laboratory analysis in the hospital, the patient's biological media (vomitus, blood, urine, feces), as well as residues of the toxicant itself and its original packaging, must be collected and preserved.

Step 1: Primary Decontamination

Comprehensive treatment of exogenous poisonings is divided into four groups. At the pre-hospital stage, the absolute priority is the first group—removal of the poison that has not yet entered the systemic circulation.

Care tactics are strictly differentiated depending on the route of administration of the poison:

1. Oral poisoning: gastric decontamination (stomach cleansing) is indicated for all children, regardless of the presence of preceding spontaneous vomiting. The sole exception is strychnine poisoning. Induction of vomiting (mechanical irritation of the root of the tongue) or gastric lavage using drinking water or 0.9% sodium chloride solution is used. After lavage, an aqueous suspension of enterisorbents (activated charcoal) is administered to bind residual toxins.
2. Prevention of complications: in case of spontaneous vomiting, the child must be persistently given fluids after each episode to prevent dehydration. To prevent aspiration, the patient is placed on their back, and during vomiting, the head is turned to the side. Important: it is strictly forbidden to induce vomiting in poisoning with corrosive liquids (acids, alkalis) and gasoline, as retrograde passage will cause a secondary chemical burn of the esophagus and respiratory tract.
3. Percutaneous route (skin): gentle washing of the skin with warm soapy water. It is strictly forbidden to rub the skin, so that hyperemia does not increase the absorption of the poison.
4. Ophthalmologic contact: abundant washing of the eyes with warm water followed by instillation of local anesthetics (tetracaine, procaine) to relieve pain.
5. Inhalation poisoning: immediate evacuation from the hazard area, removal of restrictive clothing, ensuring patent airways, and oxygen therapy.

Steps 2, 3, and 4: Elimination, Antidotes, and Symptomatic Therapy

The second major treatment phase involves methods of eliminating the absorbed poison from the systemic circulation. Stimulation of natural excretion (forced diuresis), peritoneal dialysis, extracorporeal hardware detoxification, and exchange blood transfusion are used (particularly relevant in pediatrics for hemolytic poisonings).

The third direction is specific (antidote) therapy, aimed at the chemical neutralization of the poison or the blockade of its effects at the receptor level. This method has rigid limitations: antidotes exist only for a narrow spectrum of substances, are used exclusively in the toxicogenic stage (while the poison is circulating in the blood), and only when the toxicant is reliably known.

The fourth stage is syndromic (symptomatic) therapy. It is aimed at maintaining vital functions and includes the management of respiratory and cardiovascular failure, neurological disorders (cerebral edema, seizures), hyperthermia, as well as acute hepatic or renal failure.

Prognosis and Prevention of Poisoning

The outcome of exogenous poisoning depends on numerous variables: characteristics of the toxin (dose, exposure time), initial health status and age of the child, as well as the speed and clinical effectiveness of the medical care provided.

The set of measures to prevent children's access to poisons includes:

• Organizational measures: introduction of special labeling for toxic substances and the use of packaging with "child-resistant" mechanisms.
• Household measures: strict storage of all medications and household chemicals out of the child's reach.
• Behavioral measures: continuous supervision of young children and active health education work with parents.

Class and exam questions

What else to study on this topic

• Clinical Manifestations and Diagnosis of Specific Toxidromes in Children
• Methodology and Specifics of Gastric Lavage
• Types of Enterosorbents and Rules of Their Application in Pediatric Practice
• Indications and Technique of Exchange Blood Transfusion in Hemolytic Poisonings
• Principles of Symptomatic Management of Seizure Syndrome and Cerebral Edema

Other topics in "Chapter 13. Main syndromes requiring emergency care"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.