General measures and antidotes - poisoned patient in the ED
Poisoning commonly follows accidental or deliberate overdose of prescribed drugs, recreational substances, household chemicals or industrial agents. The cornerstone of emergency management is prompt, systematic supportive care; antidotes and decontamination are adjuncts used selectively.
Follow resuscitation principles, contact specialist toxicology/poison‑information resources (NPIS/TOXBASE) early, and follow local/RCEM guidance for antidote availability and use.
Initial assessment and priorities
- Use an ABCDE approach and treat life‑threatening problems first (Resuscitation Council UK).
- Priorities are airway protection, adequate ventilation/oxygenation, circulatory support (fluids, vasopressors), control of seizures, and correction of temperature and glucose abnormalities.
- Do not delay airway or haemodynamic resuscitation for decontamination or antidotes.
- Obtain a focused history: agent, amount, time of ingestion/exposure, intent, co‑ingestions, chronic medications and relevant medical history.
- Perform baseline tests rapidly: capillary or laboratory glucose, VBG/ABG, electrolytes, renal and liver function, coagulation, paracetamol level in any significant oral overdose, and ethanol/drug levels if available.
- Call NPIS/TOXBASE or local toxicology early for agent‑specific advice, antidote dosing and indications for enhanced elimination.
Decontamination - principles and practicalities
- Always balance potential benefit against delay or risk to the patient. Decontamination must not postpone lifesaving care.
- Skin and eye exposure: