The physical exam should be comprehensive with special attention directed at finding evidence of a specific toxidrome. Knowledge of medications, medical problems, and potential ingestions or exposures are very important historical facts in order to narrow down the list of potential toxic agents. A detailed history and physical examination is key. At a minimum, the readily available PPE (cap, gown, gloves, mask, and eye protection) should be worn by all personnel in order to prevent accidental exposure.Īs with all unstable patients, the initial assessment (once safe) begins with the ABCs. In the uncommon event of an exposure which could be transmitted to emergency personnel, be sure to perform decontamination FIRST and OUTSIDE of the Emergency Department in order to not contaminate your personnel or life-saving equipment.

Most toxicologic exposures involve ingestions or localized chemical/biologic exposures involving single individuals with limited risk to medical personnel. When in doubt, in the US, always call 1-80 to speak to your regional poison control center and obtain directed advice.

This discussion is by no means to be considered comprehensive, as Toxicology is a vast subject that cannot be quickly covered in depth. This article will discuss the initial assessment, identification of toxidromes, and stabilization of patients suspected of toxic exposures.

Author: Levi Kitchen, MD (EM Chief Resident, Naval Medical Center – Portsmouth) // Edited by: Alex Koyfman, MD, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD EM Chief Resident at SAUSHEC, USAF)

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