Initial management of poisoned patients in the out-of-hospital environment
Poisoning and suspected poisoning are very common problems in pre-hospital emergency care. The challenge is to identify the 1-2% of individuals who have taken sufficient toxin to be at risk of developing serious sequelae and use and develop effective methods of preventing such sequelae. Few randomised controlled clinical trials are available, and management decisions often have to be made on isolated case reports in the more unusual cases of poisoning.
Care of the unconscious poisoned patient includes care of the airway, breathing, and circulation. Clues to the aetiology of poisoning in such cases may be gained from clinical signs which are discussed. The use of activated charcoal in the pre-hospital environment for a conscious, non-vomiting patient who has taken a substantial quantity ofa poison within 1-2 hours is to be encouraged. However users must be aware of potential complications ofits use, including aspiration pneumonitis and formation of charcoal bezoars. The features and management of specific toxins in the out-of-hospital environment are discussed. Specific antidotes are available only for a minority of toxins. Essential equipment for a "poisons bag" to provide out-of-hospital care for poisoned patients is also discussed.