- identify the toxidrome
- get some labs to help you figure things out: anion gap, osmolal gap, oxygen saturation gap (exists when the measured oxygen saturation of blood on pulse oximetry differs from the oxygen saturation calculated by routine abg analysis by more than 5% suggesting presence of abnormal hemoglobin ie carboxyhemoglobin, methemoglobin or sulfhemoglobin), drug levels (ethanol, acetaminophen, salicylate and others depending on the clinical situation)
- give activated charcoal except with alcohols, hydrocarbons, organophosphates, acids, iron and lithium; and to patients at risk of aspiration.
- give specific antidote as indicated (see table)
- supportive care
- call the regional poison control center for further guidance: 1-800-222-1222
That's it. You've just completed the 5 minute toxicology fellowship.
Source
Mokhlesi, Babak MD and Corbridge, Thomas MD. "Toxicology in the critically ill patient." Clin Chest Med. 2003.
