Poisoned patient general evaluation:

General approach to poisoned patient. First :Resuscitation and triage. Second: comprehensive evaluation(clinical assessment)

first: triage and resuscitation 1-immediate measurement of vital signs 2-assess conscious level. 2-identify poison involved and obtain adequate information about it.(obtain history) 3-decontamination for those with possible external contamination. 4- identifying patients at risk of further attempts at self harm. 5-critically ill patient should be resuscitated.

6-E.C.G should be performed and cardiac monitoring instituted in all patients with cardiovascular features or possible cardio toxic substances. 7-weight of patient when feasible 8- substances of very low toxicity should be identified so inappropriate admission and intervention are avoided.

Taking history in poisoned patient 1-what toxin(s) have been taken and how much. 2-what time were they taken and by what route 3-has alcohol or any drug of misuse been taken as well. 4-details of circumstances of overdose from family, friends and ambulance friends. 5-ask the general practitioner for background and details of prescribed medication. 6- assess suicide risk by full psychiatric evaluation.

SECOND:comprehensive evaluation of poisoned patient:what do examine:(clinical assessment). 1-ABC vital signs, oxygen satutation. 2-level of consciousness. 3-chest. 4-movement of muscles. 5-reflexes. 6-eyes. 7-psychiatric evaluation 8-mouth. 9- skin. 10 abdomen.

Clinical signs suggestive of poisoning 1-small pupil:opioids,organophosphorus compounds, clonidine. 2- dilated pupils: tricyclic antidepressants,cocaine,amphetamine. 3-hypotension:tricyclic antidepressant and haloperidol. 4-cocaine causes hypertension. 5-decreased respiratory rate:opioids,benzodiazepine. 6-increased respiratory rate: salicylate.

7-right upper quadrant:paracetamol hepatotoxicity. 8-renal angle tenderness: salicylate poisoning. 9-epigastric tenderness:NSAIDS. 10- rhabdomyolysis:amphetamine. 11-hperthermia:salicylates. 12-hypothermia:any CNS DEPRESSANTS DRUGS. 13-TACHCARDIA:TCA,theophylline,digoxine. 14-bradycardia:b-blocker,calcium channel blocker 15-needle tracks: opioids and drugs of misuse. 16-extrapyramidal signs:phenothiazine;haloperidol

Investigations: 1-Urea,creatinine,electrolytes should be measured in most patients. 2-ABG in most patient who are respiratory and cardiac compromised. 3-toxin screen in blood. 4-urine for toxicology screen.

General management: 1- patients with skin and eyes contamination should be decontaminated locally. 2- patient who have ingested potentially life threatening quantities of toxins may be considered for gastrointestinal decontamination. If poisoning has been recent.