1. Union Hospital Emergency Department

2.  Basic Information  Name and amount of substance  Time of exposure  First aid measures initiated prior to arrival in ED  Current symptoms  Situation prior to the event: traumatic, medical or psychological factors

3.  Inhalation  Ingestion  Dermal  Ocular  Parenteral

4.  Accidental  Intentional: suicide attempt or abuse

5.  Chemical exposure  Pesticide application  Stained Glass Worker (lead)  Pain stripper (Methylene Chloride and Carbon Monoxide

6.  Maintain ABC’s  Provide Gastrointestinal Decontamination to prevent absorption

7.  Use 36-40 FR orogastric hose 500-3000 ml fluid  Consider intubation if the patient requires airway protection secondary to respiratory depression  Patient should be on left side position to minimize risk of aspiration  Do not use orogastric tube if patient has intact gag reflex  Continue to lavage until the contents return to clear  Contraindications: ingestion of caustics, co- ingestion of sharp objects, non-toxic ingestions

8.  Dose depends on patient’s weight and is 50- 100 G per kg  Administer orally or via lavage tube  Multiple dose charcoal may be helpful in specific overdoses  Contraindications: corrosive ingestion, decreased or absent bowel sounds, toxins not bound by charcoal (metal, iron)

9.  Ensure provider protective gear is used  Remove all contaminated clothing  Immediately flush area with saline/water and soap, particularly for caustic exposures, includes the hair and under the nails

10.  Cathartic administration  Mix and administer with charcoal orally or via lavage tube (magnesium citrate)  Contraindication: caution in absent bowel sounds, especially in peds or elderly  Avoid patients with pre existing renal impairment or heart failure

11.  The use of sodium bicarbonate is contraindicated in  Pulmonary edema  Renal failure

12.  Oxygen for carbon monoxide (CO)  Naloxone for opiates  Atropine/Pralidoxime for organophosphates  Cyanide antidote kit for cyanide  Flumazenil for benzodiazepines  Chelation therapy for heavy metal poisoning

13.  Poison Control  Gastric Lavage  Urine Drug Screen/Rapid Drug Screen  Opiates, TCA, Benzodiazepines, Marijuana, Cocaine, Amphetamines, Methamphetamines, Barbiturates