Ingestion/Poison/Overdose

Question 1

What might you ask for on history?

Answer 1

• Ingestion
	○ Type - drug, preparation, mixed?
	○ Amount 
	○ How did they obtain it
• Current symptoms 
	○ E.g. vomiting, headache, decreased consciousness
	○ If unexplained, do a urine drug screen 
• Patient 
	○ Weight 
• Incident 
	○ Time
	○ What's been done since
	○ Reason: accident, DSH, suicide...

Question 2

Who can you ask for for help on assessment and Mx?

Answer 2

Poisons helpline: 13 11 26

Question 3

What Ix might you do?

Answer 3

• UEC
• Glucose 
• Urine drug screen: opioids		
- If mixed or undetermined ingestion Paracetamol level should be done
- Serum drug levels can be done
• Septic screen

Question 4

Primary mx of poisoning?

Answer 4

DRS ABC

Question 5

What follow-up neuro obs could you do, and how often?

Answer 5

Neuro obs, often done 30-60min baseline:
		○ PEARL
		○ Reflexes
		○ Movements
		○ GCS

Question 6

Psychosocial mx of poisoning

Answer 6

○ Social work referral
○ Child first
○ DHS/VFPMS
○ Educate

Question 7

Paracetamol poisoning:

• which Ix
• Mx

Answer 7

• Ix: LFTs esp. ALT
• 4h after ingestion level take paracetamol level and ALT level
○ Above line (of normogram): NAC
○ Below line: not NAC

• Activated charcoal has risk of aspiration issues due to altered conscious state - not used in paeds

Question 8

Generally, how might you remove poisons?

Answer 8

• Gastric Lavage
• Specific antidotes e.g.:
○ Hypoglycaemia - glucose
○ Benzos - flumazenil
• Whole Bowel Irrigation(not good for slow release preparations)
• Emesis (no role in the hospital setting)