1. Could it be a poison?Mark Little Cairns Hospital

2. ...Polypharmacy OD... 3. Deliberate self poisoning - up to 5% of EDpresentations Australian life time risk: MALE: 2500 / 100 000 FEMALE: 4430 / 100 000 Highest: Females 15 - 24 yrs Boyce B J Clin Pharm 2003 4. NSW PIC Report 2012 5. Paracelsus (1493 - 1541)All things are poison and nothing is without poison, only thedose permits something not to be poisonous 6. Aim:An approach to the patient that may bepoisoned 7. Not all poisonings are humanWA PIC Report 2004 8. Resuscitation 9. Approach to apoisoning arrest Continue CPR andresuscitation for prolongedperiods Tachyarrythmias may needcorrection of electrolyte andacid base abnormalities Use of antidotes Non standard drug therapies Seek urgent advice fromtoxicologist 10. ResuscitationCOMAIf under 40 yrs age: 80% chance your diagnosis isa toxicology one 11. Quetiapine:No 1 cause of DSP coma needing intubationin Australia. 12. NSW PIC Report 2012 13. Screening Test 14. Screening Test 15. Risk Assessment 16. Drug(s)DoseSymptoms and SignsPre morbid stateTime since ingestion 17. The neat thing about an overdose case is ifyou have a good risk assessment theclinical course is entirely predictable 18. History:Often forgottenAttention to detail 19. Ask the patient 20. NSW PIC Report 2012 21. Dont forgetcomplementary &alternative medications(CAMS) 22. Poppy Seed 23. Examine the patient 24. Observations 25. Pupils Size? 26. Open i Beta 27. Risk assessment 28. ED Short Stay Units 29. Children are small adults 30. NSW PIC report 2011 31. If they ingest anything, children will ingestone or two tablets 32. Common paediatric exposures2009 US PIC data 33. One or two tabs cankill 34. AmphetaminesCalcium Channel Blockers SRChloroquine & OH ChloroquineDuloxene OpioidsPropanolol SulphonylureasTheophylline TCA 35. Have they been poisoned by a venomouscreature? 36. Some present with sudden collapse orseizures 37. Thanks to Bart Currie 38. Children whosuddenly becomeunwellThanks to Bart Currie 39. Of course not all cases are straight forward 40. ConclusionAn approach to the poisoned patient 41. Questions?