Approach to the Poisoned Patient

The assessment of the poisoned patient can be quite challenging. It is often unclear on presentation whether or not an exposure has occurred at all, and furthermore it is often even more difficult to ascertain the time course of the event. The timeline of a toxicologic event can be represented visually:

The most important aspect of the history of the poisoned patient is the time of ingestion. That information will allow the patient's current location on the above timeline to be determined, and will guide your treatment options and potentially dictate the eventual outcome for the patient.

Another key factor that is highlighted by the timeline is that the condition of the poisoned patient will likely evolve during the course of the clinical encounter as they move through the different stages of toxicity. Therefore, it is crucial that the patient be frequently reassessed, as worsening or improvement of symptoms will help one to more accurately place the patient at the correct point on the timeline.

Assessment

As with any field of medicine, the best approach to assessing the patient is a systematic one. A useful approach is the classic ABC's approach, with some modifications specific to toxicology. This can be thought of in the "Pyramid of Toxicology":

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