General approach to management for toxin related admissions to the ICU

a review

The lecture duration is 22min.

0.5 CPD Points, 0.5 CEUs, 0.5 CME credits approval pending.
Accredited by CPDUK, CBRN and Provider Pending.

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Binila Chacko
Professor and Head of Division of Critical Care, Christian Medical College, Vellore, India
Lecture Summary

This session is focused on a general overview of the management of toxin-related admissions to the ICU. The key focus is on ensuring that the listener understands that resuscitation and acute stabilization is the cornerstone for the successful management of these patients. Specific points pertaining to toxicology and relevant to resuscitation are covered in this session. Whilst resuscitation is ongoing, there must be a simultaneous attempt to ascertain the toxic agent, the timing of ingestion and the dose. In situations where the agent is unknown, physical toxidromes may help. These toxidromes however have certain limitations such as overlapping features, masking of clinical findings and the fact that all agents may not have the typical toxidrome. The role of investigations is limited to refining risk assessment and prognosis, confirming the diagnosis (blood drug levels and other tests such as pseudocholinesterase levels for organophosphorus poisoning) and assessment of organ function. Osmolal gap and urine drug levels have little use in the acute setting. The traditional concept of decreasing absorption by gastrointestinal decontamination has been knocked out by the lack of evidence of benefit and the potential for harm. With regards to enhanced elimination, there may be a role in specific situations: for eg: urinary alkalinisation for salicylate poisoning and dialysis for lithium overdose. Finally, the listener must understand that antidotes only serve as an adjunct to therapy. It is difficult to give a prescribed approach to guide the decision on how to administer an antidote in a toxicological emergency as this depends on the lag time to presentation, toxicokinetics properties, and the mechanism of action of the antidote.

Target Audience

Critical Care Doctors
Experienced or advanced Critical Care Nurses

Learning Objectives:

Upon completion of this activity, you should be able to:

  • Understand that resuscitation of the poisoned patient is the prime focus of management and should be able to list the points relevant to toxicological resuscitation
  • Discuss the pitfalls of commonly described screening tests for toxicology
  • Describe the role of gastrointestinal decontamination and enhanced elimination in the poisoned patient