1. Substance Abuse and Toxicology Emergencies
Union Hospital

2. History of Present Exposure
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. Type of Exposure
Inhalation
Ingestion
Dermal
Ocular
Parenteral

4. Reason for Exposure
Accidental
Intentional: suicide attempt or abuse

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

6. Institute Appropriate Interventions
Maintain ABC’s
Provide Gastrointestinal Decontamination to prevent absorption

7. Gastric Lavage 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. Charcoal Administration
Dose depends on patient’s weight and is 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. Ocular Decontamination
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. Promote Excretion 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. Urine Alkalization The use of sodium bicarbonate is contraindicated in
Pulmonary edema
Renal failure

12. Antidote Therapy 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. Procedure/Skills Poison Control Gastric Lavage
Urine Drug Screen/Rapid Drug Screen
Opiates, TCA, Benzodiazepines, Marijuana, Cocaine, Amphetamines, Methamphetamines, Barbiturates