Snapshot A 30-year-old woman self-presents to the ED, reporting that she ingested an entire bottle of pills less than an hour ago. She refuses to disclose the type of pill. She has a sweet scent to her breath. She is escorted to the trauma bay, where her blood pressure is 130/80 mmHg, pulse is 90/min, respirations are 24/min, and SaO2 of 96% on room air. ECG reveals no unusual dysrhythmias. Large-bore IVs are inserted. Thiamine is provided, followed by D5 1/2 NS. The patient undergoes gastric lavage, followed by a single dose of activated charcoal. Abdominal radiograph is unremarkable. ASA/acetaminophen levels are unremarkable. The patient remains hemodynamically stable. She is admitted to the psychiatry inpatient service for further monitoring. Introduction Poisoning and overdose cause more deaths than firearms and motor vehicle accidents Leading cause of nontraumatic cardiac arrest General approach to undifferentiated overdose/poisoning patient involves trauma risk management including the following resuscitation screening (clinical evidence of toxidromes) decrease absorption of drug increase elimination of drug Specific toxin search is secondary Presentation When to suspect overdose/poisoning altered mental status/coma young patient with life-threatening dysrhythmia trauma patient bizarre/unusual patient presentation History age weight past medical history medications substance and dose amount time since exposure determines prognosis and need for decontamination route (PO, IV, IM) intention (accidental,suicidal,homicidal) Evaluation and Management Primary survey with resuscitation ADD: (Universal) Antidotes, Draw bloods, Decontamination (universal) Antidotes: DON'T not considered harmful, high benefit profile login to view 9 more bullets Draw bloods essential tests login to view 4 more bullets useful/nonessential tests login to view 3 more bullets negative drug screens/levels do NOT rule out toxic overdose login to view 1 more bullet Decontamination and elimination gastrointestinal login to view 13 more bullets ocular and dermal login to view 1 more bullet urine alkalization login to view 2 more bullets hemodialysis login to view 8 more bullets Secondary survey physical exam with search for toxidromes AMPLE history to identify toxin vitals, ECG, Foley, radiographs Specific antidote discussed elsewhere Disposition strongly consider admission due to delayed onset of many side effects arrange psychiatric evaluationafterpatient is medically optimized