Treatment of Intoxicated Patients

Initial Assessment and Management

Patients with alcohol or drug intoxication should be assessed and treated according to Advanced Trauma Life Support (ATLS) principles, with simultaneous evaluation for signs of specific toxidromes, as recommended by the American Society of Anesthesiologists 1, 2
Securing airway, breathing, and circulation is the first priority in any intoxicated patient, regardless of the substance involved, according to the American Heart Association 4, 5
Personal protective equipment must be used when caring for patients with potential chemical exposures to prevent contamination of healthcare providers, as advised by the American College of Occupational and Environmental Medicine 3

Standard life support measures including airway management are the primary treatment for benzodiazepine intoxication, as recommended by the American Heart Association 4, 5
Flumazenil can reverse CNS and respiratory depression but has significant risks including precipitating seizures in patients with benzodiazepine tolerance or preexisting seizure disorders, according to the American Heart Association 4, 5
Immediate decontamination is essential for external exposure to organophosphates by removing contaminated clothing and irrigation with soap and water, as recommended by the American College of Medical Toxicology 3
Administer atropine immediately for severe organophosphate poisoning manifestations, as advised by the American College of Medical Toxicology 3
Early endotracheal intubation is recommended for life-threatening organophosphate poisoning, according to the American College of Medical Toxicology 3
Pralidoxime should be administered early to reactivate the acetylcholinesterase enzyme in organophosphate poisoning, as recommended by the American College of Medical Toxicology 3
Avoid neuromuscular blockers metabolized by cholinesterase in organophosphate poisoning, as advised by the American College of Medical Toxicology 3

The primary assessment of intoxicated trauma patients must follow ATLS principles while simultaneously evaluating for toxin-specific effects, as recommended by the American Society of Anesthesiologists 1, 2
Patients with combined trauma and intoxication may have severe hypovolemia requiring judicious fluid administration and possibly vasopressors, according to the American Society of Anesthesiologists 1, 2
Traumatic cervical injury needs to be excluded in every patient before airway manipulation, as recommended by the American Society of Anesthesiologists 1
Patients should be considered to have a "full stomach," requiring awake intubation or rapid sequence induction using the Sellick maneuver, as advised by the American Society of Anesthesiologists 1

Abdominal pain with nausea and vomiting can be due to intoxication but could also signal perforation or obstruction of a viscus, as noted by the American Society of Anesthesiologists 1, 2
Mixed overdoses are common and require careful assessment; benzodiazepine overdose should not preclude timely administration of naloxone when opioid overdose is suspected, according to the American Heart Association 4, 5
Delayed muscle weakness can follow the initial cholinergic crisis in organophosphate poisoning, even as late as 4 days after acute exposure, as reported by the American Society of Anesthesiologists 6, 3
Intoxicated patients may have misleading mixed signs that can confound the clinical picture, requiring meticulous and repetitive examinations, as recommended by the American Society of Anesthesiologists 1