Emergency Management of Poisoning

General Management Principles

• In life-threatening situations, the first priority is to call emergency medical services and apply life-support techniques, according to the American Heart Association 1, 2
• When contacting a poison center, it is essential to provide information about the character, time, and product name of the poisoning, as recommended by the American Heart Association 3, 2

Specific Poisoning Types and Interventions

Chemical Burns

• Remove chemical powders from the skin with gloves or a piece of cloth, as recommended by the American Heart Association 1, 3
• Remove all contaminated clothing and avoid contaminating yourself, according to the American Heart Association 1, 2
• In cases of acid or alkali exposure, wash the affected area with large amounts of water (Class I, LOE B), as recommended by the American Heart Association 1, 3

Toxic Eye Injuries

• Flush eyes exposed to toxic substances with large amounts of water (Class I, LOE C), unless a specific antidote is available, as recommended by the American Heart Association 3, 2

Ingested Poisonings

• Do not give anything by mouth in cases of poisoning unless advised by a poison center or emergency medical personnel (Class III, LOE C), according to the American Heart Association 1, 3
• There is insufficient evidence to support the use of dilution with water or milk as a first-aid measure, as stated by the American Heart Association 2, 4

Specific Antidotes and Treatments

Opioid Poisoning

• Naloxone is effective for opioid-induced respiratory depression, but its duration of action is often shorter than that of opioids, requiring continuous monitoring, as recommended by the American Heart Association 5
• Naloxone has a favorable safety profile and is unlikely to cause harm when administered to a person without opioid overdose who has respiratory depression, according to the American Heart Association 5

Benzodiazepines

• Flumazenil is a competitive antagonist at the GABA-A receptor benzodiazepine binding site, reversing central nervous system and respiratory depression, as recommended by the American Heart Association 6, 7
• However, administration of flumazenil may precipitate benzodiazepine withdrawal syndrome and seizures in tolerant patients, according to the American Heart Association 7, 8

Organophosphate and Carbamate Poisoning

• Atropine should be administered promptly in cases of severe poisoning, including bronchospasm, bronchorrhea, seizures, or significant bradycardia, as recommended by the American Heart Association 9
• Early endotracheal intubation is recommended for life-threatening organophosphate or carbamate poisoning, according to the American Heart Association 9
• Benzodiazepines are recommended for the treatment of seizures and agitation, as stated by the American Heart Association 9

Special Considerations and Warnings

• Multiple drug exposures are common, and suspected opioid poisoning should not delay the administration of naloxone in cases of benzodiazepine poisoning, as recommended by the American Heart Association 7, 8
• Regional poison centers should be contacted for expert advice on the management of poisoning cases, according to the American Heart Association 6, 8

Treatment for Chemical Exposure to Hydrochloric Acid and Bleach

Immediate Decontamination

• The American Heart Association recommends removing all contaminated clothing and irrigating the affected area with copious amounts of water for at least 15 minutes, as this is the cornerstone of treatment for both hydrochloric acid and bleach exposures 10
• Flush eyes immediately with copious amounts of water for at least 15 minutes, with a Class I, Level of Evidence B-NR recommendation for chemical eye exposure 10

Important Pitfalls to Avoid

• The Centers for Disease Control and Prevention recommends never using sodium hypochlorite (bleach) solutions for decontamination of hydrochloric acid burns, as this creates additional chemical reactions 11, 12, 13
• Do not delay water irrigation while searching for "better" decontamination solutions, as recommended by the American Heart Association 10
• The American Heart Association recommends not applying neutralizing agents to chemical burns, as water irrigation is the standard of care 10

Personal Protective Equipment for Healthcare Workers in Yellow Phosphorus Poisoning

Risk of Secondary Exposure

Immediate Emergency Management of Hydrochloric Acid (HCl) Exposure

Life‑Threatening Situations

• Activate emergency medical services without delay when a patient exposed to HCl shows sleepiness, seizures, respiratory difficulty, vomiting, altered mental status, or reduced consciousness. Class I, LOE B 15
• While initiating treatment, call the national Poison Help hotline (800‑222‑1222 in the United States) and provide the product name, concentration, amount ingested, and time of exposure. Class I, LOE B 15

Skin and Eye Decontamination

Skin Exposure

• Remove all contaminated clothing immediately, taking care to avoid self‑contamination. Class I, LOE B 15
• Before irrigation, brush off any powdered chemical with a gloved hand or cloth. Class I, LOE B 15
• Irrigate the affected area with copious amounts of water for at least 15 minutes. Class I, LOE B 15

Eye Exposure

• Flush the eyes immediately with copious amounts of water for at least 15 minutes unless a specific antidote is available. Class I, LOE C 15

Oral Management Pitfalls

• Do not give anything by mouth (water, milk, or any other substance) unless specifically directed by a poison‑control center or emergency medical personnel. Class III, LOE C 15
• Current evidence does not support dilution with water or milk for ingested caustic agents; such measures may provoke vomiting and aspiration. Class III, LOE C 15