Emergency Management of Unknown Poisoning

Initial Assessment and Stabilization

Ensure scene safety first, assessing for risks from toxic fumes, chemicals, or other environmental hazards before approaching the patient, as recommended by the British Medical Journal 3
Assess circulation and provide cardiovascular support according to standard ACLS protocols, as suggested by the American Heart Association, with a strength of evidence level of high 1

Assess for opioid toxidrome, characterized by respiratory depression, pinpoint pupils, and decreased level of consciousness, with a strength of evidence level of high 1
Check for cholinergic toxidrome, marked by bronchorrhea, bronchospasm, bradycardia, miosis, hypersalivation, lacrimation, urination, and diarrhea, as described by the American Heart Association, with a strength of evidence level of moderate 4
Evaluate for sympathomimetic toxidrome, which includes agitation, tachycardia, hypertension, hyperthermia, and mydriasis, with a strength of evidence level of high 5

For respiratory depression with suspected opioid overdose, administer naloxone immediately, as recommended by the American Heart Association, with a strength of evidence level of high 1
For extreme agitation or hyperthermia from sympathomimetics, provide sedation with benzodiazepines, as suggested by the American Heart Association, with a strength of evidence level of moderate 5

Remove all contaminated clothing and avoid self-contamination when handling the patient, as recommended by the Praxis Medical Insights, with a strength of evidence level of low 6
For chemical exposures on skin, remove chemical powders with gloves before washing with water, as suggested by the Praxis Medical Insights, with a strength of evidence level of low 2

For suspected cyanide poisoning, administer hydroxocobalamin, as recommended by the American Heart Association, with a strength of evidence level of high 1
For organophosphate poisoning, give atropine for bronchospasm, bronchorrhea, seizures, or bradycardia, as suggested by the American Heart Association, with a strength of evidence level of moderate 4
For benzodiazepine overdose, consider flumazenil only if no contraindications, as recommended by the American Heart Association, with a strength of evidence level of high 1
For calcium channel blocker or beta-blocker poisoning, consider high-dose insulin therapy early, as suggested by the American Heart Association, with a strength of evidence level of moderate 1

Contact a poison control center immediately for expert guidance on management, as recommended by the American Heart Association, with a strength of evidence level of high 1
Consider venoarterial extracorporeal membrane oxygenation (VA-ECMO) early for patients with cardiogenic shock or refractory dysrhythmias, as suggested by the American Heart Association, with a strength of evidence level of moderate 5
For severe metabolic acidosis with exposure to fire, consider empiric treatment for cyanide poisoning, as recommended by the American Thoracic Society, with a strength of evidence level of high 7

Do not delay treatment waiting for identification of the specific toxin, as recommended by the American Heart Association, with a strength of evidence level of high 1
Do not use neuromuscular blockers metabolized by cholinesterase in organophosphate poisoning, as suggested by the American Heart Association, with a strength of evidence level of moderate 4
Do not forget to protect yourself and other healthcare providers from potential secondary contamination, as recommended by the British Medical Journal, with a strength of evidence level of low 3
Do not assume a single toxin; multiple drug exposures are common, as suggested by the Praxis Medical Insights, with a strength of evidence level of low 2