Management of Common Poison Intake in Children

Initial Assessment and Stabilization

Immediately establish an open airway and provide bag-mask ventilation if respiratory compromise is present, followed by endotracheal intubation when appropriate, as recommended by the American Heart Association 1
Contact a poison control center for assistance with diagnosis, prognosis, and management guidance, as suggested by the American Academy of Pediatrics 3

Ipecac syrup should NOT be used as a first aid treatment for acute poisoning, according to the American Heart Association 4
There is insufficient evidence for administering diluents for caustic substance ingestion, as stated by the American Heart Association 4

For respiratory depression/arrest caused by suspected combined opioid and benzodiazepine poisoning, administer naloxone first before other antidotes, as recommended by the American Heart Association 2, 5
Flumazenil can be effective in select patients with pure benzodiazepine poisoning who don't have contraindications, according to the American Heart Association 2, 5
Avoid flumazenil in patients with benzodiazepine dependence, seizure disorders, or when cyclic antidepressant co-ingestion is suspected due to risk of seizures and dysrhythmias, as warned by the American Heart Association 1, 2
Administer naloxone 0.1 mg/kg IV/IO/IM for children with respiratory depression, as recommended by the American Heart Association 6
Titrate naloxone to reversal of respiratory depression and restoration of protective airway reflexes, as suggested by the American Heart Association 6
For organophosphate poisoning, administer Atropine 0.02 mg/kg, doubled every 5 minutes, titrated to reversal of bronchorrhea, bronchospasm, bradycardia, and hypotension, according to the American Heart Association 6
For carbon monoxide poisoning, administer 100% oxygen immediately, as recommended by the Association of Anaesthetists 7
For methemoglobinemia, consider methylene blue 1-2 mg/kg, as suggested by the American Heart Association 2

Warm shower water should be used for decontamination to avoid hypothermia, and at lower pressure to prevent additional skin damage, as recommended by the American Academy of Pediatrics 3
In cold climates, use heat lamps and blankets to prevent hypothermia during decontamination, as suggested by the American Academy of Pediatrics 3