Supportive care (toxicology)

#complete #carded

Related FACEM curriculum (2022) learning objectives:

• ME 3.8.1.6(b) Principles of management of toxicological presentations including: General approach to management

• Priority: Begins after resuscitation and risk assessment.
• Goals:
  • Support cardiovascular, CNS, and respiratory systems to prevent morbidity and mortality.
  • Monitor to detect progress, timing of interventions, and withdrawal of care.

Observation and Monitoring

• Initial Observation: Emergency department for close monitoring and correlation with risk assessment.
• Preparation for Complications:
  • Anticipate early complications (e.g., intubation for decreased consciousness).
  • Reassess if unexpected deterioration occurs.
• Observation Duration:
  • Depends on agent, formulation, and potential complications.
  • Examples:
    • Beta-blockers/tricyclic antidepressants: Symptoms within 2–4 hours.
    • Sustained-release calcium channel blockers/valproic acid: 6–12 hours for toxicity.

Supportive Care Measures

• Airway: Intubation if required.
• Breathing: Supplemental oxygen, ventilation support.
• Circulation:
  • Intravenous fluids.
  • Inotropes.
  • Blood pressure control.
  • Extracorporeal membrane oxygenation (ECMO) if severe.
• Sedation and Seizures: Titrated IV benzodiazepines.
• Metabolic:
  • Normoglycaemia maintenance.
  • pH balance.
  • Fluid and electrolyte management.
• Renal Function: Hydration, haemodialysis as needed.
• General Care:
  • Nutrition, bladder care, respiratory toilet.
  • Pressure area prevention, thromboembolism prophylaxis.
  • Mobilisation as mental status improves.