Toxicology and Overdose Management

Toxicology and Overdose Management

1. Reading the Pattern Instead of the History

A poisoned patient usually can't tell you what they took. So you don't start with the history. You start with the exam.

Every toxin does one of two things to the body. It either speeds it up or it slows it down. Sort a patient into one of those two buckets, and you're most of the way to naming the toxidrome. A toxidrome is a recognizable cluster of pupils, skin, vitals, and mental status that a class of drugs produces.

And then, once you've named it, the treatment is mostly the same regardless of the exact drug. Support the airway. Support breathing. Support circulation. Give the one antidote you actually carry, if this toxidrome has one. Very few poisonings have a field antidote. As an AEMT you carry naloxone for opioids, and, where your protocol allows it, glucose for hypoglycemia from diabetic medications. Everything else is supportive care and transport.

Scene safety comes first on every one of these calls. Some of these patients are contaminated. Some environments dropped them for a reason. Don't walk into a clandestine lab or a confined space to reach a patient you haven't assessed from the doorway.