Toxicology and Overdose Management

1. What poison actually does to the body

Every poisoning falls into one of two buckets. Either it's a straightforward insult — a drug that slows breathing, a caustic that burns tissue. Or it's a substance that hijacks your nervous system and pushes it too far in one direction. Most of what the National Registry tests is that second bucket. That's where the specific antidotes live.

So here's the frame for this whole lesson. Supportive care is the treatment for the large majority of poisonings. Airway, ventilation, circulation, glucose, temperature, and monitoring — that covers most of what walks through your door. A small number of poisons have a specific antidote, and those are the ones the exam wants you to catch. Missing one of them costs a life that supportive care alone would not have saved.

Before you even reach the patient, scene safety is a clinical decision here in a way it is not on most calls. Nerve agents, hydrogen sulfide, and hydrocarbon vapors have put responders on the ground who walked in without decontaminating first. You're not obligated to become the second patient.