Clinical Conversations: CE: Recorded Pharmacist Series: Approach to the Poisoned Patient

·33 min·3 clips

Pharmacist Raymond Patterson details the five key toxidromes, including how to distinguish anticholinergic from sympathomimetic overdoses.

The episode is a recorded educational presentation from ASHP's Recorded Pharmacist series, hosted by Vicki Basileke and presented by Raymond Patterson. Patterson introduces himself as a clinical pharmacist at Northside Cherokee Hospital with prior residency training at a level one trauma center. He begins by listing learning objectives focused on the six steps of triaging and treating poisoned patients. Common challenges in emergency toxicology are discussed, including unreliable patient histories and limited antidote availability. Epidemiology data from 2021 shows over 2 million poisoning calls annually in the U.S., with opioids, ethanol, and acetaminophen as leading causes. The triage process emphasizes ABCs (airway, breathing, circulation) and assessing vital signs, mental status, and exposure history. Patterson explains how to quantify exposures, especially in children, using mouthful measurements. A major section covers the five most common toxidromes: anticholinergic, cholinergic, opioid, sympathomimetic, and sedative-hypnotic, with key signs and differentiation tips. Initial care steps include discontinuing exposure and performing external decontamination via dry or wet methods. Internal decontamination methods are reviewed, such as induced emesis, orogastric lavage, whole bowel irrigation, and activated charcoal, including dosing and contraindications. Supportive care topics include sedation for airway management, hemodynamic support for hypotension or hypertension, and seizure treatment. The discussion touches on toxokinetics, noting how overdoses can alter drug absorption and protein binding. Lab utility is addressed, emphasizing turnaround times and the limitations of urine drug screens. Common overdose treatments are listed, such as N-acetylcysteine for acetaminophen, naloxone for opioids, and bicarbonate for salicylates. Lesser-known therapies include lipid infusions for lipophilic drugs and specific treatments for mushroom poisoning or valproic acid overdoses. The episode also covers xylazine, an adulterant in illicit drugs, and its veterinary use and toxicity. It concludes with a warning about medications that can be fatal to pediatric patients in single doses, like certain antidepressants and heart medications.

As heard by us

A careful review of poisoned-patient decontamination, centered on timing, contraindications, and restraint.

For poisoned-patient decontamination, this review keeps the emphasis where it belongs: on restraint, timing, and the risk of making a dangerous exposure worse.

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Why you'd press play

You want to sort safer decontamination choices from risky reflexes in a poisoned patient.

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