Risk assessment is the quantitative cognitive step through which we attempt to predict the clinical course for the individual patient. It enables us to predict a benign course or one that might require further investigations, supportive care only (including early intubation or decontamination), or early initiation of specific therapeutic interventions (such ashaemodialysis or administration of specific antidotes).
The components to form the risk assessment are:
- Time since ingestion
- Clinical features and progress
- Patient factors (weight and co-morbidities)
If the patient is unconscious information can be gathered from:
- Ambulance officers or family
- Counting missing tablets
- Checking medical records, GP and local pharmacy
- History from the family in regards to access or previous overdoses.
- However, you will need to assume the worst case scenario where details are sparse.
Risk assessment in children:
- Time of ingestion is assumed to be the latest possible time (except paracetamol)
- Assume all the missing agents have been ingested
- Do not account for spillage
- If more than one child is involved, assume that each of them has taken the maximum amount unaccounted for.
- Don’t forget the potential of non-accidental injury (NAI).
The show notes are presented as a ‘show and reveal’ mini quiz.
Calcium channel blockers (diltiazem and verapamil)
Chloroquine and Hydroxychloroquine
Hydrocarbons (solvents, eucalyptus oil and kerosene)
Naphthalene (one mothball, however, most contain paradichlorobenzene, which is non-toxic after a single ingestion)
- Daly FF, Little M, Murray L. A risk assessment based approach to the management of acute poisoning. Emergency Medicine Journal 2006; 23:396-399
- Murray L, Little M, Pascu O, Hoggett K. Toxicology Handbook 3rd Edition. Elsevier 2015. ISBN 9780729542241