Risk Assessment • Toxicology RRSIDEAD • LITFL Tox Library

Risk Assessment Overview

As with any basic and advanced life support it is important to have a systematic approach to managing toxicological emergency presentations. Pioneers in the field developed RRSIDEAD as a mnemonic to remember the key steps in Tox patient assessment and management.

R is for Risk Assessment

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:

Agent(s)
Dose(s)
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.

Question 1

List the pharmaceuticals with the potential for severe toxicity if one or two tablets are ingested by a 10kg toddler (previously called one-two pills can kill list – hint = there are a lucky 13)

+ Reveal the Answer

Amphetamines
Baclofen
Calcium channel blockers (diltiazem and verapamil)
Carbamazepine
Chloroquine and Hydroxychloroquine
Clozapine
Dextropropoxyphene
Opioids
Propranolol
Sulphonylureas
Theophylline
TCAs
Venlafaxine

Question 2

List the non-pharmaceuticals with the potential for severe toxicity if a sip or a mouthful is ingested by a 10kg toddler (only 7)

+ Reveal the Answer

Organophosourous agents
Paraquat/Diquat
Hydrocarbons (solvents, eucalyptus oil and kerosene)
Camphor
Corrossives
Naphthalene (one mothball, however, most contain paradichlorobenzene, which is non-toxic after a single ingestion)
Strychnine

References