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These are in-fact rarely used, many are not widely available and expensive. It is your risk assessment that will determine whether an antidote is required, and whether its administration outweighs the risks as with any treatment.
Our list of antidotes for the emergency situation included:
Naloxone (opiate toxicity)
Dextrose (correct hypoglycaemia in insulin or sulphonylureas)
Calcium gluconate (arrhythmias with hydrofluoric acid; temporizing measure in calcium channel blockers toxicity)
Sodium bicarbonate (severe TCA overdose or sodium channel blockade)
Atropine (organophosphate poisoning)
Otherwise you have time to assess the requirement for antidotes.
Individual antidotes will be discussed in greater depth throughout our tox tute series.
Your risk assessment will inform you as to when the patient will be medically cleared. If this can be done in a timely fashion in the emergency department, then no further arrangements will be needed. However, if it indicates the need for ongoing observation, supportive care, enhanced elimination or antidote administration, you will need to admit the patient to an environment where staff are capable of providing an appropriate level of care.
Remember those patients who have deliberately self poisoned will need psychiatric and social work review.
Points to consider when retrieving a poisoned patient:
- Risk assessment is vital
- Identify early who may need to be transferred to another facility
- Patients should only be retrieved for specific clinical indications
- Remember the worst phase of their poisoning may occur during transport
- Consider bringing expertise or resources to the patient instead
- Assess, manage and stabilise potential resuscitation and supportive care priorities prior to transport
- Ensure that transport dose not lead to an interval of lower level of care
- Transport to a centre capable of definitive care.
- Murray L, Little M, Pascu O, Hoggett K. Toxicology Handbook 3rd Edition. Elsevier 2015. ISBN 9780729542241