Guideline for Toxicology Patients

Purpose

To outline the general procedures and notifications regarding toxicology patients presenting to the Emergency Department

Procedures

Notification and General Procedures:

Please notify the Toxicologist on call via switch 24/7 for the following toxicology patients:

  1. Any toxicology patient you are concerned about after having first discussed the patient with the ED Consultant on the floor / on-call.
  1. All patients presenting after-hours who have taken an overdose who are being medically cleared prior to the Toxicology team reviewing the patient at 8:00am the following morning.
  1. Toxicology patients requiring admission to ICU. These patients are to be admitted under the Toxicology Unit ‘CTOX’ in ICU.
  1. Patients who fulfil the criteria for inclusion into any Toxicology Unit research studies.   These research studies are outlined on the Toxicology pin board in the doctor’s write up area. Please contact the toxicologist on call once their eligibility is recognised as it may have implications on when blood tests need to be taken.

The reason for notification of patients detailed above in (1) and (2) is to confirm that there has been an accurate recording of the risk assessment information – time of ingestion, drug(s) and dose(s) taken – and to confirm that the ECG has been scanned on the main photocopy/printer between the two clinical work areas using the pre-set button Toxicology.

Special groups of toxicology patients that do not require notification, but the Toxicology Unit is happy to be contacted about to discuss:

  1. Patients who have taken recreational drugs (e.g. THC, cocaine, amphetamines, heroin etc). Ensure that as much information as possible is recorded with respect to the drug(s) taken and when. ECGs should be scanned to Toxicology.
  1. Patients with THC hyperemesis. These patients will be managed by the Toxicology Unit and should be managed as per (1).
  1. Carbon monoxide exposure – accidental or deliberate exposure should be given a minimum of 6 hours of high flow oxygen. Assessment of severity using a carboxyhaemoglobin level is unreliable. These patients should be admitted to short stay for review by the Toxicology team.

The oncall Clinical Toxicologist is always available 24/7 via switch to discuss toxicology patients.

Medical Clearance of Toxicology Patients

The medical clearance of toxicology patients is an important component of their medical care. It should be focused and needs to assess both the patient’s physical and mental state. It consists of the following:

  1. Patient is past the peak of their toxicity and is on the improve. Be wary of clearing patients within 6 hours of ingestion.
  1. Mentally recovered &/or OK.  (Abbreviated MSQ/MMSE) – orientated to time & place, day of week, month of year, year, PM, previous PM, Serial 7’s or WORLD backwards as well as an assessment of short term memory i.e. remember 3 objects.  Very briefly you have checked orientation, short & long term memory as well as attention/cognition.
  1. Physically recovered &/or OK– check for cerebellar signs – nystagmus, finger nose etc. WALK your patient to check for ataxia including heel toe. Can they walk to the toilet? Can they pass urine? Can they feed themselves?

 

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