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.
A is for Antidote
- R – Resuscitation
- R – Risk Assessment
- S – Supportive Care
- I – Investigations
- D – Decontamination
- E – Enhanced Elimination
- A – Antidotes
- D – Disposition
Antidotes
Antidotes are in-fact rarely used, many are not widely available and most are 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.
LITFL list of most useful antidotes in the emergency and critical care:
- 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)
In most cases you have time to assess the requirement for antidotes – Individual antidotes will be discussed in greater depth throughout our tox tute series.
RRSIDEAD Tox Tutes: Antidote
Tox Tute AUDIO
Tox Tute VIDEO
References
LITFL Further Reading
- Toxicology Basics: Principles of RRSIDEAD in toxicology and toxinology
- Drugs and Synthetic Toxicants: Assessment and management of poisoning
- Antidotes: Chemical management for ingested drugs, toxicants and toxins
- Toxins: Assessment and management of envenoming (Toxinology)
- Antivenoms: Chemical management of toxins and envenoming.
- Toxicological Conundrums: Toxicology emergency management in clinical context.
- Toxicology Resources: Toxicology and toxinology resources on the web
Further Reading
- Toxicology in a Box – Flashcards
- Toxicology Handbook 3e
- Toxicology Secrets 1e
- Goldfrank’s Toxicologic Emergencies 10e
- Poisoning and Drug Overdose 7e
- Oxford Desk Reference – Toxicology
Toxicology Library
BASICS
Emergency Physician and Clinical Toxicologist who thinks that life exists outside Emergency Departments and that there is a wide and wonderful world outside the web.