Disposition 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.

D is for Disposition

• R – Resuscitation
• R – Risk Assessment
• S – Supportive Care
• I – Investigations
• D – Decontamination
• E – Enhanced Elimination
• A – Antidotes
• D – Disposition

Disposition

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.

RRSIDEAD Tox Tutes: Disposition

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

Tox Library

Ioana Vlad

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.