- R – Resuscitation
- R – Risk Assessment
- S – Supportive Care
- I – Investigations
- D – Decontamination
- E – Enhanced Elimination
- A – Antidotes
- D – Disposition
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 as haemodialysis or administration of specific antidotes).
The components to form the risk assessment are:
- 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).
RRSIDEAD Tox Tutes: Risk Assessment
Listen to the Tox Tutes below to work out which three investigations we most commonly do. Discover what is the difference between screening and specific tests and what tests would you consider in the unconscious patient.
Tox Tute AUDIO
Tox Tute VIDEO
Q1. 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
- Calcium channel blockers (diltiazem and verapamil)
- Chloroquine and Hydroxychloroquine
Q2. 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
- Hydrocarbons (solvents, eucalyptus oil and kerosene)
- Naphthalene (one mothball, however, most contain paradichlorobenzene, which is non-toxic after a single ingestion)
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
- 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
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.