Supportive Care 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.
S is for Supportive Care
- R – Resuscitation
- R – Risk Assessment
- S – Supportive Care
- I – Investigations
- D – Decontamination
- E – Enhanced Elimination
- A – Antidotes
- D – Disposition
RRSIDEAD Tox Tutes: Investigations
For the most part, your poisoned patient will require careful and thoughtful supportive care. This is the first of five pages that divide up our tox tute on supportive care, investigations, decontamination, enhanced elimination, antidotes and disposition. The tox tute does not change but each page has extra dedicated videos and question.
Tox Tute AUDIO
Tox Tute VIDEO
Read FAST HUGS in BED Please to help you remember the Supportive care required for ICU patients (and also your poisoned patient).
- Fluid therapy and feeding
- Analgesia, antiemetics and ADT (AAA)
- Sedation and Spontaneous breathing trial
- Head up position (30 degrees) if intubated
- Ulcer prophylaxis
- Glucose control
- Skin/ eye care and suctioning
- Indwelling catheter
- Nasogastric tube
- Bowel cares
- Environment (e.g. temperature control, appropriate surroundings in delirium)
- De-escalation (e.g. end of life issues, treatments no longer needed)
- Psychosocial support (for patient, family and staff)
Some of these steps will also apply to your conscious patient, especially IV fluids if they are too delirious to drink. Also a common trick for beginners if not to monitor their bladder volume. It is common for patients who have taken anticholinergic medications to develop urinary retention and suddenly become really agitated for no apparent reason.
Top tip: Always check their bladder before giving more benzodiazepines
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.