Office management of acute pediatric poisonings

Over the past five years, the role of the office practitioner in diagnosis and management of acute poisoning has developed into an important first line of defense in preventing serious morbidity and mortality associated with these exposures. The prime role of the practitioner is to accurately identify and quantify a poisoning exposure, to institute appropriate initial stabilization and management, and to recognize individuals who require further treatment and transfer to hospital settings. Beyond the obvious importance of initial stabilization of severely poisoned patients, the most important step in approaching the acute overdose is to identify what was taken, how much was taken, and when it was taken. To ensure appropriate treatment, the practitioner must use all the resources possible to obtain accurate identification and quantification of these exposures. Nontoxic exposures judged by the product (see Table 5) or by the quantity ingested (see Table 4) may safely be discharged with follow-up care. With toxic exposures, all attempts must focus on terminating the exposure by gastrointestinal decontamination with oral poisonings, adequate aeration with inhalational poisonings, and copious washing with topical and/or ocular exposures. The skillful approach of the office practitioner will provide the most effective initial management of the poisoned child. Appropriate referral to an emergency department for further evaluation and treatment may then be considered.