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- Airway with specific care on cervical spine immobilization (unless trauma has been excluded)
- Breathing, oxygenation, and need for intubation
- Circulation—fluid resuscitation and continuous cardiac monitoring
- Decontamination of GI—only if ingestion within 1 hour
- Elimination of toxin—antidotes, charcoal hemoperfusion, hemodialysis
- History—past medical and psychiatric history, prescription drugs, empty bottles found and pill count, time of ingestion
- Examination—a quick, but detailed exam focusing at identifying a toxidrome to narrow on the toxin ingested (multiple drug ingestion common)
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Always check pupils, temperature, and GCS along with vitals to identify toxic syndrome.
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- Laboratory investigations: CBC, Chem-7, blood glucose, anion gap, osmolar gap, PT/PTT/INR, LFTs, drug levels (acetaminophen, salicylate, digoxin, phenytoin, valproate, phenobarbital, lithium, theophylline as per history; quantitative levels useful for these drugs as they will change management), urine tox screen, alcohol level
- EKG—rate, rhythm, ORS duration, QTc interval
- CXR and abdominal x-ray to look for radio-opaque drugs (iron, heavy metals, and enteric-coated drugs) or packets of illicit drugs
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