›Immediate stabilization workflow
›Cardiorespiratory monitoring
›IV access criteria
›Symptomatic ingestion
›High risk agent ingestion
›Glucose check without delay
›Capnography for any CNS depression
Decontamination decision logic
›Decontamination options
›Activated charcoal
›Time window typically within 1 to 2 hours for many agents
›Consider later for sustained release agents with toxicology guidance
›Contraindications to activated charcoal
›Unprotected airway
›Caustic ingestion
›Hydrocarbon ingestion with aspiration risk
›Whole bowel irrigation
›Sustained release ingestion large burden with toxicology guidance
›Iron ingestion with radiopaque tablets and toxicity concern
Antidotes and targeted therapy
›Antidote protocols
›Naloxone for suspected opioid toxicity
›0.1 mg/kg IV or IN
›Maximum single dose 2 mg
›Repeat every 2 to 3 minutes to adequate ventilation
›N acetylcysteine for acetaminophen toxicity
›Start if above treatment line on nomogram
›Start if delayed presentation with elevated AST or ALT and concerning history
›Dextrose for hypoglycemia
›D10W 5 mL/kg IV
›Recheck glucose in 10 to 15 minutes
›Octreotide for sulfonylurea induced hypoglycemia
›1 to 1.5 mcg/kg IV or SC
›Repeat every 6 hours or infusion with toxicology guidance
›Pyridoxine for isoniazid seizures
›Gram for gram replacement of suspected ingestion
›If unknown dose 70 mg/kg IV maximum 5 g
›Atropine for cholinergic toxicity with bronchorrhea
›0.02 mg/kg IV
›Minimum 0.1 mg
›Maximum 0.5 mg child and 1 mg adolescent per dose
Supportive care and monitoring
›Monitoring plan
›Serial vitals frequency based on severity
›Repeat neurologic exams
›Repeat ECG timing for cardiotoxic ingestions
›Fluid resuscitation for shock
›Isotonic crystalloid 20 mL/kg
›Reassess perfusion after each bolus
›Specialist involvement
›Poison control or regional toxicology
›Gastroenterology and ENT for caustic ingestion concern
›Pediatric surgery or GI for magnet or battery ingestion
›ICU for persistent instability
›Time based reassessment
›Recheck mental status and ventilation every 15 to 30 minutes early phase
›Repeat glucose until stable if hypoglycemia risk
›Reevaluate for delayed onset symptoms with extended release agents