Approach to the Critical Patient

Immediate priorities

Airway and respiratory threat

Monitoring and escalation

Monitoring bundle

Escalation triggers

Key actions

No antidote exists for saxitoxin

Poison control consultation for all suspected cases

Public health notification immediately

History

Exposure and onset

Shellfish ingestion history

Timing of symptom onset

Symptom progression

Classic progression pattern

Associated symptoms

Key historical differentiators

Preserved consciousness throughout

Cluster exposure

Red tide or bloom advisory

Risk factors

High-risk exposure

Host risk factors

Physical Exam

Vital signs and respiratory assessment

Vital signs snapshot

Respiratory function assessment

Neurological exam

Sensory findings

Motor findings

Cranial nerve exam

Cardiovascular exam

Cardiac findings

PITFALLS

Missed respiratory failure

Misdiagnosis

Differential Diagnosis

Neurotoxin causes

Shellfish and marine toxin syndromes

Other neurotoxic exposures

Neuromuscular and CNS causes

Acute neuromuscular disorders

Central nervous system events

Allergic reactions

Laboratory Tests

Baseline labs for mimic exclusion

Metabolic and electrolyte panel

Hematology

Respiratory and perfusion monitoring

Arterial blood gas

Venous blood gas

Lactate

Confirmatory and public health labs

Saxitoxin testing

Additional studies as guided by clinical picture

Diagnostic Tests

Scoring Systems

PSP severity classification

Respiratory monitoring thresholds

MRI

MRI role in PSP evaluation

CT

CT head indications

CT chest indications

Ultrasound

Bedside ultrasound in PSP

ECG as essential diagnostic test

Disposition

ICU admission criteria

ICU indications

Ward admission criteria

Observation admission for moderate presentation

Discharge criteria

Discharge considerations

Consultation triggers

Treatment

Airway management

Airway strategy

Extubation readiness

Gastrointestinal decontamination

Activated charcoal

Gastric lavage

Do not induce emesis

Supportive care

IV fluid resuscitation

Antiemetics

Medications to avoid

Cardiac management

Bradycardia and AV block management

Special Populations

Pregnancy

Pregnancy-specific considerations

Geriatric

Older adult considerations

Pediatrics

Pediatric-specific features

Background

Epidemiology

Global burden

Seasonal patterns

Vector species

Pathophysiology

Toxin mechanism

Clinical correlation with mechanism

Toxin accumulation in shellfish

Therapeutic Considerations

No antidote currently available

Evidence basis for management

Public health considerations

Patient Discharge Instructions

copy discharge instructions

What happened

At home care

Return to the emergency department immediately if

Shellfish safety instructions

Follow up

References

Guidelines and key sources

Primary references

Additional clinical references

ICD-10 coding references

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.