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Immediate priorities
First 10 minutes
Airway and ventilation strategy
Avoid apnoea and hypoventilation
Maintain or exceed pre-intubation minute ventilation if intubated
Early senior airway support and pre-brief on ventilation targets
Breathing and oxygenation
High-flow oxygen for hypoxia
Pulmonary oedema pathway if respiratory distress
Circulation and perfusion
IV access x 2
Isotonic crystalloid for hypovolaemia
Vasopressor support if shock after fluids
Neuro and temperature
Point-of-care glucose
Seizure precautions
Active cooling for hyperthermia
Key early triggers
Altered mental status
Sustained tachypnoea
Pulmonary oedema
pH < 7.2
Rising salicylate concentration on serial levels
Renal failure or oliguria
Early tox-focused actions
Parallel actions
Poison centre and nephrology early for possible dialysis
High-risk features present
Salicylate concentration in severe range
Decontamination window assessment
Recent ingestion
Sustained-release or enteric-coated product
Early alkalinisation pathway
Serum pH goal 7.45 to 7.55
Urine pH goal 7.5 to 8.0
Potassium repletion to enable urine alkalinisation
Monitoring
Continuous ECG
Frequent vitals and mental status checks
Strict urine output tracking
Key concepts
High-yield physiology
Non-ionised salicylate crosses BBB and lung tissue more readily
Acidaemia increases non-ionised fraction
Respiratory alkalosis is protective
Mixed acid-base pattern is common
Primary respiratory alkalosis from medullary stimulation
Anion gap metabolic acidosis from organic acids and uncoupling
Clinical deterioration can occur as salicylate moves into tissues
Serum concentration may fall while toxicity worsens
Serial levels and clinical trajectory both required
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.