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Overdoses and accidental ingestions or exposures are common throughout the world. With more than 2.4 million toxic exposures each year, poisoning is the second most common cause of injury-related morbidity and mortality in the United States. In the United States in 2015 antidotes for various overdoses were used 184,742 times. While for many overdoses and intoxications the treatment involves supportive care and treatment of the sequelae there are specific antidotes available for a variety of substances. Identifying the ingestion and prompt administration of the correct antidote can prevent significant morbidity and mortality for many patients. This activity will focus on updating the health team on sixteen of the most common overdose presentations and their corresponding antidotes. This activity reviews the evaluation and treatment of common overdoses, and highlights the role of the interprofessional team in evaluating and treating patients that have experienced an overdose. Objectives: Describe the evaluation of a patient with hydrofluoric acid exposure. Identify the presentation of a patient with organophosphate exposure. Review the clinical manifestations of iron overdose. Outline the importance of how collaboration and coordination among the interprofessional team can enhance patient care when a patient presents with an overdose. Access free multiple choice questions on this topic.

Overdoses and accidental ingestions or exposures are common throughout the world.  With more than 2.4 million toxic exposures each year, poisoning is the second most common cause of injury-related morbidity and mortality in the United States.[1] In the United States in 2015 antidotes for various overdoses were used 184742 times.[2] While for many overdoses and intoxications the treatment involves supportive care and treatment of the sequelae there are specific antidotes available for a variety of substances. Identifying the ingestion and prompt administration of the correct antidote can prevent significant morbidity and mortality for many patients. This article will focus on sixteen overdose presentations and their corresponding antidotes.

Overdoses and accidental exposures to toxic agents are a significant cause of morbidity and mortality worldwide. Combating this issue involves an interprofessional team and multiple approaches. First, there should be a focus on prevention. Community leaders, health care workers, and educators can all play roles in the prevention of toxic exposures. Patients should be educated on the correct way to take various medications and to keep them out of the hands of small children. The public should similarly receive education on the proper storage and disposal of medications and household supplies as well as potentials for toxic exposures and how to avoid them. The next area of focus is on preparation which again involves a team approach. Health professionals from a variety of specialties (such as emergency medicine, toxicology, critical care, hematology/oncology, pediatric emergency medicine, etc.) should work with pharmacists, local poison centers, EMS, and hospital administration to form a consensus on which antidotes should be stocked in the hospital. Knowing what is available and how soon a specific antidote is obtainable is critical as the administration of most antidotes is very time sensitive with morbidity and mortality drastically increasing with treatment delay. The next area of focus is a timely and adequate treatment which again involves a team approach. A patient with an overdose or toxic exposure may arrive by EMS or private vehicle. EMS can provide not only a description of patients clinical condition and treatments given on scene or en route but also information on the scene itself that can help point to a particular toxic exposure. Nurses are critical in triage and assessment of the patient, obtaining labs and other tests, carrying out treatment plans, and monitoring and reassessing the patient's clinical status. Respiratory therapists are often needed to help treat the pulmonary manifestations of various toxicological emergencies. Pharmacists should have involvement with recommendations of multiple antidotes and their dosing. Regularly communication with local poison center is also important in the patient's management. Psychiatry and social work will often need to be involved after patient stabilization if the exposure is deemed to be from an attempt at self-harm. Additional treatment teams will likely offer consultation as the patient will often need admission to the hospital and possibly to the intensive care unit. By preparing ahead of time and communicating efficiently with various health care professionals, we can improve the outcomes of patients presenting with toxic exposures.