<b>Supportive Treatment in Poisoning</b><br>ffEnsure safety of the patient and minimize/stop exposure e.g. wash off/clean skin with water and soap ffMonitor and stabilize all vitals (blood pressure, heart rate, respiratory rate, oxygen saturation AND temperature)<b>Airway and breathing (often impaired in unconscious patient)</b><br>ffEnsure the airway is cleared and maintained –– Insert an airway cannula if necessary ffPosition patient semiprone to minimise risk of inhalation of vomit ffAssist ventilation if necessary ffAdminister oxygen if necessary<br><b>Blood pressure</b><br>–– Hypotension is common in severe poisoning with CNS depressants. A systolic BP <70 mmHg may cause irreversible brain or renal damage ffCarry the patient’s head down on the stretcher and nurse in this position in the ambulance -ffSet up an IV normal saline line –– Fluid depletion without hypotension is common after prolonged coma and after aspirin poisoning due to vomiting, sweating and hyperpnoea ffHypertension is less common but may be associated with sympathomimetic poisoning e.g. amphetamines, cocaine, pseudoephedrine}<b>Heart</b><br>–– Cardiac conduction defects and arrhythmias may occur in acute poisoning especially with tricyclic antidepressants, but the defects usually respond to correction of any hypoxia or acidosis}<b>Body temperature</b><br>–– Hypothermia may develop in patients with prolonged unconciousness especially after overdose of barbiturates or phenothiazines e.g., chlorpromazine, trifluoperazine –– Hypothermia may be missed unless temperature is monitored –– Treat by covering the patient with a blanket ffHyperthermia may occur with anticholinergics and sympathomimetics –– Treat by tepid sponging and antipyretics if appropriate}<b>Convulsions</b><br>ffDiazepam 10 mg rectally repeated if necessary Child: 0.5 mg/kg per dose (1.5-2.5 mg if <1 month, 5 mg if 1 month-2 years, 5-10 mg if 2-12 years) Or diazepam 5- 10 mg slow IV repeated if necessary max 30 mg Child: 200 micrograms (0.2 mg)/kg max 10 mg}<b>Other considerations</b><br>ffCounsel patient and families concerning poisoning ffA psychiatric evaluation is necessary if poisoning was intentional ffIf environmental or ccupational exposure, follow up to assess if other people have been affected and take appropriate measures