Immediate Questions

A. What should clinician do first? Assess and treat patient's airway, breathing, and circulation (ABCs). When indicated, place child on cardiac monitor and establish IV access; this may be carried out while obtaining history and performing physical exam. Obtain initial, brief history, including product name, active ingredients, amount ingested, and time of ingestion (see later discussion). A detailed history should be obtained once patient is stabilized. In many cases, history is inaccurate, and ingested substance may not be known. A focused exam also assesses pupillary size, pupillary response to light, and neuropsychiatric status.

B. How severe is patient's condition? Evaluation of severity of poisoning is based on knowledge of ingested substance, maximum possible intake, and clinical condition. Once this information is gathered, poisoning case can be categorized as immediately life threatening, potentially toxic, or nontoxic. If an unknown substance has been ingested, integration of data from history, vital signs, and physical exam into various toxic syndromes (toxidromes)

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