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Therapeutic Approach to the Critically Poisoned Patient

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Critical Care Toxicology

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Abstract

Aggressive supportive care is the mainstay of treatment provided to patients in the intensive care unit (ICU). Basic aspects of care must be reevaluated or adjusted to account for unique aspects in the pathophysiology of the critically ill poisoned patient. This may include the use of gastrointestinal (GI) decontamination or the administration of antidotes. This chapter discusses the initial management and resuscitation of the critically ill poisoned patient. Subsequent chapters describe therapeutic decisions unique to particular drugs and xenobiotics and discuss specific antidotes in greater detail.

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Acknowledgment

Edward M. Bottei and Donna L. Seger contributed a prior version of this chapter in the previous edition of this text.

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Authors and Affiliations

  1. Emergency Medicine, Washington University, St Louis, MO, USA

    Evan S. Schwarz

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  1. Evan S. Schwarz
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Correspondence to Evan S. Schwarz .

Editor information

Editors and Affiliations

  1. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Jeffrey Brent

  2. Office of New Drugs Drug Evaluation and Research, FDA, Silver Spring, Maryland, USA

    Keith Burkhart

  3. Clinical Toxicology, St Thomas' Hospital, London, United Kingdom

    Paul Dargan

  4. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Benjamin Hatten

  5. Med & Toxicological Intensive Care Unit, Lariboisière Hospital Paris-Diderot University, Paris, France

    Bruno Megarbane

  6. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Robert Palmer

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology, 2nd Edition

  1. I

    Evidence obtained from at least one properly randomized controlled trial.

  2. II-1

    Evidence obtained from well-designed controlled trials without randomization.

  3. II-2

    Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.

  4. II-3

    Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence.

  5. III

    Opinions of respected authorities, based on clinical experience, descriptive studies, and case reports, or reports of expert committees.

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Schwarz, E.S. (2016). Therapeutic Approach to the Critically Poisoned Patient. In: Brent, J., Burkhart, K., Dargan, P., Hatten, B., Megarbane, B., Palmer, R. (eds) Critical Care Toxicology. Springer, Cham. https://doi.org/10.1007/978-3-319-20790-2_63-1

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  • DOI: https://doi.org/10.1007/978-3-319-20790-2_63-1

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  • Publisher Name: Springer, Cham

  • Online ISBN: 978-3-319-20790-2

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