EMERGENCY TOXICOLOGY

It is 3 a.m. A young adult is brought in drowsy after an overdose. Naloxone works, the vital signs settle, and discharge looks reasonable. But the tablets were a combination product, no acetaminophen level was drawn, and the window for a fully effective antidote is quietly closing. Missed co-ingestions, wrong antidotes, and premature discharge are among the most common and most preventable errors in emergency care.



Emergency Toxicology is a 25-chapter bedside reference for emergency physicians, residents, nurses, physician assistants, and paramedics. It shows how to recognize the poisoned patient quickly, stabilize first, choose the right antidote at the right time, and decide safely who can go home.



What this book gives you:

• A five-question bedside framework, used in every chapter, for thinking like a toxicologist under time pressure


• Toxidrome recognition: sympathomimetic, serotonergic, anticholinergic, cholinergic, opioid, sedative-hypnotic, and mixed patterns


• Resuscitation of the critically poisoned patient: airway, shock, dysrhythmias, seizures, agitation, and temperature extremes


• Laboratory and ECG interpretation, including drug screens, anion and osmolar gaps, and targeted drug levels


• Decontamination, enhanced elimination, and a full working approach to antidotes, including when not to give one


• Overdose chapters on acetaminophen, salicylates, opioids, alcohol and sedatives, stimulants, antidepressants, antipsychotics, lithium, and cardiovascular drugs


• Toxic alcohols, anticoagulants, diabetic medications, cannabinoids, and novel psychoactive substances


• Household products, caustics, button batteries, pesticides, heavy metals and chelation, carbon monoxide, cyanide, and smoke inhalation


• Envenomations from snakes, spiders, scorpions, and marine animals, plus plants, mushrooms, and foodborne toxins


• Chemical, biological, and radiological incidents, special populations, and safe disposition


• Case challenges at the end of chapters showing the errors that recur most in practice and the correct approach


• Chapter summaries, reference tables, illustrated diagrams, toxidrome comparison charts, antidote quick-reference tables, checklists, and a glossary

• Miss acetaminophen or salicylate in a patient who reports only one substance


• Give an antidote that worsens the poisoning, or delay one that would have worked


• Be falsely reassured by a normal level, a normal ECG, or a well-looking patient


• Discharge a patient before a delayed or extended-release toxicity appears

• Read the Introduction first to learn the five-question framework


• Study a chapter, then work through its case challenges before reading the discussion


• Keep the appendices close at hand for quick lookup during a shift