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Paediatric Emergency Department Poison Protocol

Poisoning (whether accidental or intentional ) is a common emergency department problem in children and adolescents. While many poisonings are trivial and can be observed in the emergency department without admission, death can still occur from some poisons in seemingly insignificant doses, particularly in infants.

All poisonings can be treated along general principles outlined in this protocol. In addition the poison index on the computer next to the paediatric emergency desk has a large database covering the vast majority of poisonings you are likely to encounter.

Flowchart showing the Poisoning Protocol

Flowchart showing the Poisoning Protocol

IMPORTANT POINTS

  1. Ensure adequate airway protection: Many patients are more at risk of death from aspiration due to depressed conscious state than the primary effects of the poison itself. If the patient has a poor gag reflex or Glasgow Coma Score less than 10 they should be intubated to protect their airway. This should be done using a rapid induction technique by experienced personel (eg. anaesthetic registrar/consultant).

  2. If possible obtain the actual container that contains the poison.
    This is important even if you think you know what the poison is as drug names are often confused by lay people. eg. "Amoxil":"Maxalon".

  3. ACTIVATED CHARCOAL is the method of choice for removal of poisons from the gastrointestinal tract. Emesis & gastric lavage not routinely used in the emergency department.
    NOTE: Activated charcoal is INEFFECTIVE against poisoning with iron, lithium, cyanide, pesticides, acids and alkalis.
    Consult poison index before giving charcoal.

  4. Poisoning should always be considered in the differential of any patient with depressed conscious state of uncertain cause.

  5. Adolescents and older children will often take drugs/poisons as suicide attempts or for experimentation. It is common for these poisonings to be multiple eg. Tricyclics, benzodiazapines & alcohol.

Note: all suicide attempts should be admitted for assessment however trivial the actual poisoning might be.