| Risk assessment of Toxicology |
A careful risk assessment is the most important step in managing the poisoned patient after the initial resuscitation. A sensible approach that balances the risks of toxicity in the individual patient will make it much easier to institute decontamination, specific treatments and decide on the appropriate disposition. Early recognition of a low-risk patient will prevent unnecessary decontamination and expensive retrieval of patients in remote locations. Conversely, early recognition of severe toxicity will allow the institution of early decontamination and life-saving treatment, as well as early retrieval to appropriate critical care services and/or specialised toxicological units. In difficult cases, it is advisable to contact a clinical toxicologist or the Poisons Information Centre.
A risk assessment should be based on:
- toxin/drug:
- type of drug or chemical (intrinsic toxicity)
- dose (amount of drug/chemical ingested)
- route of exposure (ingestion, contact, inhalation, parenteral)
2. individual patient: age, sex, comorbidities
3. time since ingestion
4. clinical effects.
It is essential to get a good patient history as well as corroborating history (eg relatives, ambulance officer). Patients very rarely lie but may not recall events accurately.
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