Emergency Toxicology- Optimizing the Chain of Collaboration and Care
主講人：Bruno Mégarbane, MD, PhD(Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris-Diderot University)
簡介：Poisonings represent one of the first causes of admission to the emergency department. Due to the significant morbidities and mortality resulting from poisonings, patient transfer to the ICU may become mandatory. Poisoning should be considered as severe and require ICU admission for: i- onset of life-threatening symptoms including loss in consciousness, respiratory, and circulatory failure; ii- close monitoring in relation to marked drug exposure; iii- enhanced individual vulnerability. Toxicity could result either from the direct effects of the drug or from non-specific complications. Absence of severe symptoms on admission does not necessarily mean that the poisoning is not severe. The risk assessment should take into account the dose, the formulation, the co-ingestions, the delay in management since exposure, patient vulnerability and potential delayed toxicity. The poison control centers contribute to inform and guide the specific management of drug exposures. For decision at the bedside, readily available prognosticators are mandatory. Prognosticators including clinical, biological, ECG, and analytical parameters are drug-specific. During the last thirty years, they have been determined for antidepressants, acetaminophen, aspirin, chloroquine, colchicine, paraquat, corrosives organophosphates and recently for cardiotoxicants. In contrast, general (such as SAPSII and SOFA) and specific poisoning scores (such as Poisoning Severity Score) are interesting for retrospective stratification but of limited usefulness for decision at the bedside. This lecture will present the history of collaboration between the partners involved in the management of poisonings in France including the poison control centre, the pre-hospital medical services, the emergency department, the toxicological ICU and the toxicology laboratory.