Adult Medical Emergency Handbook - Scottish Intensive Care Society

Chapter 10
TOXICOLOGY
National Poisons Information Service (NPIS)
NPIS (Edinburgh) is one of the UK Units commissioned by the Health
Protection Agency that contribute to the TOXBASE® website. This
provides guidance on the management of poisoning by any one of
a large number of different drugs, chemicals and plants. TOXBASE®
is a standard reference for advice on the features and treatment of
poisoning cases, and is updated on a daily basis. It can be accessed
from the Combined Assessment Area (Base 6) and A&E departments
at the Royal Infirmary, ARAU at the WGH, the A&E department of St.
John’s Hospital, and the critical care areas on all three sites. Additional
information related to unusual or severe poisoning can also be obtained
by telephone. Website: http://toxbase.u5e.com
NPIS : 0844 8920111
24-hour information service for more severe and complex
poisoning cases
ADMISSION POLICY
• Patients who present after drug overdose or deliberate selfharm
(e.g. self-cutting) normally require admission to hospital. In
some cases this may be for psychiatric assessment alone, rather
than ongoing medical care. The preferred site for admission in
Edinburgh is CAA Base 6, Royal Infirmary (0131-242-1443).
• Patients who are unconscious or at high risk of airway or
haemodynamic compromise should normally be admitted to a
critical care area (e.g. HDU, ICU).
• Patients expressing suicidal thoughts but who have not actually
harmed themselves or taken a drug overdose do not usually need
admission to a medical unit, and should be discussed with the oncall
duty Psychiatrist.
• At SJH patients are managed in A&E.
IMMEDIATE MANAGEMENT
• Maintain airway using nasopharyngeal or oropharyngeal airway if
conscious level is reduced
• Endotracheal intubation is required if unresponsive and loss of
protective airway reflexes. Make ICU referral early
• Give oxygen if drowsy aiming to maintain SpO 2 > 92%
adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
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