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Medically toxicology is a broad, non-organ-system-based specialty. While the numbers of potential poisons and clinical scenarios are vast, the fundamental principles of toxicological assessment, stages of poisoning, and initial care can be mastered. Watch out for the “deadly dozen,” consider decontamination early, and become a master of strong supportive care. The immediate use of certain antidotes may be lifesaving; however, many should be administered in collaboration with a medical toxicologist. We highly recommend utilization of a toxicology specialist to aid in the safest and most efficient treatment of your emergency psychiatric patients.


American College of Toxicology. n.d. Introduction to medical toxicology. American College of Medical Toxicology.

Bentur, Y, Y Lurie, A Tamir, D C Keyes, and F Basis. 2011. Reliability of history of acetaminophen ingestion in intentional drug overdose patients. Human and Experimental Toxicology 30 (1): 44-50.

Centers for Disease Control and Prevention. 2016. Injury prevention and control: Opioid overdose. December.

Choi, H S, and Y H Choi. 2015. Accuracy of tablet counts estimated by members of the public and healthcare professionals. Clinical and Experimental Emergency Medicine 2 (3): 168-173.

Clemmesen, C, and E Nilsson. 1961. Therapeutic trends in the treatment of barbiturate poisoning the Scandinavian method. Clinical Pharmacology 2 (2): 220-229.

Dowling, J, G K Isbister, C M Kirkpatrick, D Naidoo, and A Graudins. 2008. Population pharmacokinetics of intravenous, intramuscular, and intranasal naloxone in human volunteers. Therapeutic Drug Monitoring 30 (4): 490-496.

Elsevier: Gold Standard. n.d. Tox ED: The clinician’s toxicology resource. Elsevier: Clinical Decision Support.

Ingels, M, D F Marks, and R Clark. 2003. A survey of medical toxicology training in psychiatry residency programs. Academic Psychiatry 27 (1): 50—53.

Kerr, D, A Kelly, P Dietze, D Jolley, and B Barger. 2009. Radomized controlled trial comparing the effectiveness and safety of intranasal and intramuscular naloxone for the treatment of suspected heroin overdose. Addiction 104: 2067—2074.

Kreshak, A A, G Wardi, and C A Tomaszewski. 2015. The accuracy of emergency department medication history as determined by mass spectrometry analysis of urine: A pilot study. Journal of Emergency Medicine 48 (3): 382—386.

Moll, J, W Kerns, C Tomaszewski, and R Rutherfoord. 1999. Incidence of aspiration pneumonia in intubated patients receiving activated charcoal. Journal of Emergency Medicine 17 (2): 279—283.

Monte, A A, K J Heard, Hoppe J A, V Vasiliou, and F J Gonzalez. 2015. The accuracy of self-reported drug ingestion histories in emergency department patients. Journal of Clinical Pharmacology 55 (1): 33—38.

Offerman, S R. 2012. Informal survey of Kaiser Permanente emergency physicians regarding the use of the regional toxicology service. Unpublished data.

Olshaker, J S, B Browne, D A Jerrard, H Prendergast, and T Stair. 1997. Medical clearance and screening of psychiatric patients in the emergency department. Academic Emergency Medicine 4: 124—128.

Truven Health Analytics. n.d. Micromedex toxicology management. Microdex Solutions. http://microme-

Wanger, K, L Brough, I Macmillan, J Goulding, L MacPhail, and J M Christenson. 1998. Intravenous vs subcutaneous naloxone for out-of-hospital management of presumed opioid overdose. Academic Emergency Medicine 5 (4): 293—299.

Wax, P M. 1997. Analeptic use in clinical toxicology: A historical appraisal. Journal of Toxicology. Clinical Toxicology 35 (2): 203—209.

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