Poisoning should be suspected in all cases of sudden, severe, and unexpected illness. You should investigate such situations by ascertaining, as quickly and thoroughly as possible, the answers to the following questions:

What are the signs and symptoms of the illness?
What was happening before the illness occurred? (Remember, there may have been a chronic exposure over time with the signs and symptoms just becoming apparent.)

What substances were in use? Could more than one substance have been involved?

Is there a container of the suspected substance? If so, how much was there initially, and how much is there now? (If possible, bring the container to the treatment facility. The label will often identify the contents and the recommended precautions and treatment. The label may also list a contact number for emergency advice. Remember, though, that other people- including you-may become contaminated through contact with the container. Handle it carefully.)

What was the duration of exposure? When did it happen?

What is the location of the bite or injury (if applicable)?
Has this happened before?

Are there other people involved?
Does the patient have a significant past medical history?

Is the patient's condition improving/ deteriorating?

The presence of a toxic syndrome or toxidrome can help establish that a poison has been involved by suggesting the class of poison(s) to which the patient may have been exposed. Table 5-1 provides a list of commonly encountered toxidromes, their sources and symptoms.

The "non-syndrome syndrome" is of special importance. The only method to recognize the potential for a delayed onset poisoning to occur is to suspect the possibility from the history or presentation of a person. In some cases, the individual's affect or behavior may provide a clue. In other cases, the examiner must rely on clinical experience or even a hunch.

GENERAL TREATMENT Once poisoning has been established, the general rule is to quickly remove as much of the toxic substance from the victim as possible. The method of removal of the poison varies depending upon how the poison was introduced:

Ingested poisons: There is a choice between emetics and gastric lavage, followed by adsorbents and cathartics.
Inhaled poisons: Oxygen ventilation is the method of choice.

Absorbed poisons: Removal of the poison is primarily attained by cleansing the skin.
Injected poisons: Antidotal medications are recommended.