Pitfalls
- Not taking a thorough history: It is vital to establish what agent might have been ingested, how much, when and what has happened subsequently. These details alone will determine your management in the majority of toxicology presentations to the Paediatric ED.
- Not being aware of those drugs on the one pill can kill list: Whilst the vast majority of ingestions in children are minor and require no specific intervention certain drugs if ingested by a baby or small child (<10kg) may prove fatal.
- Not seeking expert help: Children are not small adults and there can be significant differences between children and adults with regard to anatomy, physiology and developmental differences. If in doubt, call the National Poisons Information Service. Although you may feel comfortable managing a child with a specific ingestion, obtaining Toxbase information can assist other healthcare professionals involved in that childs care as well as contributing to epidemiological data with regard to paediatric poisonings.
- Being distracted by the use of antidotes: Good supportive care is the key to achieving good outcomes in the poisoned patient. Antidotes play a very limited role and should only supplement good basic care.
- Blind use of screening toxicology urine analysis: Assessment for signs and symptoms of a particular toxidrome generally proves more clinically useful than urinary toxicology screening tests. Results from these screens are not qualitative and thus it is not possible to determine if a positive test relates to a current toxic ingestion or previous exposure with detectable, but clinically insignificant, drug levels.
- Failing to identify potential safeguarding concerns: A significant proportion of children who present with ingestion of a toxin will return to the ED with a subsequent episode. This may be a symptom of a family network requiring extra support. On very rare occasions the child may have been deliberately poisoned. Be alert to these possibilities and where you have concerns follow local safeguarding policies and ensure clear documentation in the notes.