TABLE 102.1 SUBSTANCES MOST OFTEN REPORTED IN HUMAN EXPOSURES Substance Percentage of total exposures Analgesics (including opioids) Cleaning substances Cosmetics/personal care products Sedatives/hypnotics/antipsychotics Antidepressants Antihistamines Cardiovascular drugs Foreign bodies/toys Pesticides Alcohols 11.1 7.4 6.8 5.7 4.3 4.2 3.5 3.3 2.8 From Gummin DD, Mowry JB, Spyker DA, et al 2017 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 35th Annual Report Clin Toxicol 2018;56(12):1213–1415 Adapted by permission of Taylor & Francis Ltd, www.tandfonline.com CLINICAL CONSIDERATIONS Following the analogy between unintentional poisoning and traumatic injury, a similar model may be used in formulating a management approach The poisoned patient often represents an acute-onset emergency with a broad spectrum of multiorgan system pathophysiology akin to the multiple trauma patient In essence, poisoning might be viewed as a multiple chemical trauma The concept of a brief window of opportunity to make critical diagnostic and management decisions is likewise analogous One may conceptualize a management approach that attempts to prioritize critical assessment and, at times, simultaneous management interventions ( Table 102.4 ) The initial phase (or primary survey) addresses the traditional airway, breathing, and circulation (ABCs) of airway securement and cardiorespiratory support, with a slight additional emphasis on emergent toxicologic considerations The more specific evaluation and detoxification phase (or secondary survey) is aimed at simultaneously initiating generic treatment while assessing the actual extent of intoxication (in cases of known or presumed exposures) and/or identifying the actual toxicants involved (in unknown but highly suspected intoxications)