Initial life support phase Airway: Maintain patency, assess protective reflexes Breathing: Adequate tidal volume? ABG or ETCO2 ? Circulation: Secure IV access, assess perfusion Disability: Level of consciousness (AVPU or GCS) Pupillary size, reactivity Drugs: Dextrose (rapid bedside test) Oxygen Naloxone (Other ALS medications) Decontamination: Ocular—copious saline lavage Skin—copious water, then soap and water GI—consider options Evaluation and detoxification phase History —Brief, focused Known toxicant: Estimate amount Elapsed time Early symptoms Home treatment Significant underlying conditions Suspected but unknown toxicant—consider poisoning if: Patient: Acute onset of illness Pica-prone age History of pica, ingestions Current household “stress” Multiorgan system dysfunction Significantly altered mental status Puzzling clinical picture Family: Medications at home Recent illness (under treatment) Social: Grandparents visiting Holiday parties, other events, new baby Physical examination Vital signs