POISONING

Rationale
Prerequisites
Competencies

Rationale
Poisonings and ingestions are major preventable causes of childhood morbidity and mortality. Poisoning control centers across the U.S. receive more than millions calls a year regarding accidental and non-accidental ingestions and exposures to toxic materials.

Prerequisites

• Knowledge of the routes of absorption of toxins including the gastrointestinal tract, the skin, and lungs.
• An understanding that a relationship exists between the mechanism of injury, the child and the environment
• The concept of therapeutic index

Competencies

Knowledge

1. Describe the developmental vulnerability for poisoning and accidental ingestions in infants, toddlers, children, and adolescents. (CP)
2. List the ages at which prevalence of unintentional and intentional poisonings is highest and the passive and active interventions that decrease the incidence of childhood ingestions (e.g. locks or safety caps). (CP)
3. Describe the emotions of guilt and anxiety that may be present in the parent, caregiver or child at the time of ingestion. (CP)
4. Describe the environmental sources of lead, the clinical and social importance of lead poisoning, and screening tools to identify children at risk for lead poisoning. (CP)
5. Describe the acute signs and symptoms of accidental or intentional ingestion of acetaminophen (CP), iron (CP), alcohol (CP), narcotics (CP) PCP (M), tricyclic antidepressants (M), volatile hydrocarbons (M), and caustics (M).
6. Describe the immediate emergency management of children with toxic ingestions e.g. acetaminophen (CP), iron (CP), hydrocarbons (M), and strong alkali (M).
7. Describe the role of the Poison Control Center (1-800-222-1222) and other information resources in the management of the patient with an accidental or intentional ingestion. (CP)
8. Describe the agents and acute signs and symptoms of intentional chemical (e.g. cholinergic) or biologic agents. (M)

Skills:

1. Provide anticipatory guidance regarding home safety and appropriate techniques to prevent accidental ingestions (see also Prevention) (CP)
2. Elicit a complete history when evaluating an unintentional ingestion or exposure to a toxic substance (including the substance, the route of exposure, the quantity, timing, and general preventive measures in the household) (U)
3. Elicit a complete history surrounding the intentional ingestion of a toxic substance (including the substance, route of exposure, amount, timing, antecedent events, and stressors). (M)

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