What is the management approach for suspected SBEDC (unknown substance) toxicity?

Management of Suspected SBEDC Toxicity

For suspected SBEDC (unknown substance) toxicity, immediately contact a poison control center (1-800-222-1222) while simultaneously providing supportive care and administering appropriate antidotes based on presenting symptoms.

Initial Assessment and Management

• Ensure proper personal protective equipment (PPE) when caring for patients with suspected toxic exposure to prevent contamination of healthcare providers 1
• Remove all contaminated clothing and perform immediate dermal decontamination with copious irrigation using soap and water for external exposure 1
• Activate emergency medical services (EMS) immediately if the patient exhibits any signs or symptoms of a life-threatening condition (e.g., sleepiness, seizures, difficulty breathing, vomiting) 2
• Do not delay transportation to obtain activated charcoal 3

Supportive Care

• Establish and maintain airway, breathing, and circulation as the first priority 1
• For respiratory depression or arrest, provide rescue breathing or bag-mask ventilation until spontaneous breathing returns 2
• For cardiac arrest, focus on high-quality CPR (compressions plus ventilation) as the priority over specific antidotes 2
• Consider early endotracheal intubation for life-threatening poisoning, especially with signs of respiratory compromise 1

Symptom-Based Antidote Administration

For respiratory depression:

• If opioid toxicity is suspected, administer naloxone 0.2-2 mg IV/IO/IM (adult) or 0.1 mg/kg (pediatric) and repeat as needed 2
• Titrate naloxone to reversal of respiratory depression and restoration of protective airway reflexes 2

For cardiovascular toxicity:

• If β-blocker or calcium channel blocker toxicity is suspected, consider:
  • Calcium (calcium chloride 2000 mg or calcium gluconate 6000 mg for adults) 2
  • Glucagon 2-10 mg (adult) or 0.05-0.15 mg/kg (pediatric) 2
  • High-dose insulin therapy 1 U/kg bolus followed by 1-10 U/kg/hr infusion 2

For seizures or agitation:

• Administer benzodiazepines for seizure control 1
• Avoid flumazenil if there are contraindications (e.g., history of seizures, chronic benzodiazepine use, or possible cyclic antidepressant overdose) 2

For metabolic acidosis or suspected cyanide toxicity:

• Administer hydroxocobalamin (preferred) or sodium nitrite plus sodium thiosulfate 2
• Provide 100% oxygen 2

Gastrointestinal Decontamination

• Do not administer anything by mouth for any poisoning ingestion unless advised by poison control center or emergency medical personnel 2
• Do not induce emesis 3
• Activated charcoal administration should only be carried out by health professionals if no contraindications are present and if advised by poison control center 2, 4

Advanced Interventions

• Consider venoarterial extracorporeal membrane oxygenation (VA-ECMO) early for patients with cardiogenic shock or dysrhythmias refractory to other treatments 2
• Hemodialysis may be considered for certain toxins based on poison center recommendations 2

Critical Pitfalls to Avoid

• Do not delay treatment while waiting for confirmatory testing when dealing with life-threatening toxicity 2
• Do not use neuromuscular blockers metabolized by cholinesterase (succinylcholine and mivacurium) if organophosphate poisoning is suspected 1
• Do not administer flumazenil to patients who are at increased risk for seizures or dysrhythmias 2
• Do not rely solely on history, as patients may not disclose all ingested substances 5

Follow-up Care

• Monitor patients for at least 48-72 hours after significant toxic exposures 1
• Consult with a medical toxicologist or regional poison center for specialized guidance throughout treatment 2