An adult patient is brought to the emergency department with altered consciousness following suspected ingestion of an unknown substance. Demonstrate your initial emergency assessment, identify important clinical findings, obtain a focused toxicological history, and outline the urgent investigations and stabilization priorities.

Immediate priority: Ensure personal safety, call for emergency assistance and assess airway, breathing and circulation using ABCDE.

Consciousness: Assess GCS or AVPU, pupils, capillary blood glucose and evidence of seizures or respiratory depression.

Poison identification: Ask about the substance, estimated dose, time, route, co-ingestants and possible intentional exposure; recognize characteristic toxidromes.

Investigations: Bedside glucose, ECG, blood gas, electrolytes, renal function and targeted toxicology, including paracetamol level when indicated.

Stabilization: Support airway and ventilation, establish IV access, treat hypoglycemia or seizures promptly, give an appropriate antidote when indicated and arrange monitored emergency care.

1. Recognize the emergency: Ensure scene and staff safety, use appropriate PPE, call for senior/emergency support and request resuscitation equipment.
2. Airway and breathing: Check airway patency, protective reflexes, respiratory rate, oxygen saturation and chest movement. Give oxygen if hypoxemic and assist ventilation or secure the airway when indicated.
3. Circulation: Assess pulse, BP, capillary refill and perfusion. Attach ECG monitoring, obtain IV access and treat shock with appropriate fluid resuscitation and reassessment.
4. Disability and exposure: Assess AVPU/GCS, pupils, bedside glucose, temperature, seizures, skin findings and possible needle marks. Correct hypoglycemia promptly.
5. Focused toxicological history: Obtain information from the patient, relatives or ambulance staff: substance, dose, timing, route, co-ingestants, medications and possible deliberate self-harm. Check packaging if available.
6. Recognize toxidromes: Identify opioid toxicity (pinpoint pupils, respiratory depression), cholinergic toxicity (salivation, sweating, bronchorrhea), anticholinergic toxicity (dry skin, mydriasis, tachycardia) or sympathomimetic toxicity (agitation, sweating, tachycardia).
7. Investigate and stabilize: Obtain ECG, blood glucose, blood gas, electrolytes, renal function and indicated toxicology tests. Treat immediately reversible threats; consider naloxone for suspected opioid-induced respiratory depression and other specific antidotes when indicated.
8. Reassess and escalate: Monitor vital signs, consciousness, oxygenation and ECG continuously as clinically indicated. Arrange appropriate observation, toxicology advice or critical-care referral for persistent instability.

⚠️ Critical examination point: Never delay airway support or ventilation while identifying the poison. Do not induce vomiting or perform routine gastric lavage; decontamination is considered only in selected cases after appropriate assessment and airway protection.

ABCDE Assessment — Resuscitation Council UK

Practical demonstration of systematic emergency patient assessment, recognition of deterioration and immediate resuscitation priorities. Apply the same sequence when approaching an acutely poisoned patient.

▶ Watch ABCDE Emergency Assessment