Inadequate assessment of the airway and ventilation in acute poisoning, a need for improved education?

Aims and objectives: To analyse the initial management of acute poisoning patients, and whether respiratory morbidity was related to inadequate assessment of airway and ventilation. Methods: A retrospective analysis of the assessment and resuscitation of a group of acute poisoning patients, as documented in the clinical records. Subjects and setting: Forty one patients admitted to either Intensive Care or Coronary Care Units in a UK teaching hospital with a diagnosis of acute poisoning, between 12 January 1997 and 21 January 1998. Standards: Advanced Life Support Guidelines were used to compare initial assessment. Criteria for intubation and ventilation described by Gentleman was used as the standard for intubation. Results: Thirty seven patients had documented Glasgow Coma Scales at the time of admission, 27 were managed appropriately; one exhibited signs of aspiration. Ten patients were judged to be managed inappropriately; six exhibited clinical signs of aspiration. Four patients had unidentified Glasgow Coma Scales. Conclusions: Increased emphasis on 'Airway and Breathing' remains necessary in medical education. Regional recommendations for the management of acute poisoning require 'intubation guidelines'. Appropriate ward settings for monitoring such patients may pre-empt the onset of major respiratory problems. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.