Support of airway and breathing in poisoning
The most common airway and breathing problems due to poisoning are:
- hypoventilation due to respiratory depression
- airway obstruction due to central nervous system depression.
Respiratory depression is a common result of sedation—be vigilant for airway compromise in sedated patients.
Follow the principles of advanced life support for all patients with poisoning, prioritising airway assessment and, if required, intervention. If the airway is not adequately protected or the patient is at risk of aspiration, intubate and ventilate the patient according to advanced airway support protocols1. Patients with direct airway injuries due to caustic ingestions or button battery ingestions are at high risk of airway swelling and obstruction. Tracheal intubation in these patients can be difficult.
Perform regular and careful assessment of the airway and breathing to ensure:
- the airway is patent and protected from potential obstruction or aspiration
- ventilation is adequate
- oxygenation is adequate; however, oxygen therapy over hours can mask respiratory depression in patients with poisoning.
For cardiorespiratory arrest, follow advanced life support protocols2 and see also Management of cardiorespiratory arrest due to poisoning.
Poisoning rarely causes hypoxia in otherwise healthy individuals, but hypoxia can be seen in patients with aspiration pneumonitis due to poisoning, or as a direct result of the poison (eg carbon monoxide poisoning causing asphyxia).