Principles of Emergency Treatment for Swallowed Poisons

berately taken an overdose, and these form the vast majority of poisonings that we see, often needs rapid assessment and may require instant resuscitative management; almost certainly the conscious case will require efficient removal from the body of any unabsorbed toxic material. The demeanour of patients may range from highly hysterical and tearful to grossly depressed and uncommunicative; and they are frequently accompanied by family, friends or colleagues from whom further information may be desirable and to whom reassurance may be necessary. The appropriate emergency treatment cannot, however, be considered as a definitive clinical procedure: according to the nature of the poison, equally urgent measures may be needed to minimize the effects of the substance already absorbed; and a small but significant proportion, probably about 5% of all poisoned patients, will require further, and sometimes complicated, techniques for active removal of the toxic chemical from their bodies. Such techniques include peritoneal and hemodialysis and require the expertise of the appropriate hospital units. As a sombre background to this symposium must be borne in mind the enormous cost not only of emergency management but of the subsequent hospitalization of 100 000 persons a year in the United Kingdom. Add to this the cost ofmanaging those 5 % who require further, sometimes longterm treatment and follow up, and of the psychiatric treatment of those who have deliberately taken a poisonous substance, and it becomes apparent that the topic is one with very considerable significance to society as a whole. A few other questions perhaps remain to be answered. Do we admit too many poisoned patients and would it be better to establish more poison treatment centres that would act as specialized units for the treatment, both medical and psychiatric, of all cases of ingested poisoning? Or is our present management reasonably acceptable, and has the trend passed its peak?