Curious what toxicologists are typically being consulted and rounding on. Seems like the vast majority of toxic ingestion are relatively straight forward cases easily handled by competent emergency and critical care physicians. Is the vast majority of a toxicology practice providing over-site to those cases or are you primarily seeing the more interesting stuff??
Yes & yes. d=)
I would argue though that, while many ingestions may be "straight forward," there are nuances to every case - some important, others not - that may be important.
For example, I've had to argue at the bedside with a very competent ED physician (who trained me, no less) about the proper course of action for a CCB OD. Furthermore, our colleagues still perform lavage, intubate solely to give AC, and may not appreciate the pharmacokinetic ramifications of APAP-diphenhydramine (delayed absorption/peak) or other xenobiotics.
As such, while I think that EM-trained physicians are more than qualified to deal with the simple stuff, the problem is that sometimes they're not the best at recognizing the nuances. Plus, the handoff to the ICU or inpatient service is frought with danger.
I want my colleagues to call me for everything - bread&butter or "sexy." Many times they're already doing the right thing, but I can confirm it. I can do legwork while they run the room, and I can act as a bridge between the ED & inpatient setting.
Think of it like calling cards for a NSTEMI; we know what to do, and we do it well... and cards frequently won't disagree. But as they're getting in from the get-go, if things go south they're in a better position to deal.
Hope this helps; I think I got the gist of your question, but I'm sleep deprived & in a lecture at NACCT. d=)
-d
