Patients who present in extremis after an ingestion will not survive regardless of management and should be treated palliatively. Large >50mL ingestions of<unk>  are universally fatal. Aggressive resuscitation is futile.
Airway: consider early aggressive intubation for any respiratory distress or large (>100mL) ingestions
Breathing: CXR, O2
Avoid aggressive oxygen therapy unless severe hypoxia due to increased free radical production
Circulation: may develop early shock and require aggressive inotropic support
Avoid aggressive oxygen therapy unless severe hypoxia due to increased free radical production<unk>  is absorbed transdermally. Unprotected first responders and healthcare workers are at risk
Remove clothing and wash patient's skin if spillage or obvious skin involvement present
Consider activated charcoal or Fuller's Earth if within 1-2 hrs of ingestion
Consider NG tube for administration of activated charcoal
Must weigh risks as NGT placement can exacerbate caustic injury
Must weigh risks as NGT placement can exacerbate caustic injury
IV fluids: patients often 2-3L fluid down
Pain control
Some centers administer glucocorticoids (typically dexamethasone 6mg-10mg IV q6h)
Consider NAC, vitamin C, other free radical scavengers in consultation with toxicologist or poison control
No role for extracorporeal elimination (hemodialysis/Hemoperfusion, CRRT)
Paraquat toxicity
Caustic Ingestion
Hydrazine toxicity
Toxic Alcohols
Tin toxicity
Foreign Body Ingestion
Kratom toxicity
Burns