Toxicological Chain of Survival (TCS): An integral approach to the intoxicated patient. Narrative review

Intoxications are a frequent cause for consultation and admission in emergency medical services. Treating these patients is a challenge both diagnostically and therapeutically, where some critical circumstances may determine the prognosis. A structured search was conducted in the PubMed/Medline database, for articles discussing how intoxications were handled in emergency medical services published between March 2005 and December 2023. A combination of the following keywords was used to perform the search: “intoxication”, “poisoning”, “management”, “emergency”, and “patient”. All reviews, clinical trials, observational studies, and case reports related to handling intoxicated patients were considered. Lastly, articles in the authors’ databases were included, as well as reference books and gray literature. 42 articles that met the selection criteria were chosen. Upon review of the literature, a Toxicological Chain of Survival (TCS) was devised, a basic diagnostic and therapeutic algorithm that can be useful for the first responder.