First 30 seconds
- 1Time of ingestion (single vs staggered)
- 2IV access, bloods (paracetamol level + INR + LFT + U&E + glucose + VBG)
- 3Activated charcoal 50 g if <1 h and willing
- 4Plot 4-hour level on treatment nomogram
Hepatotoxicity from depletion of glutathione by NAPQI when paracetamol ingested >150 mg/kg (or >75 mg/kg + risk factor).
A
Airway
- • Patent? Talking? Stridor?
- • Suction, jaw-thrust, adjuncts, definitive airway if needed
B
Breathing
- • RR, SpO₂, auscultate, percuss
- • O₂ to target sats, NIV / intubate as required
C
Circulation
- • HR, BP, cap refill, JVP
- • 2× large-bore IV, bloods, monitor, ECG
D
Disability
- • AVPU/GCS, pupils, glucose, temp
E
Exposure
- • Full exposure, skin, rash, bleeding, lines, infection source
