Synopsis
Treat poisoning and injury without delay, obtain a needs-led psychosocial assessment at the earliest safe opportunity, understand intent and function without judgement, and coordinate physical, toxicological, safeguarding and mental-health follow-through.
- Begin with ABCDE, observations, glucose, consciousness, ECG and focused exposure or injury history; call toxicology, trauma or surgical support according to physiology and substance.
- Record substance, preparation, dose, time, pattern, co-ingestants, alcohol, body weight, symptoms, treatment and available packaging without delaying resuscitation.
- For a single acute paracetamol ingestion, interpret a timed concentration from at least four hours against the current UK treatment pathway; earlier levels cannot exclude toxicity.
- Use current toxicology guidance for acetylcysteine, decontamination, serial concentrations and discharge because staggered, uncertain and modified-release ingestions need different logic.
- Assess wounds for bleeding, tendon, nerve and vascular injury, foreign body, infection, tetanus and safeguarding; manage pain and repair to the same standard as other injuries.
- Offer psychosocial assessment at the earliest safe opportunity and do not delay automatically until all medical treatment is complete if the person can participate.
- Explore what happened before, during and after, expected lethality, suicidal intent, the function of self-harm, rescue, regret, current thoughts, means and social context.
- Identify abuse, exploitation, dependants, accommodation and access to medicines; use consented collateral information and necessary safeguarding sharing.
- Before discharge, complete physical and psychosocial plans, means safety, medicines review, accessible contacts and named aftercare, with active response to missed contact.
Key red flags
Unknown or staggered paracetamol ingestion, presentation more than eight hours after a potentially toxic dose or unreliable timing requires immediate toxicology-guided action rather than waiting for a routine concentration.
Modified-release products, multiple substances, sustained-release toxicity, body-packing, tricyclic ingestion, opioids or toxic alcohols can deteriorate after an initially reassuring appearance.
Ligature or strangulation can cause delayed airway, vascular and neurological complications despite minimal external injury and needs an appropriate emergency pathway.
A medically minor wound can accompany high suicidal intent, extensive planning or abuse; injury severity must not determine psychosocial urgency.
Do not use risk scores to predict suicide or decide discharge, and do not withhold physical analgesia or treatment because harm was self-inflicted.
Investigation priorities
Identify airway, respiratory, circulatory, neurological, glucose and temperature threats requiring emergency treatment.
Understand intent, function, mental state, needs, context, strengths, safeguarding and preferred treatment.
Management branches
Recent self-poisoning is known or clinically suspected.
- Use ABCDE, glucose, cardiac monitoring and focused substance, formulation, dose, time and co-ingestant history.
- Contact toxicology support and obtain timed concentrations, ECG and laboratory tests that change antidote, observation or enhanced-elimination decisions.
- Treat without delay when the pathway indicates, trend delayed effects and transfer the physical plan alongside psychosocial care.