Paracetamol poisoning is a common presentation to the ED. Management of these patients can seem complex, but there are some clear guidelines to help us. It is important to remember that patients who present late after a significant paracetamol ingestion must be treated as a medical emergency as timely treatment is essential. There are departmental guidelines available in the department and on display on the wall in resus. This link takes you to the RCEM website which details of the current recommendations regarding treatment with NAC and links to some useful protocols from Leicester which you might find helpful to review.
Don't forget that TOXBASE is an excellent resource for management of all poisoning.
This is a video recorded at SMACC Gold by an Australian toxicology consultant. He gives a great approach to the poisoned patient, including how to integrate toxicology management into ALS. It is an entertaining talk with some interesting stories and anecdotes. The #EM3 group have produced an infographic summarising the talk. Click on the image below to view the complete infographic.