When a doctor attends a case of poisoning, the duties are divided into duties towards the patient, towards the law, and towards the investigation.
The Ten Duties
- Save life of the patient (PRIMARY duty)
- Immediate treatment should be started.
- No medicolegal formalities should delay treatment.
- Maintain Airway, Breathing, Circulation.
- Diagnose the poisoning
- Obtain detailed history; identify suspected poison; look for characteristic signs and symptoms; assess severity.
- Provide emergency treatment
- Gastric lavage when indicated, activated charcoal, specific antidotes, symptomatic treatment, supportive care.
- Register as a Medicolegal Case (MLC)
- Every suspected poisoning case should be treated as a medicolegal case.
- Record: name, age, address, date and time of admission, history of poisoning, circumstances of poisoning.
- Inform the police (mandatory)
- If poisoning is suspected, accidental, suicidal, homicidal or unknown in nature, the doctor should inform the police.
- Preserve evidence
- Preserve suspected poison: poison container, medicine strips, vomitus, gastric lavage fluid, remaining tablets, food material.
- Preserve clothing if relevant.
- Collect and preserve samples for chemical analysis
- Stomach wash / gastric lavage — most important in living cases.
- Vomitus — preserve if available.
- Blood — for toxicological analysis.
- Urine — useful in many poisonings.
- Preservation: proper labeling, sealing, documentation.
- Maintain proper records
- History, clinical findings, treatment given, progress of patient. These records may later be produced in court.
- Issue medicolegal documents when required
- Injury certificate, medicolegal report, death certificate (where appropriate), postmortem requisition (if patient dies).
- If patient dies
- Inform police immediately.
- Do not issue an ordinary death certificate if medicolegal investigation is required.
- Send body for medicolegal autopsy.