FM14.{2-3,16} | Toxicology Practical Skills: Clinical Exam, Sampling & Specimen Inference — Summary & Reflection

KEY TAKEAWAYS

The toxicology practical skills (FM14.2, FM14.3, FM14.16) are performance skills requiring deliberate practice:

FM14.2 — Clinical examination in suspected poisoning:
Systematic nine-step approach: vital signs → consciousness/CNS → pupils → skin → smell → mouth → GI → urine → neuromuscular. Identify the toxidrome. Document objective findings. Write MLR opinion distinguishing observation from inference.

FM14.3 — Specimen collection and chain of custody:
Specimen priority: gastric aspirate > blood (fluoride-oxalate) > urine > vomitus. Label at bedside; seal; 4-fold witness countersignature; document continuously. PM specimens: femoral blood + vitreous + gastric contents + liver + kidney + hair. No preservative in gastric contents.

FM14.16 — Specimen identification (16 poisons):
Visual signatures: abrus = red-black rosary bead; nux vomica = flat disc with silky hairs; dhatura = dark kidney-shaped seeds in spiny capsule; castor = large mottled seed with caruncle; aconite root = tuberous dark-brown; copper sulphate = blue crystals; oleander = narrow lanceolate leaves with milky sap; calotropis = milky latex-exuding plant.

MLR inference format: Identity → Toxin → Effect → Forensic significance → Analytical confirmation.

REFLECT

You are a newly-posted duty medical officer at a district hospital. A police officer arrives with a young woman who is apparently unconscious. The officer hands you a form for a 'drunkenness examination' but you notice the woman's pupils are 2 mm, she has mild fasciculations, and there is a faint organophosphate smell to her clothing. The officer insists she is drunk and just needs a BAC test. How do you navigate the clinical priority (this patient may have OP poisoning, not alcohol intoxication) against the statutory request (the officer has a legal form requiring a specific type of examination)? What do you document and what immediate actions do you take?