Kent R. Olson, MD (in part)
The first priority in the poisoned patient is to assure a patent airway and adequate breathing. Respiratory arrest and pulmonary aspiration are two common complications of depressed mental status that can lead to serious morbidity or death.
The decision to intubate should be based primarily on:
If it is obvious that the airway reflexes are impaired (deep coma, no gag or cough reflex) then the patient will need to be intubated endotracheally. This is usually performed via the orotracheal route, although if the patient is breathing spontaneously the nasotracheal route can be used. Rapid sequence intubation (RSI) is a standardized procedure that includes pre-oxygenation, administration of sedative-hypnotic drugs (e.g., midazolam, etomidate) and muscle relaxants (e.g., succinylcholine, rocuronium) in conjunction with orotracheal intubation. After intubation, a rapid assessment is needed to assure that the endotracheal tube is in the trachea and not the esophagus. This is done by listening over the lungs and stomach, watching for chest rise with ventilation, and use of a carbon dioxide detector on the end of the ET tube. Looking for condensation in the ET tube is also helpful.