Version May 2024
| CNS depression, including significant lethargy, coma |
| Agitation requiring chemical or physical restraint |
| Respiratory depression (PCO2 >45 mmHg), hypoxia or respiratory failure (ARDS), and/or endotracheal intubation |
| Hypotension (SBP ≤80 mmHg) |
| Seizures that are prolonged or recurring |
| Second or third degree AV block on ECG |
| Nonsinus cardiac rhythm on ECG |
| Significant acid-base disturbances (eg, metabolic acidosis with pH ≤7.2) |
| Significant metabolic abnormalities requiring close monitoring or aggressive correction (eg, symptomatic hypoglycemia following sulfonylurea or insulin overdose) |
| Extremes of temperature (eg, hyperthermia with T >104°F) |
| Poisoning with a "toxic time bomb" |
| Ingested drug packets, sustained-release preparations |
| Quantitative level of drug which predicts unfavorable outcome |
| Need for invasive hemodynamic monitoring (eg, pulmonary artery catheter or arterial line) or cardiac pacing |
| Need for whole bowel irrigation to enhance GI elimination of poison |
| Need for emergency hemodialysis, hemoperfusion, hemofiltration |
| Need for emergency antidote which requires close monitoring (eg, crotalid antivenin, Digibind, physostigmine, naloxone drip) |
| Ischemic chest pain from toxin (eg, cocaine, carbon monoxide) |
| TCA or other drug exposure with QRS >120 msec or QTc >500 msec |
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