A Trip to the Emergency Room
There are two normal ways to get to the emergency room - you can be transported (ambulance) or you can just walk right in.
If you walk in, you will first see a person who will take information on who you are and how you're going to pay for your visit. They will also do triage - they will evaluate your condition, take vital statistics (blood pressure, temperature, etc.), and decide if you need to be seen immediately or if you can wait with everybody else. That decision will be based on the severity of your condition and the importance of timely treatment. If you present with severe poisoning symptoms and indicate the possibility of mushroom ingestion as a cause you will probably be moved up the list and receive treatment a bit quicker.
If you ride in an ambulance, the triage phase will be done by the EMTs. They will radio ahead and notify the hospital of your condition and vitals. While you are in the emergency room somebody will come and get your personal information. Presumably you're already pretty sick or you wouldn't be riding in an ambulance.
Depending on things like how busy they are and how sick you seem to be, a physician will eventually show up to evaluate and treat you. Assuming that you've told them that you (may) have eaten an poisonous mushroom, they will hopefully ask if you have a specimen with you that they can see, or if you can tell them what kind it was. If you have a specimen, it will be given to somebody who will contact the local Poison Control Center. These Centers have lists of mycological consultants who they will call to get an identification on the mushroom.
Unfortunately, there are no antidotes for mushroom toxins except a very few. So treatment will mostly consist of removing any toxins from your stomach (if there are any still) and supportive care to alleviate any dangerous symptoms. Blood will be taken in many cases to look for symptoms like elevated liver enzymes (way bad - pray you never get this one). The main exception is the case of muscarine poisoning - atropine is an antidote for muscarine. If muscarine is diagnosed as the toxin you will be given atropine, and (if it really was muscarine) you will be well enough to walk out the door in a half hour (unless they give you too much atropine - I've heard that happens sometimes).
Removal of the toxins can be done in any of several ways. If the only symptoms are gastrointestinal distress, then you will probably be given a bucket or bedpan and they will mostly watch to make sure you don't become dehydrated. It will be a long evening, because they'll just let nature take its course and you could be puking and having diarrhea for a long time (some toxins can last for 36 hours of fun). This is often the course of treatment if the victim is already vomiting a lot.
If you aren't vomiting much and the toxins might still be in your stomach (less than 4 hours after ingestion) then they'll remove them. Frequently activated charcoal is given (in a delicious drink) first, to help adsorb toxins for removal. If you are fully conscious you are likely to be given ipecac.
If you are in a coma, convulsing, or cannot protect your airway; have not vomited enough for them to believe you've eliminate the toxins; and ingestion occurred less than 4 hours earlier; then you will receive gastric lavage (stomach pump). They will take a fairly large plastic tube (they don't know how well you chewed those mushrooms up - don't want the tube to get blocked with a big chunk of something) and put it up your nose. It will go around the back of the nose, down your throat, and down to your stomach. If you've never seen this, it's amazing how much tube they feed into somebody's nose - they just keep shoving it in. When it gets to your stomach, they may run a slurry of activated charcoal through the tube into your stomach. They use (the ones I've seen) a big syringe to pump the fluids through the tube. They will keep pumping liquid (tap water or saline solution) in and everything out until the stuff coming out is clear. They will pump liquid in in 200ml aliquots and pump it out up to a total of 10 liters (for an adult - children get less).
Once the toxins have been removed, treatment turns to supportive care. The primary symptoms they will watch for are fluid and electrolyte balance, pain, convulsions, anxiety or hallucinations, and nausea and vomiting.
If amatoxins or phallotoxins are suspected, then there will be a close watch kept on liver enzymes. If poisoning by these types of toxins is severe enough, the treatment may require a liver transplant.
Assuming everything turns out OK, you've still got the bills to pay. Depending on your insurance and specifics of the treatment your bills could range from an insurance copayment to several thousand dollars. If you require a liver transplant, expect the bill to get into the hundreds of thousands of dollars.
Disclaimer time - I am not a physician, nor do I work in or near an emergency care facility. Some of the above is taken from personal experience and some from Mushrooms - Poisons and Panaceas by Dr. Denis Benjamin. How you will be treated could vary significantly from the description above. New treatements are constantly being developed and old ones discarded.
If you suspect that you have eaten poison mushrooms, call 911 or your Poison Control Center. Delay can make things worse.
Of course, the best situation is to not be poisoned in the first place. Never eat a mushroom which has not been identified.
When trying a new species, save a few (uncooked and whole) in your refrigerator so that if you're wrong on the ID you will have specimens for an expert to ID (this will help in your treatment). Eat only a small amount the first time (not more than the size of a fingernail) - if you feel OK after 12 hours, go ahead and eat a bit more (if it's a Cortinarius you need to wait a week!).
Never overeat mushrooms. Even well-known edible species can cause problems in some people or if you eat too much.
Learn the deadly poisonous mushrooms. There aren't that many of them, and if you know them then you can be sure that you aren't eating one of them. I doesn't hurt to learn the more common poisonous mushrooms while you're at it.
Avoid mushrooms from potentially contaminated habitats. Golf courses and some parks spray some nasty pesticides on everything in the place. Mushrooms concentrate these chemicals and you can be poisoned by edible mushrooms in this way. Here in Colorado there are a lot of toxic mine tailings. Mushrooms should not be eaten which could have been contaminated from things like this - lead poisoning is nasty.
Be a sure as you can be of your identifications. If in doubt, throw it out - don't eat it!
Is all that stuff scary? It should be. But I've been collecting and eating wild mushrooms for over 25 years without ever being poisoned once. Caution has cost me a few nice meals over those years, but saved me any trips to the emergency room. I think it's worth it.
Happy mushrooming!
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Happy mushrooming!
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