initial management of poisoning and overdose

ABCD to stabilize patient

• A = airway, suction, jaw-thrust

• B = breathing rate and depth

• C = circulation: skin, pulses and BP

• D = dextrose, naloxone, oxygen

dextrose use for

• acute alcohol intoxication

• sulfonylurea overdose

• insulin overdose

• high blood potassium

• insulin induced hypoglycemia in pediatric patients

how does naloxone work

• opioid antagonist

• binds to opioid receptors and can reverse and block the effects of opioids

3 steps for clinical evaluation/ treatment

• history

• physical examination

• treatment

clinical evaluation: history

• is patient a child or adult

• when

• where

• why

• what

clinical evaluation: physical exam

• vitals signs

• pupils

• skin

• LOC

• odors

polydrug use

mixing prescription drug use

single best specimen for toxicology screen

urine

test only useful for quantitative levels

serum

what do routine drug screens show

• amphetamines

• barbiturates

• benzodiazepines

• cannabinoids

• cocaine metabolites

• opiates

• propoxyphene

• PCP

• ethanol

secure ABC - airway

• check gag/cough reflex

• patient position

• airway cleared and suctioned

• endotracheal intubation

secure ABC - breathing

• arterial blood gases

• mechanically assist ventilation

• supplemental oxygen

• hypoxia

• bronchospasm

• pneumonia/ pneumonitis

secure ABC - circulation

• pulse and blood pressure

• CPR or ACLS protocol treatment

• EKG

• volume replacement

reasons for altered mental status

• hypoglycemia

• fever/hypothermia

• neuroleptic malignant syndrome

• serotonin syndrome

• seizures

• agitation, delirium, psychosis

activated charcoal

• absorbs toxin

• becoming proactive standard of practice

whole bowel irrigation

substances with delayed absorption or concretions