Narcotic overdose 2 Flashcards
Explain the vital signs for a narcotic overdose? What should be done immediately as emergency management?
Hypotension, bradycardic, low respiratory rate; ABCD Because hemodynamically unstable
When is Entracheal intubation indicated?
Patients who cannot protect her airway.
Oxygen saturation does not improve with O2 nasal/facemask
PaO2<55
PaCO>50 on ABG
What does A stand for?
Airway suction, post oximetry, oxygen, continuous monitoring, Endotracheal intubation if necessary
What does B stand for?
Blood ABGs
What does the C stand for?
Place a Foley, obtain a fingerstick glucose, continuous cardiac monitoring, IV access
What does the D stand for?
Administer Thiamine, dextrose 50%, the naloxone all our IV bolus one time does
What physical exam should be done for narcotic overdose patient?
Respiratory to assess breathing pattern, General HEENT, neck, heart, CVS, skin, chest/lungs, abdomen, extremities, neurological examination
What are the initial orders for narcotic overdose?
Suction airway, pulse ox, oxygen inhalation or intubation, IV access, fingerstick glucose, ABGs, Thiamine, dextrose 50%, Naloxone, normal Saline .9%
What a positive findings for a narcotic overdose⁉️
Pinpoint pupils, very drowsy
What a classic symptoms for narcotic overdose?
Hypotension, bradycardia, pinpoint pupils, and lower respiratory rate
What are the diagnostic investigations for narcotic overdose?
EKG 12 lead, CBC with differential, BMP, CXR, LFT’s, urine toxicology screen, USA, blood alcohol, BHCG serum
Where should the patient be transferred and what should be done?
Patient moved to ICU, Urine Output, NPO, BMP and bed rest
What is the initial treatment for this patient?
NG-tube, gastric lavage. Activated charcoal. Naloxone IV continuous
This 28-year-old has an attempted suicide attempt which should be done before discharge?
Psychiatry consult, suicide precautions, suicide contract, patient counseling, start on antidepressants if needed
Explain hypotension and patient with narcotic overdose?
Mild Peripheral dilation may result in orthostatic hypotension however persistent or severe hypotension should raise suspicion for co-ingestants
What lab results are important in moderate to severe toxicity patients? What are the baseline studies?
CBC with differential, BMP, ABG, LFTs, creatinine kinase level
When are positive urine drug screens observe?
36 to 48 hours post exposure
Why should a 12 lead EKG be obtained in all patients with intentional overdose?
Possibility of Cardiotoxic co-ingestants
Why is a Chest X-ray done?
To check for pulmonary edema or aspiration especially in a patient who has an unprotected airway
Naloxone should be given to what type of patients?
CNS or respiratory depression
When is continuous IV infusion of the Naloxone be problematic?
Very safe in patients who are not opioid dependence however opioid dependent, this practice is dangerous and May precipitate withdrawal symptoms
When should activated charcoal be administered? Why is it so effective?
I’ll patient with opiate intoxication following ingestion, delayed gastric emptying produced by intoxication makes it effective and even patients who present late.
When Orogastric lavage be given to these patients?
If ingestion occurred within one hour
How long should a patient be observed in the hospital if significant respiratory depression or reoccurring sedation occurs?
At least 12 to 24 hours, most physicians admit patients if they require a second dose of Naloxone
