Narcotic overdose 2

Question 1

Explain the vital signs for a narcotic overdose? What should be done immediately as emergency management?

Answer 1

Hypotension, bradycardic, low respiratory rate; ABCD Because hemodynamically unstable

Question 2

When is Entracheal intubation indicated?

Answer 2

Patients who cannot protect her airway.
Oxygen saturation does not improve with O2 nasal/facemask
PaO2<55
PaCO>50 on ABG

Question 3

What does A stand for?

Answer 3

Airway suction, post oximetry, oxygen, continuous monitoring, Endotracheal intubation if necessary

Question 4

What does B stand for?

Answer 4

Blood ABGs

Question 5

What does the C stand for?

Answer 5

Place a Foley, obtain a fingerstick glucose, continuous cardiac monitoring, IV access

Question 6

What does the D stand for?

Answer 6

Administer Thiamine, dextrose 50%, the naloxone all our IV bolus one time does

Question 7

What physical exam should be done for narcotic overdose patient?

Answer 7

Respiratory to assess breathing pattern, General HEENT, neck, heart, CVS, skin, chest/lungs, abdomen, extremities, neurological examination

Question 8

What are the initial orders for narcotic overdose?

Answer 8

Suction airway, pulse ox, oxygen inhalation or intubation, IV access, fingerstick glucose, ABGs, Thiamine, dextrose 50%, Naloxone, normal Saline .9%

Question 9

What a positive findings for a narcotic overdose⁉️

Answer 9

Pinpoint pupils, very drowsy

Question 10

What a classic symptoms for narcotic overdose?

Answer 10

Hypotension, bradycardia, pinpoint pupils, and lower respiratory rate

Question 11

What are the diagnostic investigations for narcotic overdose?

Answer 11

EKG 12 lead, CBC with differential, BMP, CXR, LFT’s, urine toxicology screen, USA, blood alcohol, BHCG serum

Question 12

Where should the patient be transferred and what should be done?

Answer 12

Patient moved to ICU, Urine Output, NPO, BMP and bed rest

Question 13

What is the initial treatment for this patient?

Answer 13

NG-tube, gastric lavage. Activated charcoal. Naloxone IV continuous

Question 14

This 28-year-old has an attempted suicide attempt which should be done before discharge?

Answer 14

Psychiatry consult, suicide precautions, suicide contract, patient counseling, start on antidepressants if needed

Question 15

Explain hypotension and patient with narcotic overdose?

Answer 15

Mild Peripheral dilation may result in orthostatic hypotension however persistent or severe hypotension should raise suspicion for co-ingestants

Question 16

What lab results are important in moderate to severe toxicity patients? What are the baseline studies?

Answer 16

CBC with differential, BMP, ABG, LFTs, creatinine kinase level

Question 17

When are positive urine drug screens observe?

Answer 17

36 to 48 hours post exposure

Question 18

Why should a 12 lead EKG be obtained in all patients with intentional overdose?

Answer 18

Possibility of Cardiotoxic co-ingestants

Question 19

Why is a Chest X-ray done?

Answer 19

To check for pulmonary edema or aspiration especially in a patient who has an unprotected airway

Question 20

Naloxone should be given to what type of patients?

Answer 20

CNS or respiratory depression

Question 21

When is continuous IV infusion of the Naloxone be problematic?

Answer 21

Very safe in patients who are not opioid dependence however opioid dependent, this practice is dangerous and May precipitate withdrawal symptoms

Question 22

When should activated charcoal be administered? Why is it so effective?

Answer 22

I’ll patient with opiate intoxication following ingestion, delayed gastric emptying produced by intoxication makes it effective and even patients who present late.

Question 23

When Orogastric lavage be given to these patients?

Answer 23

If ingestion occurred within one hour

Question 24

How long should a patient be observed in the hospital if significant respiratory depression or reoccurring sedation occurs?

Answer 24

At least 12 to 24 hours, most physicians admit patients if they require a second dose of Naloxone