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HCPAR6012 Exam Revision > Overdose > Flashcards

Overdose Flashcards

1
Q

What evidence do you need to gather/questions to ask with a suspected OD?

A
  • confirm clinical evidence of substance use/exposure
  • identify substances involved collect packaging if possible
  • identify route taken e.g. ingested/IV/inhaled
  • determine the time substance was taken
  • determine the amount of substance taken
  • establish what the substance was taken with (e.g. water/alcohol and volume)
  • Determine if any intervention prior to AV arrival (e.g. vomiting/naloxone)
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2
Q

What are some short term effects for drug use

A
  • changes in appetite
  • consciousness
  • HR
  • BP
  • mood
  • AMI
  • CVA
  • psychosis
  • OD
  • death
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3
Q

What are some long term effects of drug use?

A
  • heart or lung disease
  • Ca
  • mental illness
  • HIV/AIDS
  • Hepatitis
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4
Q

What are some examples of opioids?

A
  • heroin
  • morphine
  • codeine
  • ordine
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5
Q

What are some examples of sedatives?

A
  • GHB
  • alcohol
  • benzo’s
  • volatile agents
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6
Q

What are some examples of TCA’s?

A
  • Amitriptyline
  • Norttriptyline
  • Dothiepin
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7
Q

What are some examples of psychostimulants?

A
  • Cocaine
  • Amphetamine (ice, speed)
  • ecstasy
  • PCP
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8
Q

What are some signs of a narcotic overdose? (eg. heroin)

A
  • ACS
  • pin point pupils
  • resp depression
  • track marks
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9
Q

When do you transport a narcotic OD?

A
  • after 10 mins if nil response to narcan
  • Must be a GCS 15 to leave at home with a responsible person
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10
Q

What are some examples under the “other opioid” arm of the OD CPG?

A
  • endone, morphine, codiene, fentanyl patches, methadone,
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11
Q

What is the treatment for “other opioid” overdose

A
  • assist airway and ventilations
  • naloxone 100mcg IV
  • ## repeat 100mcg IV every 2/60 (max 2mg) until patient adequately self ventilating
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12
Q

What is the presentation of naloxone?

A
  • 400mcg in 1ml
  • if administering IV dilute with 3mls NaCl
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13
Q

Recite the OD Opioid CPG

A
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14
Q

What are the contraindications for naloxone?

A

nil significance in above indication

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15
Q

What are some symptoms of withdrawal?

A
  • diaphoresis
  • goose flesh
  • tremor
  • N+V
  • Agitation
  • dilated pupils
  • excessive tearing
  • convulsions
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16
Q

if the patient has had a cardiac arrest can you give naloxone?

A

NO. because MICA cant RSI - unable to give fent/midaz sedation

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17
Q

can you treat and refer a heroin OD?

A

Yes they must:
- GCS 15 + RR >10
- require only one dose of naloxone
- only have taken heroin
- no other causes (hypoglycaemia, infection, trauma)
- not have had any seizure activity
- not be pregnant
- not a risk to self/others

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18
Q

What are some symptoms of mild to moderate TCA OD?

A
  • drowsiness, confusion
  • tachycardia
  • slurred speech
  • hyperreflexia
  • ataxia
  • mild HTN
  • dry mucous membranes
  • resp depression
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19
Q

What are some symptoms of severe TCA OD? (within 6 hrs of ingestion)

A
  • Coma
  • resp depression/hypoventilation
  • conduction delays
  • PVC’s
  • SVT
  • VT
  • hypotension
  • seizures
  • ECG changes
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20
Q

What cardiac effects does TCA OD have?

A
  • HTN
  • tachycardia
  • orthostasis
  • hypotension
  • arrythmias (VT, VF)
  • ECG changes (block the fast sodium channels = wide QRS, block the K+ channels = prolonged QT)
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21
Q

How do you measure a prolonged QT interval manually?

A

> 1/2 R-R interval

22
Q

Recite the TCA OD CPG

A
23
Q

What does AEIOUTIPS stand for?

A
  • alcohol/drug intoxication
  • Epilepsy (post ictal)
  • Insulin or metabolic cause hypo/hyperglycaemia, renal/liver failure
  • Overdose/oxygen (hypoxia)
  • Underdose (alcohol/drug withdrawal)
  • Toxins
  • Infection/Sepsis
  • Pain/psychiatric condition
  • Stroke/TIA
23
Q

What does AEIOUTIPS stand for?

A
  • alcohol/drug intoxication
  • Epilepsy (post ictal)
  • Insulin or metabolic cause hypo/hyperglycaemia, renal/liver failure
  • Overdose/oxygen (hypoxia)
  • Underdose (alcohol/drug withdrawal)
  • Toxins
  • Infection/Sepsis
  • Pain/psychiatric condition
  • Stroke/TIA
24
Q

When does the OD patient require urgen transport?

A
  • temp >38
  • ACS
  • severe HA
  • HTsive
  • resp difficulties
  • seizure
  • chest pain
25
Q

What is considered mild agitation?

A
  • co-operative, not aggressive
  • anxious, pacing, restless (cant sit still) excessive talking
  • Able to safely take PO meds
26
Q

What is considered moderate agitation?

A
  • loud outbursts
  • frequent non purposeful movements
  • not aggressive or violenct
  • risk expected to be controlled with midaz or analgesia only
27
Q

What is some symptoms of severe agitation?

A
  • Uncooperative
  • combative
  • violent
  • immediate danger to self and others
  • fighting against overwhelming force (being help down)
  • lacks capacity
28
Q

How do you manage agitation in the TBI patient?

A

ANALGESIA not sedation

29
Q

What ages do you have to consult the recieving hospital for any sedation?

A

up to the age of 16

30
Q

Explain the agitation assessment tool

A
31
Q

Recite the agitated patient CPG

A
32
Q

What is acute serotonin syndrome?

A
  • it occurs when you combine 2 or more medications, illicit drugs or nutritional supplements (ending up with excessive serotonin in the CNS)
  • Can occur in minutes to hours of taking a new medication or even increasing the dose
33
Q

What are symptoms of serotonin syndrome?

A

Cognitive
- HA, agitation, hypomania, confusion, hallucinations, coma, seizure, disorientation, irritability

Autonomic
- shivering, sweating, hyperthermia, vasoconstriction, tachycardia, HTN, nausea, diarrhoea

Somatic
- myoclonus (muscle twitching), hyperreflexia, tremor

34
Q

What are some legal drugs that can cause serotonin syndrome?

A
  • SSRI’s
  • SNRI’s
  • TCA
  • MAOI’s
  • Migraine meds
  • tramadol
  • pethidine
  • fentanyl
  • buprenorphine
  • endone
  • st john’s wort
  • ginseng
  • nutmeg
  • robitussin
35
Q

what are some illegal drugs that can cause serotonin syndrome?

A
  • LSD
  • MDMA
  • Methamphetamine
  • cocaine
36
Q

Recite the psychostimulant OD CPG

A
37
Q

Recite the psychostimulant OD CPG

A
38
Q

What is a dangeous organophosphate banned in australia?

A

Paraquat

39
Q

What PPE must you wear for organophosphate OD?

A
  • normal PPE + tyvec suit for both paramedics + patient (undress)
40
Q

What is the key word to look for on organophosphates?

A

anticholinesterase

41
Q

What are some symptoms of organophosphate poisoning

A
  • salivation
  • bronchospasm
  • sweating
  • nausea
  • bradycardia
42
Q

What does SLUDGE stand for? (s/s of organophosphate poisioning)

A
  • Salivation
  • Lacrimation
  • Urination
  • Defecation
  • GI upset
  • Emesis
43
Q

Recite the organophosphate poisoning CPG

A
44
Q

what are the indications for naloxone

A
  • ACS and resp depression secondary to admin of opioid related drugs
45
Q

what are the indications for midazolam?

A
  • status epilepticus
  • sedation in agitated patient
  • sedation in psychostimulant OD
46
Q

What are the contras for midazolam?

A
  • known hypersensitivity to benzo’s
47
Q

what are some side effects of midazolam?

A
  • CNS depression
  • resp depression
  • loss of airway control
  • hypotension
48
Q

what are the indications for ketamine?

A
  • intubation
  • analgesia
  • sedation (agitation or patient moving in CPR)
49
Q

What are the contraindications for ketamine?

A
  • suspected NTBI with severe HTN >180

HCPAR6012 Exam Revision (11 decks)

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