Overdose and poisoning/ toxidrome emergencies

Question 1

what are the first 5 differential impressions?

Answer 1

1. opiate ingestion( opium, codeine, codones, meperidine, methadone)
2. sedative-hypnotic ingestion(benzodiaepines, ghb, antihistamines, alcohol, barbiturates)
3. cholinergic exposure( organophosphates, nerve agents, mushrooms)
4. anticholinergic ingestions( antihistamines, tricyclics, phenothiazines, antidiarrheals)
5. sympathomimetic ingestion( cocaine, ampehtamines, methamphetamines, ecstasy , mdpv)

Question 2

what are the second 5 differential impressions?

Answer 2

1. hallucinogen(pcp,cannabinoids, ecstacy, flakka, bath salts)
2. antipsychotic extrapyramidal syndromes
3. toxic inhalation( smoke , cyanide)
4. alkali
5. poly pharmacologic

Question 3

Basic life support actions #1

Answer 3

universal care guideline

Question 4

Basic life support actions # 2

Answer 4

patient safety guideline

Question 5

Basic life support actions # 3

Answer 5

patient restraint guidline

• Patients must be adaquatly controlled prior to loading and transporting

Question 6

Basic life support actions # 4

Answer 6

refer to exposure emergencies hypo and hyperthermia guidline as necessary or indicated

Question 7

Basic life support actions # 5

Answer 7

Dermal decontamination as necessary or indicated

Question 8

Basic life support actions # 6

Answer 8

contact poison control for consultation as necessary or indicated. 1800 222 1222

Question 9

Basic life support actions # 7

Answer 9

for opiod narcotic give naloxone 4-.5 mg IN, may repeat every 3-5 minutes prn to improve intrinsic airway patency, ventilation , oxygenation.

Goal is to restore spontaneous respiration not mentation

• Pedi dose is .01 mg kg IN, repeat every 3-5 min to restore spontaneous respiration

Question 10

Naloxone is for ..

Answer 10

known or evidence of opioid intoxication with apnea or shallow respirations

Question 11

Regarding opiod overdose , key to safe patient encounter is?

Answer 11

basic progressive airway venilation oxygenation managment while preparing naloxone.

Question 12

Titrate doese of naloxone to …

Answer 12

gain venilation and oxygenation improvment, etco2 <45 and spo2 is > 93

Question 13

when is naloxone not appropriate ?

Answer 13

when advanced airway is in place and in cardiac arrest

Question 14

Advanced life support actions / considerations #1

Answer 14

fluids at 10 ml /kg as necessary or indicated

Question 15

for the majority of toidromes , …….

Answer 15

the solution to polution is dilution. fluid may be repeated as necessary or inidicated. pedi is 20 ml / kg

Question 16

Advanced life support actions / considerations # 2

Answer 16

consider cpap 5-15 peep

Question 17

Advanced life support actions / considerations # 3

Answer 17

Exposure emergencies, consider hypo and hyperthermia guideline as necessary / indicated

Question 18

Advanced life support actions / considerations # 4

Answer 18

For opiod narcodic give naloxone .04-.05 mg iv io im in. May repeat every 3-5 min to improve intrinsic airway patency, ventilation, oxygenation, primary goal is restore spontaneous repserations not mentation.

• Pedi .01 mg / kg iv io im in

Question 19

Advanced life support actions / considerations # 6

Answer 19

for sedatives and hypnotic provide supportive therapy

Question 20

Advanced life support actions / considerations # 7

Answer 20

for hallucinogens refer to the exited delirium syndrome guideline

Question 21

Advanced life support actions / considerations # 8

Answer 21

1. for cholinergic: give atropine 1-2 mg iv io every 5 min till resolved
2. Pedi <12 y/o : atropine .05mg/kg iv io every 5 min until resolved
3. Pedi> 12 y/o : Atropine 1 mg iv / io every 5 min until resolved

Question 22

Advanced life support actions / considerations # 9

Answer 22

anticholinergic: sodium bicarbonate 1 meq/kg iv/io
* For tricyclic overdose with heart rate > 120 bpm and qrs> 100ms

Question 23

Advanced life support actions / considerations # 10

Answer 23

Sympathomimetic: give midazolam 2 mg iv io im in , may repeat every 5 min until heart rate and blood pressure normalize

• For hyperadrenic states with heart rate > 120 bpm

Question 24

Advanced life support actions / considerations # 11

Answer 24

Toxic inhalation: burn / electricution/ smoke inhalation guideline

Question 25

Advanced life support actions / considerations #12

Answer 25

Dystonic reactions/extrapyramidal syndrome: give diphenhydramine 50 mg iv im