Overdose and Toxicology

Question 1

Bloods to order in a OD assessment (7)

Answer 1

FBC
U+E
LFT
INR
ABG
Glucose 
Paracetamol/Salicylates level

Question 2

3 things to monitor for someone who has OD?

Answer 2

Plasma levels
Obs
Hepatic and renal function

Question 3

Paracetamol OD Tx

Answer 3

Activated charcoal

N-acetylcysteine (>1hr)

Question 4

How to determine if you can give N-acetylcysteine to Tx paracetamol OD?

Answer 4

Must be over the treatment line

Question 5

SE N-acetylcystine?

Answer 5

Anaphylaxis

Question 6

PS TCA OD? (4)

Answer 6

Incr HR
Dilated pupils
Urinary retention
Drowsy/coma over time

Question 7

What will an ABG of someone whos taken a TCA OD show?

Answer 7

Metabolic acidosis

Question 8

What will an ECG of someone who’s OD.d on TCAs show

Answer 8

Widened QRS complex

Question 9

Mx TCA OD?

Answer 9

Supportive therapy 
IV NaHCO3 (if tachyC)

Question 10

PS Benzo’s OD(4)

Answer 10

Drowsiness
Ataxia
DYsarthria
Coma

Question 11

Mx benzo OD

Answer 11

Flumenzanil 200microg 15s

Then futher 100microg at 1 min intervals

Question 12

Opiate OD PS (3)

Answer 12

Resp depression
Pinpoint pupils
Coma

Question 13

Mx Opiate OD

Answer 13

400 ug Naloxone
No response 1min? 800ug
No response 2 min? +800ug
Response? repeat dose 1 min intervals until adequate breathing

Question 14

What is an important factor to remember about Naloxone?

Answer 14

has a very short t 1/2 so when given IV you have to keep redosing

Question 15

PS cocaine OD? (4)

Answer 15

Agitation
Incr HR/BP/Temp
Sweating
Hallucinations

Question 16

ABG Cocaine OD?

Answer 16

Met acidosis

Question 17

Mx Cocaine O.D

Answer 17

IV diazepam

Active external cooling

Question 18

PS Salicylate OD? (4)

Answer 18

Vomiting/dehydration
Incr RR
Tinnitus
Sweating

Question 19

Mx salicylate OD

Answer 19

Monitor level at 1hrs
If >500mg/l - NaHCO3 + KCl
If >700mg/l - Dialysis

Question 20

Sx Alcohol intoxication >400mg/dl

Answer 20

Resp failure
Coma
Death

Question 21

Mx alcohol intoxication

Answer 21

IV glucose

Question 22

High risk of suicide features after OD (7)

Answer 22

Incr age
Male
Solo living 
Prev alcohol/Dx abuse 
Severe pain states, affective disorder 
Recent adverse life events 
Active suicidal intent