Overdose (Psych) Flashcards
What are the general approaches to assessing a patient who has taken an overdose?
Collateral hx A-E -GCS -pupil size/reaction to light -evidence of IVDU
What investigations are appropriate in a pt who has taken an overdose?
Bloods - FBC, U&Es, LFT, INR, ABG
Glucose/paracetamol/salicylate levels
What immediate management options are available for a pt who has taken an overdose?
Gastric lavage (w/i 60mins OD) Activated charcoal -single dose 50g, in water -repeated doses help blood elimination
What antidotes are readily available for overdoses?
Paracetamol = N-acetyl cysteine
Opiates = Naloxone
Benzodiazepines = Flumazenil
B-blockers = Atropine/Glucagon + dextrose
TCAs = NaHCO3
IV 20% lipid emulsion = LOCAL ANAESTHETIC
What are the features of alcohol intoxication?
Confusion Slurred speech Loss of co-ordination Vomiting Irregular/slow breathing Hypothermia Stupor LoC
What are the potential complications of alcohol intoxication?
Resp failure
Coma
Death
Hypoglycaemia
At what blood alcohol concentration do complications commonly occur?
> 400mg/dl
Why is hypoglycaemia common in alcohol intoxication?
Alcohol inhibits gluconeogenesis
-more common in children/malnourished adults
How is hypoglycaemia in alcohol intoxication managed?
IV glucose
-not responsive to glucagon
At what blood alcohol concentration should haemodialysis be considered?
> 500mg/dl
What are the presenting features of a TCA overdose?
Sinus tachycardia
Dilated pupils
Urinary retention
Drowsiness/coma
What investigations are appropriate in a TCA overdose?
ABG (metabolic acidosis)
ECG (widened QRS)
How should a TCA overdose be managed?
Supportive therapy
If SVT/VT: sodium bicarbonate
What are the presenting features of a benzodiazepine overdose?
Drowsiness
Ataxia
Dysarthria
Coma
How should a benzodiazepine overdose be managed?
Flumazenil
- 200 ug over 15 secs
- 100ug at 1 min intervals
- may induce fits
What are the presenting features of an opiate overdose?
Resp depression
Pinpoint pupils
Coma
How should an opiate overdose be managed?
400 ug Naloxone
- if no response @ 1min give 800 ug
- if no response @ 2mins give 800ug
- if response repeat dose every 2mins until breathing is adequate
What are the presenting features of a cocaine overdose?
Agitation Tachycardia HTN Hyperthermia Sweating Hallucinations
What are the appropriate investigations in a cocaine overdose?
ABG (metabolic acidosis)
How should a cocaine overdose be managed?
IV diazepam (hallucinations/convulsions) External cooling
What are the presenting feature of a salicylate overdose?
Vomiting Dehydration Hyperventilation Tinnitus Sweating
What investigations are appropriate in a salicylate overdose?
ABG (resp alkalosis --> met acidosis) Salicylate level (2hrs)
How should a salicylate overdose be managed?
Get salicylate level (2hrs)
- if >500mg/L alkalise urine w/ NaHCO3 & KCl (monitor ECG for hypo-K)
- if <700mg/L consider dialysis
What are the high risk factors for suicide in patients presenting w/ self harm/overdose?
Increasing age Male sex Living alone Alcohol/drug abuse Severe pain Severe affective disorder Recent adverse life events Active suicidal intent
What features of an overdose suggest active suicidal intent?
Perceived lethal mechanism
Final acts undertaken
Made attempts not to be discovered
What are the key points when taking a history from a patient who has taken an overdose?
Clear precipitant? Pre-meditated/impulsive? Suicide note? Attempts not to be discovered? What would they do if went home now? Social support? Psych sx? Mental state?
