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
