Overdose (Psych)

Question 1

What are the general approaches to assessing a patient who has taken an overdose?

Answer 1

Collateral hx
A-E
   -GCS
   -pupil size/reaction to light
   -evidence of IVDU

Question 2

What investigations are appropriate in a pt who has taken an overdose?

Answer 2

Bloods - FBC, U&Es, LFT, INR, ABG

Glucose/paracetamol/salicylate levels

Question 3

What immediate management options are available for a pt who has taken an overdose?

Answer 3

Gastric lavage (w/i 60mins OD)
Activated charcoal 
   -single dose 50g, in water
   -repeated doses help blood elimination

Question 4

What antidotes are readily available for overdoses?

Answer 4

Paracetamol = N-acetyl cysteine
Opiates = Naloxone
Benzodiazepines = Flumazenil
B-blockers = Atropine/Glucagon + dextrose
TCAs = NaHCO3
IV 20% lipid emulsion = LOCAL ANAESTHETIC

Question 5

What are the features of alcohol intoxication?

Answer 5

Confusion
Slurred speech
Loss of co-ordination
Vomiting
Irregular/slow breathing
Hypothermia 
Stupor
LoC

Question 6

What are the potential complications of alcohol intoxication?

Answer 6

Resp failure
Coma
Death
Hypoglycaemia

Question 7

At what blood alcohol concentration do complications commonly occur?

Answer 7

> 400mg/dl

Question 8

Why is hypoglycaemia common in alcohol intoxication?

Answer 8

Alcohol inhibits gluconeogenesis

-more common in children/malnourished adults

Question 9

How is hypoglycaemia in alcohol intoxication managed?

Answer 9

IV glucose

-not responsive to glucagon

Question 10

At what blood alcohol concentration should haemodialysis be considered?

Answer 10

> 500mg/dl

Question 11

What are the presenting features of a TCA overdose?

Answer 11

Sinus tachycardia
Dilated pupils
Urinary retention
Drowsiness/coma

Question 12

What investigations are appropriate in a TCA overdose?

Answer 12

ABG (metabolic acidosis)

ECG (widened QRS)

Question 13

How should a TCA overdose be managed?

Answer 13

Supportive therapy

If SVT/VT: sodium bicarbonate

Question 14

What are the presenting features of a benzodiazepine overdose?

Answer 14

Drowsiness
Ataxia
Dysarthria
Coma

Question 15

How should a benzodiazepine overdose be managed?

Answer 15

Flumazenil

• 200 ug over 15 secs
• 100ug at 1 min intervals
• may induce fits

Question 16

What are the presenting features of an opiate overdose?

Answer 16

Resp depression
Pinpoint pupils
Coma

Question 17

How should an opiate overdose be managed?

Answer 17

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

Question 18

What are the presenting features of a cocaine overdose?

Answer 18

Agitation
Tachycardia
HTN
Hyperthermia
Sweating
Hallucinations

Question 19

What are the appropriate investigations in a cocaine overdose?

Answer 19

ABG (metabolic acidosis)

Question 20

How should a cocaine overdose be managed?

Answer 20

IV diazepam (hallucinations/convulsions)
External cooling

Question 21

What are the presenting feature of a salicylate overdose?

Answer 21

Vomiting
Dehydration
Hyperventilation
Tinnitus
Sweating

Question 22

What investigations are appropriate in a salicylate overdose?

Answer 22

ABG (resp alkalosis --> met acidosis)
Salicylate level (2hrs)

Question 23

How should a salicylate overdose be managed?

Answer 23

Get salicylate level (2hrs)

• if >500mg/L alkalise urine w/ NaHCO3 & KCl (monitor ECG for hypo-K)
• if <700mg/L consider dialysis

Question 24

What are the high risk factors for suicide in patients presenting w/ self harm/overdose?

Answer 24

Increasing age
Male sex
Living alone
Alcohol/drug abuse
Severe pain 
Severe affective disorder
Recent adverse life events
Active suicidal intent

Question 25

What features of an overdose suggest active suicidal intent?

Answer 25

Perceived lethal mechanism
Final acts undertaken
Made attempts not to be discovered

Question 26

What are the key points when taking a history from a patient who has taken an overdose?

Answer 26

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?