Overdose Quiz Flashcards
What are the 4 main groups of substances that people overdose on?
- Opioids
- Sedatives
- Tricyclics
- Psychostimulants
What questions should be asked when collecting a history from your overdose patient?
- Identify substances involved
- Route taken (IV, PO, Exposure, Skin)
- Time substance was taken
- What were they taken with (alcohol?)
- Any interventions prior to ambulance arrival? (vomiting, glass of milk, narcan?)
What are some short term consequences of drug taking?
- Changes in appetite
- Wakefulness
- AMI
- CVA
- Psychosis
- Death.. can occur even after a single dose
What evidence can be gathered to confirm a heroin overdose?
- Altered conscious state
- Pinpoint pupils
- Respiratory depression
- Track marks
What are the differential diagnoses with a heroin overdose?
- Obvious head injury
- Hypoglycaemia
- Polypharmacy OD
When can you leave a heroin overdose at home/scene?
- ONLY if a patient presents with an isolated heroin OD
- Have made a full recovery (GCS 15, chest clear on auscultation, sats >94% RA, BSL above 4.0
- Patient is considered low risk and can be supervised by a responsible adult for 4 hours
A palliative care patient has taken triple the amount of their Ordine mixture, and now presents with eyes opening to pain, verbally incomprehensible and withdrawing from painful stimuli. What is their GCS? How would you manage this patient?
- GCS 9
- Determine GOC/advanced care plan
- Assist and maintain their airway with positioning, consider airway adjuncts (OP, SGA, MICA for ETT)
- Assist ventilations as required (NRB, BVM)
- Complete a full a thorough VSS, secondary survey/head to toe, consider whether this was accidental or intentional
- Insert IV cannula, treat with Naloxone 100mcg IV, repeat 100mcg IV at 2/60 intervals (Max 2mg) or until patient is ventilating adequately.
- If unable to insert IVC - treat with naloxone 400mcg IM once only
- Transport
What is the presentation of naloxone and how would you administer 100mcg IV?
- 400mcg in 1ml
- Dilute 400mcg into 3mls normal saline in a 5ml syringe
- Final concentration = 100mcg/ml
- Therefore administer 1ml
What are the side effects of naloxone?
- sweating
- goose flesh
- tremor
- nausea and vomiting
- agitation
- dilation of pupils
- excess lacrimation (tearing)
- convulsions
- (adequate ventilations and ventilator status prior to naloxone administration can present (sometimes all) side effects
You administer 2mg of Naloxone to a suspected heroin overdose, there is no effect. What do you do next?
- Transport
- Consider further airway managment (LMA, MICA for ETT)
- Ventilate with BVM
- Consider IV access
- (time on scene V time to transport V time for MICA arrival)
What are tricyclics commonly used for?
- Depression
- Chronic pain
What is particularly concerning about a tricyclic overdose?
- It can be fatal due to rapid absorption from the GI tract (alkaline conditions of the small intensine)
- Toxicity can become evidence in the first hour of ingestion
What are some cardiac effects of a tricyclic overdose? What ECG changes would you expect to see?
- blockage of myocardial fast sodium (NA+) channels (leading to a widened QRS, tall R wave in aVR
- Inhibit potassium (K+) channels (QTC prolongation - this should be under 440ms in men and under 460ms in women)
- All can lead to tachycardia, VT, VF and death
What is the GCS and ambulance management of a patient who is eye opening to pain, incomprehensible sounds and withdraws to pain, who has a HR of 144, QTC 550 on 12 lead, BP 100/50, and who is lying next to 5 empty packets of dothapin?
- GCS 8
- Oxygen therapy 100% BVM, +/- OP airway, optimal airway position (neutral/sniffing), Assess/watch for vomitus
- VSS (perfusion, respiratory, GCS), cardiac monitoring, temp, BSL, IV access, request MICA, transport with notification
Why would a TCA OD patient have a RR of 32?
- the RR would be elevated as the patient is in suspected respiratory acidosis, and is now trying to blow off the CO2
How would you ventilate your TCA OD patient if they were hypoventilating?
- BVM
- Hyperventilate at a rate of 20-24
- Aim for ETCO2 20-25mmhg
Why would Sodium Bicarbonate be administered in a TCA OD patient?
- one of the effects of TCA is to block the Na+ channels
- therefore replacing sodium by increasing the levels of extracellular Na+ allows for better transport across the cell membrane and hopefully promoting cardiac stability
What is serotinin syndrome?
- Excessive serotonin in the CNS
You are dispatched to Festival Hall for an unconscious patient. You find a female with obvious vomit around her mouth and top. Nil eye opening, nil verbal, nil motor. She has a HR orf 146, BP 180/100, RR 8, BSL 4.5, T 40.5, left lower leg twitching. What do you suspect is wrong with your patient? How would you manage her?
- Suspected Acute Serotonin Syndrome
- Dangers
- Primary Survey - suction airway sections, 100% via BVM, insert OP and manage and maintain with triple airway manoevre or SGA and positioning
- VSS, cardiac montioring, IV access, request MICA
- Consult for IM Midaz (10mg if patient over 60kg, 5mg if patient under 60kg)
- IV cold fluids 20ml/kg,
- Extricate
- Transport with notification
How much cold fluids would you administer for a suspected serotinin syndrome? and what is your target temperature?
- 20mls/kg cold IV fluids
- titrate to perfusion status (max 40mls/kg)
- Aim for a target temp of less than 40 degrees within 20 mins of symptom onset
Your serotonin syndrome patient starts to have a TC seizure, what is your management?
Midazolam 10mg IM
You are loaded in the ambulance with your OD patient, and someone alerts you of someone acting strange in the hall. You get your partner to investigate while you stay with the patient. Your partner finds a male who is trying to swat purple flies around his head. He lets your partner take VSS, HR 120, BP 140/90, RR 20, BSL 5.4, Temp 39.8 what is the management?
- Request second crew for second patient code 1
- Frequently assess for dangers
- Primary survey, VSS, secondary survey/head to toe ax
- consider sedation for agitation (olanzepine) he is cooperative
- Transport with notification
- Your primary patient is still code 1 - decide if you can leave patient with someone to look after him until the next ambulance arrives
A third suspected serotonin syndrome patient has presented to security, what do you do?
- Escalate to TOO/TOO roles
- request another crew
- Sitrep to DM
You have cleared the RMH and are dispatched to a house, with an aggressive male inside. Multiple police are on scene. On arrival you find a male pacing around the kitchen, he has cut his wrist with a knife and is obviously bleeding - leaving droplets of blood on the floor. He is yelling, and salivating, and will not let you assess him. He weighs approx 80kg. What is your management?
- Dangers
- PPE
- History from police
- Attempt to de-escalate, if able bandage wrist
- Consider AEIOUTIPS
- Restraints on stretcher (prior to sedating)
- Ketamine 300mg IM, in a coordinated response with police (request MICA for further management)
- Transport with police and notification
- Enroute - VSS, cardiac monitoring, bandage haemorrhage, temp, bsl, supplemental O2, IV access
- Consider further sedating if required - olanzapine (if cooperating) or droperidol/midazolam IM/IV
