Stimulant OD - Toxicology

Question 1

If a patient experiencing a stimulant overdose is tachycardic and/or hypertensive +/- chest pain what’s the med of choice to chill this fucker out?

Answer 1

Midazolam 0.05 - 0.1 mg/kg q 5 min prn
Note: if experiencing CP treat concurrently with ACS directive

Question 2

If a patient overdosing on stimulants has a SBP of >180mmHg what 2 meds should you consider patching for?

Answer 2

Nitroglycerin 10-200 (max!) microgram/min, titrate in 5 microgram/min increments q 5 min, titrate to effect

Phentolamine 1-5mg q 5 min prn

Question 3

If a patient overdosing on stimulants has a QRS > 0.12s or a dysrrhythmia you can use midazolam or patch for this…

Answer 3

Sodium bicarbonate 1-2 mEq/kg bolus prn
Consider ongoing bicarb infusion

Question 4

In a stimulant overdose certain meds should be avoided. What should you NOT use for stimulant-related tachycardia and hypertension? What should you NOT use for v-fib/pulseless v-tach due to stimulants?

Answer 4

Beta blockers are contraindicated (reason unk)
Avoid epinephrine if v-fib/v-tach, first line is sodium bicarb 100mEq prn (cocaine is a sodium channel blocker)