[EMed] Overdose

Question 1

what are the features of tricyclic antidepressant (TCA) overdose: anticholinergic?

Answer 1

• dry mouth
• blurred vision
• dilated pupils (mydriasis)
• hyperthermia

Question 2

what are the features of tricyclic antidepressant (TCA) overdose: cardiac?

Answer 2

• sinus tachycardia
• arrhythmias
• vasodilation

Question 3

what are the features of tricyclic antidepressant (TCA) overdose: CNS?

Answer 3

• reduced GCS
• seizures
• delirium

Question 4

what is the mx for TCA overdose: Airway?

Answer 4

airway protection

GCS <8 = intubate

Question 5

what is the mx for TCA overdose: Breathing?

Answer 5

high-flow O2

ABG analysis

Question 6

what is the mx for TCA overdose: Circulation?

Answer 6

treat hypotension with fluid bolus +/- vasopressors

ECG

sodium bicarbonate 8.4% for arrhythmias and low BP

glucagon / MgSO4 for refractory anaemia

Question 7

what does an ECG show for TCA overdose?

Answer 7

QRS prolongation >100ms

QTc prolongation >430ms

Question 8

what is the mx for TCA overdose: Disability?

Answer 8

benzodiazepines for seizure control or agitation

avoid phenytoin

Question 9

for TCA overdose, what do you do if pt is asx with no ECG or blood gas abnormalities >6 hours after ingestion?

Answer 9

discharge

Question 10

what are the features of paracetamol overdose?

Answer 10

• nausea/vomiting, features of metabolic acidosis if levels ++
• abdominal pain/RUQ pain → overt hepatic failure with coagulopathy, deranged LFTs, hypoglycaemia, jaundice, acute renal failure

Question 11

how do you manage paracetamol OD if ingestion <1 hour?

Answer 11

activated charcoal gastric lavage

Question 12

what would you send off bloods for in paracetamol OD?

Answer 12

• paracetamol levels
• U+Es
• LFTs
• VBGs
• coags

Question 13

how do you manage paracetamol OD if >8 hours from ingestion and >75mg/kg ingested?

Answer 13

start N-acetylcysteine (NAC)

Question 14

how do you manage paracetamol OD if <8 hours from ingestion?

Answer 14

wait for paracetamol levels and treat as per normogram

Question 15

when should a 4th bag of NAC be given?

Answer 15

if after full Rx: Cr above baseline, ALT 2x baseline or INR >1.3

Question 16

what do you do if there are severe derangements in ALT/INR?

Answer 16

discuss with regional hepatology centre

Question 17

what are features of opiate overdose?

Answer 17

• reduced conscious level
• reduced RR (<12 breaths/min)
• constricted pupils (miotic)

Question 18

what is the mx for opiate OD?

Answer 18

A: airway protection, manoeuvres/adjuncts if needed

B: O2, may require bag-valve mask ventilation if apneoic or very low RR

Question 19

what is the reversal agent for opiate OD?

Answer 19

naloxone

• initial dose 400mcg IV bolus
• bolus dosing can be uptitrated at 1-2 min intervals if no response
• aim: adequate ventilation

Question 20

if pt responds to rx for opiate OD, what will they likely need and why?

Answer 20

ongoing infusion as T1/2 of opioids is»_space; naloxone (especially if ingested)

Question 21

what is the antidote for: beta blocker?

Answer 21

glucagon

Question 22

what is the antidote for: benzodiazepines?

Answer 22

flumazenil

Question 23

what is the antidote for: cyanide?

Answer 23

dicobalt edetate / methylene blue

Question 24

what is the antidote for: digoxin?

Answer 24

DigiFab / Digibind

Question 25

what is the antidote for: iron?

Answer 25

desferrioxamine

Question 26

what is the antidote for: local anaesthetic?

Answer 26

intralipid 20%

Question 27

what is the antidote for: paracetamol?

Answer 27

NAC

Question 28

what is the antidote for: opiates?

Answer 28

naloxone

Question 29

what is the antidote for: warfarin?

Answer 29

vitamin K

Question 30

flushed, dry, tachycardia, dilated pupils. dx?

Answer 30

anticholinergic sx

Question 31

reduced GCS, pupillary changes and cardiorespiratory depression. dx?

Answer 31

sedative syndrome - opiates, baclofen, benzos, barbiturates

Question 32

confusion, autonomic instability and neuromuscular hyperactivity. dx?

Answer 32

serotonin syndrome

Question 33

what is the 1st line ix for overdoses?

Answer 33

blood gas and ECG