Overdose

Question 1

What do you do if the patient refuses transport?

Answer 1

Advise the patient and the responsible third person of follow-up, counselling facilities and actions to take for continuing care if symptoms recur

Question 2

When should paramedics contact police in regard to an OD?

Answer 2

• family violence (e.g. from a parent, guardian or care giver)
• Sexual exploitation or abuse
• The supply of drugs appears to be from a parent/care giver/guardian
• There is other evidence of child abuse/maltreatment or evidence of suspicious untreated injuries

Question 3

What do you do if the patient has claimed to take an OD or a potentially life threatening substance or as a suicide attempt?

Answer 3

• the patient must be transported to hospital
• police assistance should be sought to facilitate this as required

Question 4

How do you confirm clinical evidence of substance use or exposure/questions that you would ask?

Answer 4

• Identify which substance/s are involved and collect any packets if possible
• Establish route of administration
• Establish time
• Establish amount
• Establish what the substances were mixed with when taken
• Establish is any treatment has been initiated prior to AV arrival

Question 5

Recite the CPG for Overdose - Introduction

Answer 5

Question 6

What should the ‘Other opioid overdose’ arm of this CPG be used for?

Answer 6

• prescription opioid medication OD (oxycodone, morphine, codeine, fentanyl patches, methadone)
• iatrogenic opioid overdose (secondary to opioid analgesia)
• poly pharmacy OD involving opioids (opioid and methamphetamines)
• unknown cause of opioid overdose

Question 7

patients who are managed using the ‘other opioid overdose’ arm should:

Answer 7

receive supportive care, transport to hospital and titrated doses of naloxone to target return of adequate ventilation. Complete reversal of symptoms is generally not advised in these patients

Question 8

What do OD of synthetic opioids (e.g. fentanyl recreationally) require?

Answer 8

May require higher doses of naloxone than usual to reverse effects

Question 9

What are the general care points of opioid OD?

Answer 9

• ensure paramedic health and safety
• if inadequate response after 10 minutes, the patient is likely to require transport without delay
• maintain general care of the unconscious patient and ensure adequate airway and ventilation
• consider other causes e.g. head injury, hypoglycaemia, poly pharmacy OD
• Beware of the patient becoming aggressive

Question 10

Recite the Overdose Opioids CPG

Answer 10

Question 11

What are the key points in caring for a hyperthermic psychostimulant OD?

Answer 11

• the trigger point for intervention in the management of agitation/aggression is lowered
  
  • sedation should be initiated early to assist with cooling and avoid further increases in temperature associated with agitation

Question 12

Recite the Sedative agents/psychostimulants CPG

Answer 12

Question 13

What are signs and symptoms of a mild to moderate tricyclic antidepressant OD?

Answer 13

• (CHARTS MD)
• Confusion/drowsiness
• Hyperreflexia
• Ataxia
• Respiratory Depression
• Tachycardia
• Slurred speech
• Mild Hypertension
• Dry mucous membranes

Question 14

What are signs and symptoms of a severe tricyclic antidepressant OD?

Answer 14

(within 6 hours of ingestion) (SHREC)

• Seizures
• Hypotension
• Respiratory depression/hypoventilation
• ECG changes
  
  • Conduction delays
  • PVC’s
  • SVT
  • VT
• Coma

*this could lead to aspiration, hyperthermia, rnhabdomylosis and APO

Question 15

What are common tricyclic antidepressants?

Answer 15

• Amitriptyline (endep/entrip) *most common
• Clomipramine (anafranil/placil)
• Dosulepin (dothiepin/dothep)
• Doxepin (dextran/sinequan)
• Imipramine (tofranil)
• Nortriptyline (allegron/nortitabs)

Question 16

Recite the Tricyclic Antidepressant OD CPG

Answer 16

Question 17

What are some examples of opioids?

Answer 17

• Heroin
• Oxycodone
• Methadone
• Morphine
  
  • Fentanyl

Question 18

What are some signs and symptoms expected to be found in patients with an opioid overdose?

Answer 18

• constricted pupils
• respiratory depression
• sedation
  
  • coma

Question 19

What drugs can you see serotonin toxicity in?

Answer 19

• SSRI
• SNRI
• MAOI
• Methamphetamine
• MDMA

Question 20

What are some symptoms of serotonin syndrome?

Answer 20

• Dilated pupils
• tremor
• hyperreflexia
• clonus
• hyperthermia
• agitation

Question 21

What are some signs and symptoms expected in psycho-stimulants?

Answer 21

• dilated pupils
• tachycardia
• sweating
• hyperthermia
• agitation