Overdose CPGs

Question 1

when should paramedics contact police in regards to an overdose?

Answer 1

in professional opinion the pt appears to be a victim or increased risk of

• smiley violnce
  sexual exploitation
  or if supplied by parent/guardien
  other evidence of child abuse

Question 2

when must a patient be transported to hospital?

Answer 2

if OD taken as a suicide attempt

Question 3

what supportive care should be provided to all overdose paitents?

Answer 3

airway managment and ventilatory support

- hypoglycaemia, bradycardia, inadequate perfusion, hypo/hyperthermia

Question 4

what further assessments - clinical evidence needs to be gathered?

Answer 4

• identify the substance involved/collect packes
  identify route
  time taken
  amount taken
  what substances mixed with
  establish if any treatment initiated - ie induced vomiting

Question 5

what opioids can be treated under the opioid od guideline?

Answer 5

heroine, morephine, codeine, other

Question 6

what opioids fall under the other oipiod arm of the CPG?

Answer 6

• prescription- oxycodone, morphine, fentynal, methadone
  iatrogenic
  polypharmacy
  unknown

Question 7

what is the aim of administering naloxone to other opiod overdoses?

Answer 7

return to adequate ventilation - complete reversal of symptoms not recommended

Question 8

what should be sone after 10 minutes if there is no response to naloxone?

Answer 8

transport without delay

Question 9

what is the treatment for a heroin overdose?

Answer 9

assist ventilations/airway
naloxone 1.6-2mg IM

adequate response- treat and refer pathway

inadequate response - transport without delay
consider SGA/intubation - MICA

Question 10

what is the action for other opiod overdose?

Answer 10

airway-ventilation
naloxone 100mcg IV every 2 minutes until pt self ventilating max 2mg

if no IV0 naloxone 400mcg IM single dose

consider SGA/intubation-MICA and transport without delay

Question 11

what should be done in hyperthermic psychostimulant OD?

Answer 11

intervention/managment of agitation initiated early to assist with cooling/avoid further increase in temp associated with agitation

Question 12

what should be done for sedative agents?

Answer 12

manage agitation and inadequate perfusion

Question 13

what is the managment of psychostimulant overdoses?

Answer 13

reduce stimuli by calming environment

seizures, ACS, hyperthermia, hypothermia, agitation/delerium

Question 14

what are the mild to moderate sings of TCA toxicity?

Answer 14

drowsiness, confusion, tachycardia, slurred speech, hyperreflexia, ataxia, mild hypertension, dry mucus membrane, respiratory depression

Question 15

what are the severe sings of TCA toxicity?

Answer 15

Coma
respitroy depression
conduction delays
PVCs, SVT, VT, hypotension, seizures, ECG changes

Question 16

what are some generic and brand names of TCAs?

Answer 16

amitriptyline - ended, entrap, clomipramine - anafranil, plaice
doxepin - dextran, sinequan
imipramin- tofranil

Question 17

what should be assessed if there is suspicion of TCA OD?

Answer 17

substance- PSA, ECG criteria

Question 18

sings of toxicity would trigger MICA to treat a TCA OD?

Answer 18

QRS > 0.12sec, hypotension and ventricular arythmias

Question 19

what can MICA do in the setting of a TCA overdose?

Answer 19

Sodium bicarbonate