Overdose Standing Orders
The goal for effectively managing patients with an overdose/poisoning is to support the ABCs, terminate seizures, and reverse the toxic effects of the poison/ medication with a specific antidote. The treating paramedic should consider contacting the Florida Poison
Control Center at 1-800-222-1222 as soon as possible for treatment recommendations.
These recommendations are based on the type and severity of the poisoning/overdose and
the clinical condition of the patient.
* The Poison Control Center representative will ask for the patient’s name, the zip code where the call occurred and a contact number. Document the treatment and the name
of the representative on the ePCR Report.
* Resuscitation of cardiac arrest patients should follow BLS and ACLS algorithms.
What is the goal for effectively managing patients with an overdose/poisoning?
- support the ABCs,
- terminate seizures,
and - reverse the toxic effects of the poison/ medication with a specific antidote.
What is the phone number for poison control?
1-800-222-1222
The Poison Control Center representative will ask for
- the patient’s name,
- the zip code where the call occurred
and - a contact number.
What should be documented on the ePCR when Poison
Control is contacted.
the treatment and the name
of the representative
Treatment recommendations from Florida Poison Control ____
must be followed and documented whenever possible provided the
recommended treatment/ medications are available.
OVERDOSE/POISONING
• BLS Standard Requirements
- Try to identify source of the overdose/poisoning.
- Suction as needed.
- If a patient is unresponsive and spinal cord injury is not suspected, place the patient in the recovery position.
- Check BGL. If less than 60 mg/dL, with an altered mental status, and patient is able to protect their airway/swallow, give oral glucose 15g. Not recommended for patients less than 2 years old.
Initial Management for Poisoning/ Overdose
- Check GLUCOSE and administer D10 as indicated for a BGL less than 60mg/dL.
- If patient is seizing, see “SEIZURE PROTOCOL.”
• AIRWAY
- Positioning, suction, NPA/OPA, intubate or insert a IGEL prn
• OXYGENATE/VENTILATE
- Maintain an SpO2 of 95% and EtCO2 levels between 35-45 mmHg, unless otherwise noted.
- Ventilate/Intubate as needed.
• CIRCULATION
- Support blood pressure initially with fluids. Many medications depress myocardial
contractility and heart rate, which predispose the patient to heart failure even with
boluses as little as 500mL. Assess lung sounds and blood pressure after each 500mL bolus.
Beta Blocker Overdose
Information
- Common Beta Blockers include: Atenolol, Carvedilol, Metoprolol, and Propranolol.
- In addition to the treatment listed below, the Florida Poison Information Center may be contacted at: 1- 800-222-1222 for further assistance and/or medical control.
Beta Blocker Overdose
Adult - If patient is Hypotensive
- NORMAL SALINE: 1L. Assess lung sounds and blood pressure every 500mL.
- Consult with Poison Control for further orders.
- GLUCAGON: 1mg/min IV/IO for refractory hypotension. Max dose of 5mg (if available).
- For nausea/vomiting, ZOFRAN: 4mg IM or slow IV/IO, can be administered prn.
- TRANSCUTANEOUS PACING: For refractory bradycardia and heart blocks, start rate at 60 BPM and increase prn to maintain B/P.
- Etomidate: 10mg IV/IO one dose for sedation prior to Pacing
- Push Dose EPINEPHRINE
Beta Blocker Overdose
Pediatric - If patient is hypotensive.
• NORMAL SALINE: 20mL/kg bolus IV/IO. May repeat 2x prn for continued hypotension.
• Consult with Poison Control for further orders.
• GLUCAGON: 1mg IV/IO every minute until hypotension resolves (0.5mg for patients less than 20kg, if available) Max dose 4 mg
• For nausea/vomiting, ZOFRAN: 0.1mg/kg IM or slow IV/IO can be administered
prn. Max dose 4mg.
• Etomidate: 0.15 MG/KG for sedation prior to pacing- See Pediatric Med Tool
• TRANSCUTANEOUS PACING: For refractory bradycardia, start rate at 80 BPM and
increase prn to maintain B/P.
• Push Dose EPINEPHRINE
Beta Blocker Overdose
Fluid Administration:
LUNG SOUNDS
Assess lung sounds frequently. A decrease in myocardial
contractility may cause myocardial depression, limiting the
amount of fluids the patient can tolerate.
Calcium Channel Blocker Overdose
Information
- Common Calcium Channel Blockers include: Norvasc, Cardizem, Cardene, and Procardia
- In addition to the treatment listed below, the Florida Poison Information Center may be contacted at: 1- 800-222-1222 for further assistance and/or medical control.
Calcium Channel Blocker Overdose
Adult - if patient is hypotensive: SBP <100
• NORMAL SALINE: 1L. Assess lung sounds and blood pressure every 500mL.
• CALCIUM CHLORIDE: 1g slow IV/IO over 2 min.
• Etomidate: 10mg IV/IO one dose for sedation prior to Pacing
• TRANSCUTANEOUS PACING: For refractory bradycardia and heart blocks, start rate at
60 BPM and increase prn to maintain B/P.
• PUSH DOSE EPINEPHRINE: for SBP < 100, unresponsive to above
Calcium Channel Blocker Overdose
Pediatric - if patient is hypotensive.
- NORMAL SALINE: 20mL/kg bolus IV/IO. May repeat 2x prn for continued hypotension.
- Consult with Poison Control for further orders.
- CALCIUM CHLORIDE: 20mg/kg slow IV/IO over 2 min repeat every 5-10 minutes until symptoms resolve. Max dose 1gm.
- TRANSCUTANEOUS PACING: For refractory bradycardia, start rate at 80 BPM and increase prn to maintain B/P.
- Etomidate: 0.15MG/KG for sedation prior to pacing- See Pediatric Med Tool
- PUSH DOSE EPINEPHRINE: for age appropriate hypotension not responsive to above
Calcium Channel Blocker Overdose
Fluid Administration
LUNG SOUNDS
Assess lung sounds frequently. A decrease in myocardial contractility may cause myocardial depression, limiting the amount of fluids the patient can tolerate.
Cocaine Overdose
Information: Signs of Cocaine overdose
include: tachycardia, supraventricular and ventricular
arrhythmias, CP/MI, HTN, seizures, excited delirium, and hyperpyrexia.
In addition to the treatment listed below, the Florida Poison Information Center may be contacted at: 1-
800-222-1222 for further assistance and/or medical control.
Cocaine Overdose
Adult - presenting with SVT, HTN, or Seizures.
VERSED 5 mg IV/IO/ IN/IM. May repeat either route 1x prn.
• Contraindicated in hypotension.
• Monitor for respiratory depression.
Cocaine Overdose
Adult - Agitated Patients
- CONSIDER Chemical Restraint Protocols.
- KETAMINE: 200-400mg IM, OR KETAMINE: 200 mg IV/IO, Max single IV/IO dose 200mg. May repeat either route 1x prn.
- Follow appropriate arrhythmia protocol if above treatment is unsuccessful.
Cocaine Overdose
Adult - patient presents with chest pain.
- Administer Versed as noted above.
* If no response, refer to “Chest PainProtocol.”
Cocaine Overdose
Pediatric
Consult with Poison Control for orders.
TCA Overdose
Information
Common Tricyclic Antidepressants include: Amitriptyline, Desipramine, and Doxepin
Signs of significant TCA overdose include: Coma, Convulsions (seizures), Cardiac arrhythmias
& Acidosis.
In addition to the treatment listed below, the Florida Poison Information Center may be contacted at: 1-800-222-1222 for further assistance and/or medical
control.
TCA Overdose
Patient Presentation
Mad as a Hatter Red as a Beet Hot as Hell Dry as a Bone Blind as a Bat
TCA Overdose
Adult - patient is hypotensive
• NORMAL SALINE: 1L, may repeat 1x prn. Assess lung
sounds and BP every 500 mL.
• FOR PATIENT WITH A QRS COMPLEX GREATER THAN .10 SECONDS (2.5 SMALL BOXES)
- SODIUM BICARBONATE: 50 mEq slow IV/IO every 5 minutes until ECG changes are resolved.
Maximum 150 mEq.
• Consult with Poison Control for further orders.
