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Drug Overdose & Poisonings (Diagnostic Testing (Try to determine what…
Drug Overdose
& Poisonings
Etiology
Accidental or intentional abusive exposure to various drugs or chemicals
Pathophysiology
Narcotic
Inhabition of synaptic neurotransmission in the CNS
Sedative/ hypnotic
CNS depressant
Adrenergic/ sympathomimetic
Prevention of presynaptic uptake of norepinephrine and norepinephrine concentrations rise leading to excessive stimulation
Cholinergic/ parasympathomimetic
Inhibition of AChE (acetylcholinesterase)
Anticholinergics
Inhibit parasympathetic nerve impulses
Diagnostic Testing
Try to determine what was ingested, injected or exposed to, when and how much
Assess LOC, VS, Toxidromes
ABG to assess for hypoxemia, hypercapnia, and acid-base imbalances
CO-oximetry to measure HbCO levels (Carbon monoxide poisoning)
Serum electrolytes and calculation of anion gap (look for high anion-gap metabolic acidosis in salicylate, methanol, and ethylene glycol poisoning
Quantitative toxicology screen to measure serum levels of common agents such as acetaminophen, salicylate, ethanol/methanol, barbiturates, and cyclic antidepressants :red_flag:
Urinalysis to identify the presence of offending drugs or drug products :red_flag:
Differential Diagnosis
Urinalysis to identify the presence of offending drugs or drug products :red_flag:
Quantitative toxicology screen to measure serum levels of common agents such as acetaminophen, salicylate, ethanol/methanol, barbiturates, and cyclic antidepressants :red_flag:
Respiratory Management
Resuscitation and stabilization come FIRST
Obtain an ABG to assess for hypoxemia, hypercapnia, and acid-base balances
Recommend or conduct CO-oxumetry to measure HbCO
Recommend intubation for any overdose/poisoning patient who is OBTUNDED or any patient whom upper airway control is suspected or aspirations is a concern
Always prioritize ABC's
Airway
Breathing
Circulation
Provide supplemental O2 to maintain SpO2 above 90% (100% if CO poisoning)
Clinical Signs and Symptoms
Vary according to the specific substance involved and the route by which it enters the body
Narcotic
Opiate analgesics (morphine, heroin,oxycodone)
Depressed LOC, Respiratory distress,
Miosis
(pin point pupils)
Sedative/ hypnotic
Barbituates, benzodiazepines
Depressed LOC, Respiratory distress, Hyporeflexia
Adrenergic/ sympathomimetic
Ecstacy, amphetamines, methamphetamines
CNS Stimulation, mydriasis,hypertension, tachycardia, seizures
Anticholinergic
Atropine, anticholinergic bronchodilators (tiotropium), diphenhydramine (Benadryl) bupropion (Zyban)
Dry skin, hyperthermia,
mydriasis
(blown pupils), tachycardia, delirium, thirst
Cholinergic/para-sympathomimetic
Neostigmine, organophosphates (insecticides), chemical warfare nerve agents(sarin)
Salivation, lacrimation, uriniation, defecation, GI upset, and emesis ("SLUDGE"), bradycardia, fasciculation, confusion, miosis
Look for:
Toxidromes: key clustesr of symptoms "Toxic symptoms"