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Flashcards in Narcotic overdose 2 Deck (24)
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1
Q

Explain the vital signs for a narcotic overdose? What should be done immediately as emergency management?

A

Hypotension, bradycardic, low respiratory rate; ABCD Because hemodynamically unstable

2
Q

When is Entracheal intubation indicated?

A

Patients who cannot protect her airway.
Oxygen saturation does not improve with O2 nasal/facemask
PaO2<55
PaCO>50 on ABG

3
Q

What does A stand for?

A

Airway suction, post oximetry, oxygen, continuous monitoring, Endotracheal intubation if necessary

4
Q

What does B stand for?

A

Blood ABGs

5
Q

What does the C stand for?

A

Place a Foley, obtain a fingerstick glucose, continuous cardiac monitoring, IV access

6
Q

What does the D stand for?

A

Administer Thiamine, dextrose 50%, the naloxone all our IV bolus one time does

7
Q

What physical exam should be done for narcotic overdose patient?

A

Respiratory to assess breathing pattern, General HEENT, neck, heart, CVS, skin, chest/lungs, abdomen, extremities, neurological examination

8
Q

What are the initial orders for narcotic overdose?

A

Suction airway, pulse ox, oxygen inhalation or intubation, IV access, fingerstick glucose, ABGs, Thiamine, dextrose 50%, Naloxone, normal Saline .9%

9
Q

What a positive findings for a narcotic overdose⁉️

A

Pinpoint pupils, very drowsy

10
Q

What a classic symptoms for narcotic overdose?

A

Hypotension, bradycardia, pinpoint pupils, and lower respiratory rate

11
Q

What are the diagnostic investigations for narcotic overdose?

A

EKG 12 lead, CBC with differential, BMP, CXR, LFT’s, urine toxicology screen, USA, blood alcohol, BHCG serum

12
Q

Where should the patient be transferred and what should be done?

A

Patient moved to ICU, Urine Output, NPO, BMP and bed rest

13
Q

What is the initial treatment for this patient?

A

NG-tube, gastric lavage. Activated charcoal. Naloxone IV continuous

14
Q

This 28-year-old has an attempted suicide attempt which should be done before discharge?

A

Psychiatry consult, suicide precautions, suicide contract, patient counseling, start on antidepressants if needed

15
Q

Explain hypotension and patient with narcotic overdose?

A

Mild Peripheral dilation may result in orthostatic hypotension however persistent or severe hypotension should raise suspicion for co-ingestants

16
Q

What lab results are important in moderate to severe toxicity patients? What are the baseline studies?

A

CBC with differential, BMP, ABG, LFTs, creatinine kinase level

17
Q

When are positive urine drug screens observe?

A

36 to 48 hours post exposure

18
Q

Why should a 12 lead EKG be obtained in all patients with intentional overdose?

A

Possibility of Cardiotoxic co-ingestants

19
Q

Why is a Chest X-ray done?

A

To check for pulmonary edema or aspiration especially in a patient who has an unprotected airway

20
Q

Naloxone should be given to what type of patients?

A

CNS or respiratory depression

21
Q

When is continuous IV infusion of the Naloxone be problematic?

A

Very safe in patients who are not opioid dependence however opioid dependent, this practice is dangerous and May precipitate withdrawal symptoms

22
Q

When should activated charcoal be administered? Why is it so effective?

A

I’ll patient with opiate intoxication following ingestion, delayed gastric emptying produced by intoxication makes it effective and even patients who present late.

23
Q

When Orogastric lavage be given to these patients?

A

If ingestion occurred within one hour

24
Q

How long should a patient be observed in the hospital if significant respiratory depression or reoccurring sedation occurs?

A

At least 12 to 24 hours, most physicians admit patients if they require a second dose of Naloxone