Overdose Flashcards
What do you do if the patient refuses transport?
Advise the patient and the responsible third person of follow-up, counselling facilities and actions to take for continuing care if symptoms recur
When should paramedics contact police in regard to an OD?
- 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
What do you do if the patient has claimed to take an OD or a potentially life threatening substance or as a suicide attempt?
- the patient must be transported to hospital
- police assistance should be sought to facilitate this as required
How do you confirm clinical evidence of substance use or exposure/questions that you would ask?
- 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
Recite the CPG for Overdose - Introduction
What should the ‘Other opioid overdose’ arm of this CPG be used for?
- 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
patients who are managed using the ‘other opioid overdose’ arm should:
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
What do OD of synthetic opioids (e.g. fentanyl recreationally) require?
May require higher doses of naloxone than usual to reverse effects
What are the general care points of opioid OD?
- 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
Recite the Overdose Opioids CPG
What are the key points in caring for a hyperthermic psychostimulant OD?
- 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
Recite the Sedative agents/psychostimulants CPG
What are signs and symptoms of a mild to moderate tricyclic antidepressant OD?
- (CHARTS MD)
- Confusion/drowsiness
- Hyperreflexia
- Ataxia
- Respiratory Depression
- Tachycardia
- Slurred speech
- Mild Hypertension
- Dry mucous membranes
What are signs and symptoms of a severe tricyclic antidepressant OD?
(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
What are common tricyclic antidepressants?
- Amitriptyline (endep/entrip) *most common
- Clomipramine (anafranil/placil)
- Dosulepin (dothiepin/dothep)
- Doxepin (dextran/sinequan)
- Imipramine (tofranil)
- Nortriptyline (allegron/nortitabs)
Recite the Tricyclic Antidepressant OD CPG
