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Finals - Psychiatry > Overdose > Flashcards

Overdose Flashcards

1
Q

What are initial measures in the assessment of poisoning/overdose?

A

Collapsed + unresponsive – ensure airway open, check for normal breathing
i) If no normal breathing, start CPR and call ambulance
Assess consciousness – GCS
Measure respiratory rate + pulse oximetry if available
Measure BP, pulse and temp

Transfer to hospital if

i) Unconscious/low GCS
ii) Low respiratory rate/sats
iii) Hypotensive
iv) Tachy/brady/irregular pulse
v) Hypo/hyperthermia
vi) Seizure
vii) Other concerning clinical features

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2
Q

What does a hospital assessment of poisoning/overdose consist of?

A

History – circumstances of OD/poisoning:

Why? I.e. accidental/deliberate, therapeutic error, repetition?
Who? Age, weight, sex, PMH, renal/hepatic function
What? Amount, alcohol, other meds, route of administration
When? Exact timings important esp Parecetamol poisoning

Symptoms of the poisoning

Examination incl general obs i.e. alcohol smell, track marks; neuro – general and pupil/eye movements

If deliberate: risk assessment

Consult TOXBASE for info on specific poison

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3
Q

What is the general treatment plan for poisoning/overdose?

A

Respiration: ensure patency by natural methods i.e. chin lift or artificial i.e. oropharyngeal airway

BP: systolic BP <70mmHg may cause irreversible brain damage or RTN; foot raise; NaCl or colloid infusion

Heart: arrhythmias often correct selves on hypoxia/acidosis correction, can give IV bicarbonate to aid; QT prolongation seek specialist advice

Body temperature: appropriate re-warming in those that are hypothermic; removing all clothing and sponging with tepid water and using a fan for hyperthermia

Convulsions: <5mins – no treatment; continuous or frequently recurring – lorazepam/diazepam IV

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4
Q

What do you give to aid in removal and elimination?

A

Activated charcoal

Sooner given = more effective but still effective up to 1hr post poisoning

Repeated doses PO can be given to enhance the elimination of some drugs after absorption

(a) Carbamazepine
(b) Phenobarbital
(c) Quinine
(d) Theophylline
(e) Dapsone

Gastric lavage rarely indicated - maybe used in <1hr for a massive overdose where still lots of tablets present in stomach

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5
Q

What are the signs of paracetamol overdose?

A

Frequently asymptomatic – people suspected should be admitted to hospital

N+V – settle within 24hrs -if it continues past 24hrs w/R subcostal pain – indicates hepatic necrosis – encephalopathy, hypoglycaemia, haemorrhage, cerebral oedema, death..

Liver damage is maximal 3-4 days after OD

Coma/low GCS if taken with opioids or alcohol

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6
Q

What specific treatment do you give for paracetamol overdose?

A

N-acetylcystine – infusion up to and potentially over 24hrs after ingestion, most effective within 8hrs; 3 doses in 21hrs

Prescribe according to trust guidelines/protocols

Basics:

  • Dose based on actual body weight, capped at 110kg
  • Diluted in 5% glucose
  • Loading dose given over 1hr in 200ml of 5% Glu (150mg/kg)
  • 2nd dose given over 4hrs in 500ml 5% Glu (50mg/kg)
  • 3rd dose given over 16hrs in 1L 5% Glu (100mg/kg)
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7
Q

What are the signs of an opioid overdose?

A

Core triad - stupor/profound coma + respiratory rate of 4-6/min + pinpoint pupils

Cyanosis 
Low BP (from hypoxia) 
Temperature decreased 
Skeletal muscles flaccid 
Convulsions 
Vomiting/aspiration
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8
Q

What specific treatment do you give for opiate overdose?

A

Naloxone

Competitive antagonist
Short half life – require repeated dosing; can have sub dermal implants given so if they flee the resus site they don’t continue to OD when the initial injection wears off

Reverses respiratory depression and sedative effects in 1-2 mins

May precipitate acute opiate withdrawal

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9
Q

What are some common agents responsible for anticholinergic poisoning?

A

Antihistamines, tricyclics, carbamazepine, phenothiazines

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10
Q

What are the common signs/symptoms of an anticholinergic toxidrome?

A

Tachycardia, hyperthermia, dilated pupils, warm/dry skin, urinary retention, agitation

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11
Q

What are some common agents responsible for cholinergic poisoning?

A

Carbamates, organophosphates, insecticides, some mushrooms

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12
Q

What are the common signs/symptoms of an cholinergic toxidrome?

A

Salivation, lacrimation, urination, diarrhoea, bronchorrhoea, bronchospasm, bradycardia, vomiting

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13
Q

What are some common agents responsible for hallucinogenic poisoning?

A

Amphetamines, cocaine, MDMA

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14
Q

What are the common signs/symptoms of a hallucinogenic toxidrome?

A

Hallucinations, panic, seizure, hypertension, tachycardia, tachypnoea

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15
Q

What are some common agents responsible for opioid poisoning?

A

Morphine, codeine, methadone

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16
Q

What are the common signs/symptoms of an opioid toxidrome?

A

Hypoventilation, hypotension, miosis, sedation, bradycardia

17
Q

What are some common agents responsible for sedative/hypnotic poisoning?

A

Anticonvulsants, benzodiazepines, ethanol

18
Q

What are the common signs/symptoms of a sedative/hypnotic toxidrome?

A

Ataxia, blurred vision, sedation, hallucination, slurred speech, nystagmus

19
Q

What are some common agents responsible for sympathomimetic poisoning?

A

Amphetamines, cocaine, MDMA

20
Q

What are the common signs/symptoms of a sympathomimetic toxidrome?

A

Tachycardia, hypertension, mydriasis, agitation, seizure, hyperthermia, sweating

21
Q

What are the signs of aspirin overdose?

A 
Hyperventilation
Tinnitus 
Deafness 
Vasodilatation
Sweating 
Coma if severe
22
Q

What specific treatment is required for aspirin overdose?

A

Hospital – measurement of plasma salicylate, pH, electrolytes

Activated charcoal

Fluid replacement + bicarbonate to enhance excretion

Haemodialysis - >5.1mmol/L salicylate or severe metabolic acidosis

23
Q

What are the signs of SSRI overdose?

A 
N+V 
Agitation 
Tremor 
Nystagmus 
Drowsiness 
Tachycardia 
Convulsions 
Serotonin syndrome if severe
24
Q

What are the signs of TCA overdose?

A 
Dry mouth  
QRS prolongation leading to an incrwased risk of arrhythmias - NEEDS MANAGING WITH IV BICARBONATE STAT 
Hypothermia 
Hypotension 
Respiratory  failure 
Seizures 
Coma
Sometimes dilated pupils and urinary retention
25
Q

What are the signs of benzodiazepine overdose?

A 
Drowsiness 
Dysarthria 
Ataxia 
Nystagmus 
Respiratory depression and coma
26
Q

What are the signs of 2nd gen antipsychotic overdose?

A 
Drowsiness 
Hypotension 
Extrapyramidal symptoms 
Convulsions 
ECG abnormality i.e. QT prolongation
27
Q

What are the signs of lithium overdose?

A

Serum concentration >1.5mmol/L

Apathy, restlessness
Coarse tremor
Oliguria 
Vomiting/diarrhoea 
Ataxia 
Weakness 
Dysarthria 
Muscle twitching 
Electrolyte imbalance, dehydration, convulsions, renal failure, hypotension, coma

Most cases occur in those with long term Li use whose excretion is impaired i.e. due to infection or dehydration

Finals - Psychiatry (38 decks)

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