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CP3 Emergency Medicine > Overdose > Flashcards

Flashcards in Overdose Deck (19)
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1

Name some important components in A-E assessment of overdose

ECG, GCS, pupil size and reaction to light, evidence of IVDU

2

What drugs can have a blood level taken?

Paracetamol, salicylate

3

What are the key factors in treatment of alcohol overdose

- CNS depression: may need intubating and ventilating
- Hypoglycaemia: treat with iv glucose (no response to glucagon)
- Alcohol withdrawal: Chlordiazepoxide and iv thiamine

4

What are the features of paracetamol overdose and when should you take a paracetamol level

Nausea and vomiting, abdo pain and tender hepatic edge
4 hours after ingestion

5

What are some investigations into liver damage following paracetamol overdose

INR, AST/ALT, glucose

6

For what drugs and when can you give activated charcoal

- paracetamol
- Salicylates
- TCAs
within 2 hours of ingestion (or longer if the drug is modified release/ taken very large amounts)

7

What is the reversal agent for paracetamol

N-actetylcysteine

8

What is the presentation of TCA overdose
What are the key beside findings

Antimuscarinic...tachycardia, dilated pupils, urinary retention, progresses to drowsiness and come
Metabolic acidosis and widened QRS

9

Treatment of TCA overdose

Cardiac monitoring and iv sodium bicarbonate if SVT or VT
hyperventilate to maintain pH >7.5-7.55

10

Features of Benzodiazepine overdose

Drowsiness, ataxia, dysarthria, coma

11

Reversal agent for benzo overdose and its indications
What are the problems with it

Flumazenil (selective benzo receptor antagonist)
Benzo overdose often not severe but deffo need reversal in paeds, use in iatrogenic overdose and as a diagnostic tool
Can induce seizures esp in those with a lowered threshold, you then cant use a benzo to terminate that seizure

12

Features of opiate overdose, and complication

Respiratory depression, dropping GCS, pinpoint pupils and coma
Aspiration pneumonia, hypothermia, skin necrosis

13

Reversal agent for opiate overdose and when to give it

Naloxone, give 400mcg dose, and then can give further 800mcg after 1 min if no response, can repeat 800 mcg after 2 mins if no response
If there is a response give dose every two mins until breathing is adequate (has a very short half life)

14

Features of a cocaine overdose, what amount if considered potentially lethal
What does the ABG show

Agitation, tachycardia, hypertension, hyperthermia, sweating and hallucinations
1g
metabolic acidosis

15

Treatment of cocaine overdose

No specific antidote, treat agitation and convulsions with iv diazepam, treat dysrthymias with soduim bicarbonate, treat hyperthermia with active external cooling, may need to anaesthetise to stop shivering

16

Features of salicylate overdose
What happens with the blood gas

Vomiting, dehydration, hyperventilation, tinnitus and sweating
initially there is respiratory alkalosis from hypervent, then build of lactic acid causes metabolic acidosis

17

When should you take salicylate levels

2 hours

18

What is the treatment of salicylate overdose

Urine alkalisation with soduim bicarb and potassium chloride to increase salicylate (acid) excretion. monitor ECG

19

Main components in a mental state exam

Appearance, behaviour, Speech, subjective and objective mood, thought form and content, perception, cognition, and insight