Overdose

Question 1

Name some important components in A-E assessment of overdose

Answer 1

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

Question 2

What drugs can have a blood level taken?

Answer 2

Paracetamol, salicylate

Question 3

What are the key factors in treatment of alcohol overdose

Answer 3

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

Question 4

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

Answer 4

Nausea and vomiting, abdo pain and tender hepatic edge

4 hours after ingestion

Question 5

What are some investigations into liver damage following paracetamol overdose

Answer 5

INR, AST/ALT, glucose

Question 6

For what drugs and when can you give activated charcoal

Answer 6

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

Question 7

What is the reversal agent for paracetamol

Answer 7

N-actetylcysteine

Question 8

What is the presentation of TCA overdose

What are the key beside findings

Answer 8

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

Question 9

Treatment of TCA overdose

Answer 9

Cardiac monitoring and iv sodium bicarbonate if SVT or VT

hyperventilate to maintain pH >7.5-7.55

Question 10

Features of Benzodiazepine overdose

Answer 10

Drowsiness, ataxia, dysarthria, coma

Question 11

Reversal agent for benzo overdose and its indications

What are the problems with it

Answer 11

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

Question 12

Features of opiate overdose, and complication

Answer 12

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

Question 13

Reversal agent for opiate overdose and when to give it

Answer 13

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)

Question 14

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

Answer 14

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

Question 15

Treatment of cocaine overdose

Answer 15

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

Question 16

Features of salicylate overdose

What happens with the blood gas

Answer 16

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

Question 17

When should you take salicylate levels

Answer 17

2 hours

Question 18

What is the treatment of salicylate overdose

Answer 18

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

Question 19

Main components in a mental state exam

Answer 19

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