Drug Overdose Poisoning: Difference between revisions

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* Obtain and record blood sugar level and refer to [[Hypo or Hyperglycemia|HYPO / HYPERGLYCEMIA PRACTICE PARAMETERS]] (5.10), as indicated.
* Obtain and record blood sugar level and refer to [[Hypo or Hyperglycemia|HYPO / HYPERGLYCEMIA PRACTICE PARAMETERS]] (5.10), as indicated.
* If altered sensorium, refer to [[Altered Mental Status (AMS)|ALTERED MENTAL STATUS PRACTICE PARAMETER]] (5.03).
* If altered sensorium, refer to [[Altered Mental Status (AMS)|ALTERED MENTAL STATUS PRACTICE PARAMETER]] (5.03).
* IF CORROSIVE INGESTION, administer an [[Antiemetics|Antiemetic]] medication as appropriate.
* IF CORROSIVE INGESTION, administer [[Promethazine|PROMETHAZINE]] OR [[Zofran|ZOFRAN]] medication as appropriate.
* For tricyclic and tetracyclic antidepressant overdose:
* For tricyclic and tetracyclic antidepressant overdose:
** If wide complexes (QRS >0.10 sec), hypotension and any other arrhythmias, Administer [[Electrolytes|SODIUM BICARBONATE]], 1 meq/kg IVP. Repeat in 5 or 10 minutes.
** If wide complexes (QRS >0.10 sec), hypotension and any other arrhythmias, Administer [[Sodium Bicarbonate|SODIUM BICARBONATE]], 1 meq/kg IVP. Repeat in 5 or 10 minutes.
** If Torsades de Pointes administer [[Electrolytes|MAGNESIUM SULFATE]] 2 gm, IV bolus (if no renal disease).
** If Torsades de Pointes administer [[Magnesium Sulfate|MAGNESIUM SULFATE]] 2 gm, IV bolus (if no renal disease).
* For Antipsychotics and Acute Dystonic Reaction,
* For Antipsychotics and Acute Dystonic Reaction,
** Administer [[Antihistamines|DIPHENHYDRAMINE]] (BENADRYL) 25 mg IV bolus.  
** Administer [[Diphenhydramine|DIPHENHYDRAMINE]] (BENADRYL) 25 mg IV bolus.  
** If there is an inadequate response, repeat in 10 minutes.
** If there is an inadequate response, repeat in 10 minutes.
* For Calcium Channel blockers,
* For Calcium Channel blockers,
**For patients with cardiovascular toxicity, as manifested by one or more of the following:  
**For patients with cardiovascular toxicity, as manifested by one or more of the following:  
***Hemodynamically significant bradycardia or HB , including 3° HB and high grade 2° HB
***Hemodynamically significant bradycardia or HB , including 3° HB and high grade 2° HB
**** Administer [[Antiarrhythmics|ATROPINE]] 0.5 mg IV, may repeat x 2 if no response.
**** Administer [[Atropine|ATROPINE]] 0.5 mg IV, may repeat x 2 if no response.
**** If no response, [[Electrolytes|CALCIUM CHLORIDE]] 1 gm IV, If no response, repeat x 1
**** If no response, [[Calcium Chloride|CALCIUM CHLORIDE]] 1 gm IV, If no response, repeat x 1
**** If no response, [[Antidiabetics|GLUCAGON]] 3 mg IV or IN, If no response, repeat x 1
**** If no response, [[Glucagon|GLUCAGON]] 3 mg IV or IN, If no response, repeat x 1
**** If no response, begin [[Transcutaneous Pacing Procedure|TRANSCUTANEOUS PACING]] (TCP). (9.30)  
**** If no response, begin [[Transcutaneous Pacing Procedure|TRANSCUTANEOUS PACING]] (TCP). (9.30)  
***If hypotension give 200 – 300 cc NS bolus, repeat as needed.
***If hypotension give 200 – 300 cc NS bolus, repeat as needed.
**** Administer [[Electrolytes|CALCIUM CHLORIDE]] 1 gm IV, may repeat x 1.  Avoid if patient is on digoxin/lanoxin.
**** Administer [[Calcium Chloride|CALCIUM CHLORIDE]] 1 gm IV, may repeat x 1.  Avoid if patient is on digoxin/lanoxin.
**** Administer [[Antidiabetics|GLUCAGON]] 2 mg IV or IN, may repeat x 1.
**** Administer [[Glucagon|GLUCAGON]] 2 mg IV or IN, may repeat x 1.
* For Beta blockers:
* For Beta blockers:
**For patients with cardiovascular toxicity, as manifested by one or more of the following:  
**For patients with cardiovascular toxicity, as manifested by one or more of the following:  
***Hemodynamically significant bradycardia or HB, including 3° HB and high grade 2° HB  
***Hemodynamically significant bradycardia or HB, including 3° HB and high grade 2° HB  
****Administer [[Antiarrhythmics|ATROPINE]] 0.5 mg IV, may repeat x 2 if no response.
****Administer [[Atropine|ATROPINE]] 0.5 mg IV, may repeat x 2 if no response.
****If no response, [[Antidiabetics|GLUCAGON]] 2 mg IV or IN, If no response, repeat x 1
****If no response, [[Glucagon|GLUCAGON]] 2 mg IV or IN, If no response, repeat x 1
****If no response begin [[Transcutaneous Pacing Procedure|Transcutaneous Pacing]] (TCP) (9.30)
****If no response begin [[Transcutaneous Pacing Procedure|Transcutaneous Pacing]] (TCP) (9.30)
***If hypotension
***If hypotension
****200 – 300 cc NS bolus, repeat as needed.  
****200 – 300 cc NS bolus, repeat as needed.  
****Administer [[Antidiabetics|GLUCAGON]] 2 mg IV or IN, may repeat x 1.  
****Administer [[Glucagon|GLUCAGON]] 2 mg IV or IN, may repeat x 1.  


====Physician's Order: POISON CONTROL INFORMATION and subsequent treatment.====
====Physician's Order: POISON CONTROL INFORMATION and subsequent treatment.====




[[Category:Medical]]
[[Category:Medical|0505]]

Latest revision as of 13:43, 24 April 2020

Section 5 -MEDICAL

5.05 DRUG OVERDOSE / POISONING

INITIAL MEDICAL CARE (2.01) - Provide OXYGEN or assist ventilations as appropriate for patient condition.

  • DRAW BLOOD TUBES (9.03), if available.
  • Obtain and record blood sugar level and refer to HYPO / HYPERGLYCEMIA PRACTICE PARAMETERS (5.10), as indicated.
  • If altered sensorium, refer to ALTERED MENTAL STATUS PRACTICE PARAMETER (5.03).
  • IF CORROSIVE INGESTION, administer PROMETHAZINE OR ZOFRAN medication as appropriate.
  • For tricyclic and tetracyclic antidepressant overdose:
    • If wide complexes (QRS >0.10 sec), hypotension and any other arrhythmias, Administer SODIUM BICARBONATE, 1 meq/kg IVP. Repeat in 5 or 10 minutes.
    • If Torsades de Pointes administer MAGNESIUM SULFATE 2 gm, IV bolus (if no renal disease).
  • For Antipsychotics and Acute Dystonic Reaction,
    • Administer DIPHENHYDRAMINE (BENADRYL) 25 mg IV bolus.
    • If there is an inadequate response, repeat in 10 minutes.
  • For Calcium Channel blockers,
    • For patients with cardiovascular toxicity, as manifested by one or more of the following:
      • Hemodynamically significant bradycardia or HB , including 3° HB and high grade 2° HB
      • If hypotension give 200 – 300 cc NS bolus, repeat as needed.
        • Administer CALCIUM CHLORIDE 1 gm IV, may repeat x 1. Avoid if patient is on digoxin/lanoxin.
        • Administer GLUCAGON 2 mg IV or IN, may repeat x 1.
  • For Beta blockers:
    • For patients with cardiovascular toxicity, as manifested by one or more of the following:
      • Hemodynamically significant bradycardia or HB, including 3° HB and high grade 2° HB
      • If hypotension
        • 200 – 300 cc NS bolus, repeat as needed.
        • Administer GLUCAGON 2 mg IV or IN, may repeat x 1.

Physician's Order: POISON CONTROL INFORMATION and subsequent treatment.