Drug Overdose Poisoning

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 an Antiemetic 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
      • Administer ATROPINE 0.5 mg IV, may repeat x 2 if no response.
      • If no response, CALCIUM CHLORIDE 1 gm IV, If no response, repeat x 1
      • If no response, GLUCAGON 3 mg IV or IN, If no response, repeat x 1
      • If no response, begin TRANSCUTANEOUS PACING (TCP). (9.30)
    • 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
      • Administer ATROPINE 0.5 mg IV, may repeat x 2 if no response.
      • If no response, GLUCAGON 2 mg IV or IN, If no response, repeat x 1
      • If no response begin Transcutaneous Pacing (TCP) (9.30)
    • If hypotension
      • 200 – 300 cc NS bolus, repeat as needed.
      • Administer GLUCAGON 2 mg IV or IN, may repeat x 1.