BEFORE

ED Approach to the ED Approach to the Overdose PatientOverdose Patient

HistoryHistory

Often unreliableOften unreliable Rely on EMS, bystanders, family members and Rely on EMS, bystanders, family members and

other physiciansother physicians Psychiatric files: 13B? 5-4762 at GMHPsychiatric files: 13B? 5-4762 at GMH Where are the bottles?Where are the bottles? What was the environmental setting (Factory, What was the environmental setting (Factory,

Gas space heater in winter – Gas space heater in winter – think CO!!)think CO!!) Check pockets, bags, belongingsCheck pockets, bags, belongings

Physical exam: Vital signs Physical exam: Vital signs

Vital signs are very important:Vital signs are very important: Hyperthermia (ASA, cocaine, anticholinergics)Hyperthermia (ASA, cocaine, anticholinergics) Hypothermia (opiates, barbiturates and sedatives)Hypothermia (opiates, barbiturates and sedatives) HTN (cocaine, amphetamines, sympathomimetics)HTN (cocaine, amphetamines, sympathomimetics) Hypotension (calcium channel and beta blockers)Hypotension (calcium channel and beta blockers) Tachycardia Tachycardia bradycardia (Clonidine, Organophosphates)bradycardia (Clonidine, Organophosphates) Hypoxemia Hypoxemia Blood glucose (hypoglycemia from sulfonylureas, Blood glucose (hypoglycemia from sulfonylureas,

insulin overdose) insulin overdose)

Physical exam-Neuro examPhysical exam-Neuro exam

Level of consciousness: Glucose! Level of consciousness: Glucose! Glucose!Glucose!

Do not miss a focal finding.Do not miss a focal finding. Miosis (clonidine, barbiturates, opiates, Miosis (clonidine, barbiturates, opiates,

cholinergics, pontine stroke)cholinergics, pontine stroke)

Physical exam-Neuro examPhysical exam-Neuro exam

Mydriasis (sympathomimetics)Mydriasis (sympathomimetics) Clonus and rigidityClonus and rigidity

NeurolepticsNeuroleptics Serotonin receptor agonistsSerotonin receptor agonists Depolarizing neuromuscular blockersDepolarizing neuromuscular blockers

SeizuresSeizures Treat with benzodiazepines or barbiturates Treat with benzodiazepines or barbiturates

not phenytoinnot phenytoin

Physical exam: Skin examPhysical exam: Skin exam

Dry: anticholinergicDry: anticholinergic Diaphoretic: Diaphoretic:

cholinergic, cholinergic, hypoglycemiahypoglycemia

or sympathomimeticor sympathomimetic Cyanosis: MetHbCyanosis: MetHb Blisters: Barbs and COBlisters: Barbs and CO Cherry red: CyanideCherry red: Cyanide Track marks for IVDATrack marks for IVDA

AFTER

ED Approach to The ED Approach to The Overdose PatientOverdose Patient

HistoryHistory

Paramedics

Empty bottles

Psychiatric Files

Bystanders/ Family

Environment

Physical exam: Vital signs Physical exam: Vital signs

Glucocheck!Glucocheck!

Glucocheck!Glucocheck!

Glucocheck! Glucocheck!

Physical Exam (Neuro) Physical Exam (Neuro)

Examine the PUPILS Examine the PUPILS

Muscular rigidity

FOCUS ON

Myoclonus

Seizures