I totally messed up my blogging schedule this month. My self-created blogging calendar clearly states today I am to write about Poison Prevention Month. My early morning research, however has revealed that March is the month devoted to poison safety. Oops. Working in the ER, overdose is one of my favorite diagnoses to treat so I’m going to review it anyway.
If you work in urgent care, the emergency room and even family practice, you must be aware of the basics of treating overdose and ingestion. Although the number of substances a patient can potentially ingest is endless, there are a few basics to consider in every overdose.
Overdoses are not always straightforward. The patient may be too sedated to speak to you or they may be dishonest about the situation. Often, the patient may have ingested multiple medications or substances making the possible effects uncertain. Your patient may be a child and the parent uncertain what the child has taken and/or how much.
Always, always consider the ABCDE’s first in treating OD. You know, airway, breathing, circulation, drugs and environment. If your patient is in respiratory distress or sedated, they may require intubation. For any patient in significant distress, involve a physician STAT. Patients who have overdosed can deteriorate quickly and may need a higher level of care. Regardless of the level of sedation or apparent distress in a patient who has overdosed, place the patient on a cardiac monitor so you can monitor vital signs closely.
Some basic labs and tests are standard in most cases of overdose. Labs including complete blood count, basic metabolic panel and liver function studies should be ordered. Because overdoses are not straightforward, a tox screen along with serum acetaminophen (Tylenol), serum salicylate (Aspirin) and alcohol levels are typically done in case the patient has ingested additional substances. You may also need to order a urinalysis to check for dehydration and/or a CK to evaluate possible muscle breakdown. Check levels of any medications such as lithium the patient is known to take.
In addition to labs, get an EKG on your patients who have overdosed. Excessive levels of some medications can result in cardiac dysrhythmias. Some psychiatric medications for example, result in prolonged QT. A chest X-Ray should be performed in patients with respiratory distress, those requiring intubation and in patients at risk for aspiration. A CT scan of the head may be necessary in patients who are seizing, sedated, with neurological deficits or with altered mental status.
Consider administering medications to patients who have overdosed in certain situations. Ingestion of opiates like heroin and morphine can be reversed by giving Narcan. Just remember, when the Narcan wears off, the patient may return to their prior state (ex. sedated) so they still require extensive monitoring even though they may be well appearing. Other substances can cause seizure. If a patient begins seizing, give benzo’s such as lorazepam.
Still unsure what you need to do for your patient? The Poison Control Center is an amazing, wonderful, invaluable, I can’t say enough good things about them, resource for medical providers. Nope, the Poison Control Center does not exist just for concerned parents. I call them all the time. Simply dial 1-800-222-1222 (that’s from memory, folks) and an expert will help you immediately. Simply name the substance your patient has ingested, from bleach to morphine…or maybe both, and the poison control center will guide you in caring for your patient.
Always remember that overdoses should be taken seriously. Your first step must be taking care of the ABC’s. If you have questions in treating overdose, don’t hesitate to call the Poison Control Center. I hope you had a good Poison Prevention month last month.