Notes – Poisoning/Overdose Universal Care

Poisoning/Overdose Universal Care

Patient Safety Considerations

  1. Scene/environmental safety for patient and provider
    1. Consider environmental carbon monoxide monitor use
  2. Monitor patient airway, breathing, pulse oximetry, ETCO2 for adequate ventilation as they may change over time
  3. Repeat vital signs often
  4. Monitor level of consciousness
  5. Monitor EKG with special attention to rate, rhythm, QRS and QT duration
  6. Maintain or normalize patient temperature
  7. The regional poison center should be engaged as early as reasonably possible to aid in appropriate therapy and to track patient outcomes to improve knowledge of toxic The national 24-hour toll-free telephone number to poison control centers is (800) 222-1222, and it is a resource for free, confidential expert advice from anywhere in the United States

Notes/Educational Pearls

Key Considerations

  1. Each toxin or overdose has unique characteristics which must be considered in individual protocol
  2. Ipecac is no longer recommended for any poisoning or toxic ingestion – the manufacturer has stopped production of this medication
  3. Flumazenil is not indicated in a suspected benzodiazepine overdose as you can precipitate refractory/intractable seizures if the patient is a benzodiazepine dependent patient

Pertinent Assessment Findings

Frequent reassessment is essential as patient deterioration can be rapid and catastrophic.

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914135 – General-Overdose/Poisoning/Toxic Ingestion

Key Documentation Elements

  • Repeat evaluation and documentation of signs and symptoms as patient clinical conditions may deteriorate rapidly
  • Identification of possible etiology of poisoning
  • Initiating measures on scene to prevent exposure of bystanders when appropriate/indicated
  • Time of symptoms onset and time of initiation of exposure-specific treatments

Performance Measures

  • Early airway management in the rapidly deteriorating patient.
  • Accurate exposure history
    • Time of ingestion/exposure
    • Route of exposure
    • Quantity of medication or toxin taken (safely collect all possible mediations or agents)
    • Alcohol or other intoxicant taken
  • Appropriate protocol selection and management.
  • Multiple frequent documented reassessments.

References

  1. Boyer EW, Shannon MS. The serotonin syndrome. N Engl J Med. 2005;352:1112-20
  2. Cushing TA. Selective Serotonin Reuptake Inhibitor Toxicity http://emedicine.medscape.com/article/821737-overview. Updated September 8, 2016. Accessed April 24, 2017.
  3. Gresham C. Benzodiazepine toxicity treatment and management. http://emedicine.medscape.com/article/813255-treatment#d10. Updated December 22, 2016. Accessed April 24, 2017.
  4. Hoffman RS, Howland MA, Lewin NA, Nelson LS, Goldfrank LR. Goldfrank’s Toxicologic Emergencies, 10th Edition. China: McGraw-Hill Education; 2015. http://accessemergencymedicine.mhmedical.com/book.aspx?bookID=1163. Accessed April 24, 2017.
  5. Spiller H. A prospective evaluation of the effect of activated charcoal before N-Acetyl cysteine in acetaminophen overdose. Ann of Emerg Med. 1994;23(3):519-23.
  6. Tsai V. Tricyclic Antidepressant Toxicity. http://emedicine.medscape.com/article/819204-overview. Updated July 13, 2016. Accessed April 24, 2017.
  7. Wolf S. Clinical policy: critical issues in the management of patients presenting to the emergency department with acetaminophen overdose. Ann of Emerg Med. 2007;50(3):292-313.