Transcript Last EM Lecture - Captainjoe.info

The term drug overdose (or simply overdose or OD) describes the ingestion or
application of a drug or other substance in quantities that are excessive. An overdose is
widely considered harmful and dangerous as it can result in death
Classification
The word "overdose" implies that there is a common safe dosage and usage for the
drug; therefore, the term is commonly only applied to drugs, not poison, though it should
be noted that even certain poisons are harmless at a low enough dosage.
Drug overdoses are sometimes caused intentionally to commit suicide or as self-harm,
but many drug overdoses are accidental and are usually the result of either irresponsible
behavior or the misreading of product labels. Drug overdose often happens as a result of
the use of multiple drugs with counter indications simultaneously (for instance,
heroin/certain prescription pain medications and cocaine/amphetamines/alcohol) Usage
of illicit drugs that are of unexpected purity, in large quantities, or after a period of
abstinence can also induce overdose.
Accidental overdoses can eventuate out of a number of different causes including
overprescription, failing to recognise a drug's active ingredient, or unwitting ingestion by
children. A common unintentional overdose in young children involves multi-vitamins
containing iron
Signs and symptoms
Toxidrome
Signs and symptoms of an overdose varies depending on the drug or toxin exposure.
The symptoms can often be divided into differing toxidromes. This can help one
determine what class of drug or toxin is causing the difficulties.
A summary of the toxidromes
BP
HR
RR
Temp
Pupils
bowel sounds
diaphoresis
anticholinergic
~
up
~
up
up
down
down
cholinergic
~
~
unchanged
unchanged
unchanged
up
up
opioid
dow
n
dow
n
down
down
down
down
down
sympathomimeti
c
up
up
up
up
up
up
up
sedativehypnotic
dow
n
dow
n
down
down
~
down
down
toxidrome
The drugs or toxins which are most frequently involved in overdose and death
Acute alcohol intoxication
Ethyl Alcohol
Among Opioid overdose
Heroin
Codeine
Morphine
Methadone
Fentanyl
Hydromorphon
Among sedative-hypnotics
Among Barbiturate overdose
Amobarbital
Pentobarbital
Secobarbital
Among Benzodiazepine overdose
Diazepam
midazolam
Flunitrazepam
Nitrazepam
Temazepam
Uncategorized sedative-hypnotics
Ethchlorvynol
GHB
Glutethimide (Doriden)
Methaqualone
Ketamine
Among Stimulants
Cocaine overdose
Amphetamine overdose
Methamphetamine
Among Tobacco
Nicotine
Among Poly drug use
Drug "cocktails"
Medications/pharmaceuticals
Aspirin poisoning
Paracetamol toxicity
Tricyclic antidepressant overdose
Pesticide poisoning
Organophosphate poisoning
DDT
Diagnosis
Determination of the substance which was taken is often easy as usually the person
knows what they took. However, if they will not or cannot due to an altered level of
consciousness provide this information a search of the home or questioning of friends
and family may be helpful.
Examination for toxidromes, drug testing, or laboratory test may be helpful. Naloxone the
antidote for narcotics may be administered and if they improve it indicates this is
probably part of the overdose.
Negative drug-drug interactions have sometimes been misdiagnosed as an acute drug
overdose, occasionally leading to the assumption of suicide.
Prevention
The distribution of naloxone to injection drug users decreases the risk of death from
overdose.
Avoid the mixing depressant drugs like alcohol, barbiturates, benzodiazepines, and
opiates[7]
Management
Stabilization of the ABCs are the initial treatment of an overdose. This involves
establishing a stable airway, breathing rate and circulatory system as an essential first
step. Ventilation is considered when there is a low respiratory rate or when blood gases
show the person to be hypoxic. The next necessary step is to treat for shock.
Investigations should be carried out in labs to help identify the drug(s) at hand such as
glucose, urea and electrolytes, paracetamol levels and salicylate levels. Monitoring of
the patient should continue before and throughout the treatment process, with particular
attention to temperature, pulse, respiratory rate, blood pressure, urine output,
electrocardiography (ECG) and O2 saturation.[8]
Antidotes
Main article: Antidotes
Specific antidotes are available for certain causative agents. The overdose agent is
usually determined either via history or laboratory toxicology.
Poison control centers and Medical toxicologists are available in many areas to
provide guidance in overdoses to both physicians and the general public.
Epidemiology
The National Center for Health Statistics report that 19,250 people died of accidental
poisoning in the U.S. in the year 2004 (8 deaths per 100,000 population).[9]
In 2008 testimony before a Senate subcommittee, Medical Epidemiologist Dr. Leonard J.
Paulozzi[10] of the Centers for Disease Control and Prevention stated that in 2005 (the
most recent year for which data was available) more than 22,000 American lives were
lost due to overdoses, and the number is growing rapidly. Dr. Paulozzi also testified that
all available evidence suggests that unintentional overdose deaths are related to the
increasing use of prescription drugs, especially opioid painkillers.[11]