ITC Slide Redesign Competition: WINNER! (Badria Al Hatali, MD)
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ITC Slide Redesign Competition: WINNER! (Badria Al Hatali, MD)

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The April 2014 International Teaching Course held a Slide Redesign Competition, hosted by Dr. Stacey Poznanski

The April 2014 International Teaching Course held a Slide Redesign Competition, hosted by Dr. Stacey Poznanski

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  • History Often unreliable <br /> Rely on EMS, bystanders, family members and other physicians <br /> Where are the bottles? <br /> Psychiatric files <br /> The environmental setting Check pockets, bags, belongings <br /> Environmental factors e.g. (Factory, Gas space heater in winter – think CO!!) <br />
  • Vital signs are very important: <br /> Hyperthermia (ASA, cocaine, anticholinergics) <br /> Hypothermia (opiates, barbiturates and sedatives) <br /> HTN (cocaine, amphetamines, sympathomimetics) <br /> Hypotension (calcium channel and beta blockers) <br /> Tachycardia <br /> bradycardia (Clonidine, Organophosphates) <br /> Hypoxemia <br /> Blood glucose (hypoglycemia from sulfonylureas, insulin overdose) <br />
  • Miosis (clonidine, barbiturates, opiates, cholinergics, pontine stroke) <br /> Myosis (sympathomimetics, anticholinergic) <br />

ITC Slide Redesign Competition: WINNER! (Badria Al Hatali, MD) ITC Slide Redesign Competition: WINNER! (Badria Al Hatali, MD) Presentation Transcript

  • BEFORE
  • ED Approach to theED Approach to the Overdose PatientOverdose Patient
  • HistoryHistory  Often unreliableOften unreliable  Rely on EMS, bystanders, family members andRely 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 signsPhysical 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)  TachycardiaTachycardia  bradycardia (Clonidine, Organophosphates)bradycardia (Clonidine, Organophosphates)  HypoxemiaHypoxemia  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 barbituratesTreat 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 TheED Approach to The Overdose PatientOverdose Patient
  • HistoryHistory Paramedics Empty bottles Psychiatric Files Bystanders/ Family Environment
  • Physical exam: Vital signsPhysical exam: Vital signs
  • Glucocheck!Glucocheck! Glucocheck!Glucocheck! Glucocheck!Glucocheck!
  • Physical Exam (Neuro)Physical Exam (Neuro)
  • Examine the PUPILSExamine the PUPILS
  • Muscular rigidity FOCUS ON Myoclonus Seizures