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, fa...
Physical exam: Vital signsPhysical exam: Vital signs
 Vital signs are very important:Vital signs are very important:

Hy...
Physical exam-Neuro examPhysical exam-Neuro exam
 Level of consciousness: Glucose!Level of consciousness: Glucose!
Glucos...
Physical exam-Neuro examPhysical exam-Neuro exam
 Mydriasis (sympathomimetics)Mydriasis (sympathomimetics)
 Clonus and r...
Physical exam: Skin examPhysical exam: Skin exam
 Dry: anticholinergicDry: anticholinergic
 Diaphoretic:Diaphoretic:
cho...
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
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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

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

    1. 1. BEFORE
    2. 2. ED Approach to theED Approach to the Overdose PatientOverdose Patient
    3. 3. 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
    4. 4. 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)
    5. 5. 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)
    6. 6. 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
    7. 7. 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
    8. 8. AFTER
    9. 9. ED Approach to TheED Approach to The Overdose PatientOverdose Patient
    10. 10. HistoryHistory Paramedics Empty bottles Psychiatric Files Bystanders/ Family Environment
    11. 11. Physical exam: Vital signsPhysical exam: Vital signs
    12. 12. Glucocheck!Glucocheck! Glucocheck!Glucocheck! Glucocheck!Glucocheck!
    13. 13. Physical Exam (Neuro)Physical Exam (Neuro)
    14. 14. Examine the PUPILSExamine the PUPILS
    15. 15. Muscular rigidity FOCUS ON Myoclonus Seizures
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