This document discusses drug intoxication and overdose. It outlines steps for assessing and treating a patient experiencing an overdose, including maintaining airway, breathing, and circulation. Specific interventions are described such as giving naloxone for opioid overdose, dextrose for hypoglycemia, activated charcoal to prevent further drug absorption, and monitoring vital signs and labs. The goals of treatment are to support respiratory and cardiovascular functions, treat the overdose, prevent further absorption and enhance elimination of the drug.

1. Drug Intoxication
Leenard Michael A. Sajulga, RN

2. Substance abuse
• Includes the use of specific substances
that are intended to alter mood or behavior

3. Drug abuse
• The use of drugs for other than legitimate
medical purposes
• There is a growing tendency among drug
users to take a variety of drugs
simultaneously (polydrug abuse), including
alcohol, sedatives, hypnotics, and
marijuana, which may have additive
effects.

4. Drug abuse
• The clinical manifestations may vary with
the drug used but the underlying principles
of management are essentially the same.

5. PRIMARY ASSESSMENT AND
INTERVENTIONS

6. Overdose
• Refers to the toxic effects that occur when
a drug is taken in a larger-than-normal
dose.

7. • Assess the presence and adequacy of
respirations
• Attain control of the airway, ventilation,
and oxygenation
• Intubate and provide assisted
ventilation in severe respiratory-
depressed patients or in patients
lacking gag or cough reflexes

8. • If possible, intubation should be held off
until a trial dose of naloxone (Narcan) is
given
• Begin external cardiac compression
and ventilation in the absence of
heartbeat

9. SUBSEQUENT ASSESSMENT

10. • Do a thorough physical examination to
rule out insulin shock, meningitis, head
injury, stroke, or trauma.
• If the patient is unconscious, consider
all possible causes of loss of
consciousness.
• Monitor LOC continuously.

11. • Monitor vital signs frequently—some
drugs will cause depressed vital signs;
others will elevate the vital signs.
• Monitor the pupils: Extreme miosis
(pinpoint pupils) may indicate opioid
overdose.
• Look for needle marks and external
evidence of trauma.

12. • Perform a rapid neurologic survey:
Level of responsiveness, pupil size and
reactivity, reflexes, and focal neurologic
findings.
• Keep in mind that many drug abusers
take multiple drugs simultaneously.
• Be aware that there is a high incidence
of HIV and infectious hepatitis among
drug users.

13. • Examine the patient's breath for
characteristic odor of alcohol, acetone,
and so forth.
• Try to obtain a history of the drug
experiences (from the person
accompanying the patient or from the
patient).

14. GENERAL INTERVENTIONS

15. • Goals:
– Support the respiratory and cardiovascular
functions.
– Give definitive treatment for drug
overdose.
– Prevent further absorption, enhance drug
elimination, and reduce its toxicity.
• Measure ABGs for hypoxia due to
hypoventilation or for acid-base
derangements.

16. • Continuously monitor ECG.
• Draw blood samples for testing
glucose, electrolytes, BUN, creatinine,
and appropriate toxicologic screen.
• Initiate I.V. fluids.
• Administer oxygen.

17. • Pharmacologic interventions:
– Give specific drug antagonist if drug is
known.
– Naloxone (Narcan) for CNS depression due
to opioids.
– Dextrose 50% I.V. to rule out hypoglycemic
coma.
• If the drug was taken by mouth, the
primary method for preventing or
minimizing absorption is to administer
activated charcoal.

18. – Multiple doses may be administered
– A routine NG tube may be inserted to
facilitate emptying of stomach contents
(without lavage) within 30 minutes of
ingestion; or, charcoal may be instilled if
the patient is unable to drink.

19. • In unconscious or semi-conscious
patients who are or may be lacking gag
or cough reflexes, use an NG tube only
after intubation with cuffed
endotracheal tube to prevent aspiration
of charcoal stomach contents.
• Take rectal temperature—extremes of
thermoregulation
(hyperthermia/hypothermia) must be
recognized and treated.

20. • Treat seizures with diazepam (Valium).
• Assist with hemodialysis/peritoneal
dialysis for potentially lethal poisoning.
• Catheterize the patient because the
drug or metabolites are excreted in
urine.

21. • Do not leave the patient alone because
there is a potential for the patient to
harm self or emergency department
staff.
• Anticipate complications—sudden death
from cerebral hypoxia, dysrhythmias,
seizures, respiratory arrest, MI.
• Always suspect mixtures of medications
and alcohol.