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The April 2014 International Teaching Course held a Slide Redesign Competition, hosted by Dr. Stacey Poznanski
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BEFORE
ED Approach to the ED Approach to the Overdose PatientOverdose Patient
HistoryHistory
Often unreliableOften unreliable Rely on EMS, bystanders, family members and Rely 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 signs Physical 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) Tachycardia Tachycardia bradycardia (Clonidine, Organophosphates)bradycardia (Clonidine, Organophosphates) Hypoxemia Hypoxemia 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 barbiturates Treat 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 The ED Approach to The Overdose PatientOverdose Patient
HistoryHistory
Paramedics
Empty bottles
Psychiatric Files
Bystanders/ Family
Environment
Physical exam: Vital signs Physical exam: Vital signs
Glucocheck!Glucocheck!
Glucocheck!Glucocheck!
Glucocheck! Glucocheck!
Physical Exam (Neuro) Physical Exam (Neuro)
Examine the PUPILS Examine the PUPILS
Muscular rigidity
FOCUS ON
Myoclonus
Seizures