Substance Abuse and Toxicology Emergencies

Substance Abuse and Toxicology Emergencies Union Hospital

History of Present Exposure • Basic Information • Name and amount of substance • Time of exposure • First aid measures initiated prior to arrival in ED • Current symptoms • Situation prior to the event: traumatic, medical or psychological factors

Type of Exposure • Inhalation • Ingestion • Dermal • Ocular • Parenteral

Reason for Exposure • Accidental • Intentional: suicide attempt or abuse

Occupational or Hobbies • Chemical exposure • Pesticide application • Stained Glass Worker (lead) • Pain stripper (Methylene Chloride and Carbon Monoxide

Institute Appropriate Interventions • Maintain ABC’s • Provide Gastrointestinal Decontamination to prevent absorption

Gastric Lavage • Use 36-40 FR orogastric hose 500-3000 ml fluid • Consider intubation if the patient requires airway protection secondary to respiratory depression • Patient should be on left side position to minimize risk of aspiration • Do not use orogastric tube if patient has intact gag reflex • Continue to lavage until the contents return to clear • Contraindications: ingestion of caustics, co-ingestion of sharp objects, non-toxic ingestions

Charcoal Administration • Dose depends on patient’s weight and is 50-100 G per kg • Administer orally or via lavage tube • Multiple dose charcoal may be helpful in specific overdoses • Contraindications: corrosive ingestion, decreased or absent bowel sounds, toxins not bound by charcoal (metal, iron)

Ocular Decontamination • Ensure provider protective gear is used • Remove all contaminated clothing • Immediately flush area with saline/water and soap, particularly for caustic exposures, includes the hair and under the nails

Promote Excretion • Cathartic administration • Mix and administer with charcoal orally or via lavage tube (magnesium citrate) • Contraindication: caution in absent bowel sounds, especially in peds or elderly • Avoid patients with pre existing renal impairment or heart failure

Urine Alkalization • The use of sodium bicarbonate is contraindicated in • Pulmonary edema • Renal failure

Antidote Therapy • Oxygen for carbon monoxide (CO) • Naloxone for opiates • Atropine/Pralidoxime for organophosphates • Cyanide antidote kit for cyanide • Flumazenil for benzodiazepines • Chelation therapy for heavy metal poisoning

Procedure/Skills • Poison Control • Gastric Lavage • Urine Drug Screen/Rapid Drug Screen • Opiates, TCA, Benzodiazepines, Marijuana, Cocaine, Amphetamines, Methamphetamines, Barbiturates

Substance Abuse and Toxicology Emergencies