PAEDIATRIC

• majority of O/D's (approx 80%)
• usually accidental, peak age 2 years
• approx 10% paeds admits

ADULT

• minority of all O/D's ( 20%)
• majority admitted (90%)
• rarely accidental

O/D's & POISONING

• 1% all hospital admissions
• 10% all ICU pts.
• Mortality falling 4-5% p.a.due to prevention strategies, Poisons info centres & lines

MANAGEMENT

EVALUATION

AIRWAY

• Adequacy
• Protective reflexes
• Supplemental oxygen

BREATHING

• If inadequate intubate and ventilate prior to further Rx

CIRCULATION

• Hypotension
• Hypertension
• IV Access
• Monitor for arrhythmia

DEGREE OF CONSCIOUSNESS

• GCS is a useful guide though not specific for O/D.
• If GCS < 9 needs intubation

HISTORY OF EXPOSURE/ INGESTION

• What, When, How many, Coingestants
• Why?
• Route of exposure

PHYSICAL EXAMINATION

• A thorough head to toe assesment
• Identification of toxic syndromes
• Any obvious complications e.g.aspiration
• Coexistent diseases 

DECONTAMINATION

GASTRIC LAVAGE

• useful < 2hrs after ingestion or longer with agents that are stongly anticholinergic
• may be done in an awake pt. in left lateral with head down or in unconscious pt after intubation
• best done with wide bore Orogastric tube 36 Adult, >14 Child
• warm tap water 200ml/time until clear

INDUCTION OF EMESIS

• Ipecac syrup contains multiple alkaloids notably emetine
• dose
  • 10ml 6-18/12
  • 15ml > 18/12
  • 30ml adult
• onset emesis 10-25mins
• offset emesis 30-120+mins

CONTRAINDICATIONS TO EMESIS

• Coma, Convulsions, GCS<9
• Caustic, Corrosive or Hydrocarbon ingestion
• Rapid acting CNS stimulant e.g.strychnine, camphor, naphtha
• Rapid acting CNS depressant e.g.TCA's, Eucalyptus oil
• Anyone with impaired airway reflexes

ACTIVATED CHARCOAL

• may be given via orogastric tube
• adsorbs molecules to particle surface
• 1000(m)2/gram surface area
• proven effectiveness with many drugs
• usually mixed with a cathartic e.g. mannitol or sorbitol
• some use in repeated doses 4hrly

OTHER DECONTAMINATION

REMEMBER : EYES

REMEMBER : CLOTHING

RESPIRATORY

• VENTILATION * Supplemental O2
• AIRWAY PROTECTION *Prevent aspiration
• ANTIBIOTICS * For aspiration
• PEEP * Non cardiogenic Pulm Oedema especially with narcotics & salicylates

CARDIOVASCULAR

• MONITOR: BP, HR, U/O, ECG & EUC'S
• HYPOTENSION * Usually correctable with IV fluids, Inotropes
• HYPERTENSION * Manage with vasodilators e.g. nifedipine, diazoxide, SNIP
• BRADYCARDIA * Treat if CVS compromise with Atropine, Isopren, Pacing
• TACHYCARDIA * Treat if cvs risk with cardioversion, beta blocker or lignocaine

CNS

• DECREASED LOC * not a problem per se
• SEIZURES * must be properly controllede.g. diazepam, midazolam or clonazepam phenytoin &/or phenobarb if resistant
• BEHAVIOURAL DIFFICULTIES * usually as combativeness, aggression best Rx is physical and chemical restraint but be prepared to manage airway

DIAGNOSTIC STUDIES

BLOOD TESTS

• paracetamol 4hrs post ing
• FBC, EUC'S
• ABG's

ECG

ACTIVATED CHARCOAL

FORCED ALKALINE DIURESIS

HAEMODIALYSIS/PERFUSION

• Best suited to low MW
• water soluble
• low protein bind
• high toxicity

ASSOCIATED CONDITIONS

CHRONIC ILLNESS

TRAUMA

ENVIRONMENTAL INFLUENCES

DISPOSITION

• MEDICAL FITNESS * at least alert , orientated, normal vitals, no neuroabnormality, no ongoing complications
• PSYCHIATRIC FITNESS * able to be safely discharged with appropriate F/U
• FORMAL SUICIDE RISK ASSESMENT

Lismore Base Hospital