CNS depressants (opioids, sedatives): Constricted pupils, drowsiness, weakness, coma, respiratory depression, pulmonary edema, apnea, bradycardia, hypotension, hypothermia.
CNS stimulants (cocaine, amphetamines): Dilated pupils, anxiety, agitation, HA, psychosis, tachypnea, tachycardia, dysrhythmias, HTN, CP, diaphoresis, hyperthermia.
Other toxins: Symptoms vary widely depending on type of toxin and can include weakness, fatigue, HA, dizziness, visual disturbances, nausea and vomiting, bradycardia (beta blockers), hypotension (calcium channel blockers), tachycardia (tricyclic antidepressants), abdominal pain, and AMS.
- Protect yourself from potentially aggressive Pts.
- Anticipate and prepare for respiratory and cardiovascular compromise.
- Position Pt on left side and suction airway as needed (for decreased LOC).
- Definitive treatment requires rapid identification of toxin.
- Administer STAT antidote/reversal as ordered.
Caution: Avoid use of ipecac, because vomiting may complicate or worsen clinical management of OD or poisoning.
Acetaminophen (APAP, Tylenol)
- Supportive care as indicated.
- Common antidotes:Activated charcoal and N-acetylcysteine.
Aspirin (ASA; Bayer, Excedrin)
- Supportive care as indicated.
- Common antidotes: Activated charcoal and sodium bicarbonate 8.4%.
Beta Blockers (metoprolol [Lopressor], atenolol [Tenormin])
- Supportive care as indicated. Be alert for extreme bradycardia.
- Common antidotes: Activated charcoal and glucagon.
Calcium Channel Blockers (diltiazem [Cardizem], verapamil [Isoptin])
- Supportive care as indicated. Be alert for hypotension and bradycardia.
- Common antidotes: Activated charcoal and calcium chloride 10%.
CNS Stimulants (cocaine, methamphetamine, speed, crank)
- Protect self and staff, and call for security. Pt may be hostile.
- Minimize sensory stimulation.
- Supportive care as indicated. Treat symptoms of ACS.
- Common antidotes: Activated charcoal and midazolam.
Extrapyramidal Symptoms
- Symptoms associated with phenothiazines and tranquilizers.
- Supportive care as indicated.
- Common antidote:Diphenhydramine.
Hallucinogens (LSD, PCP, some mushrooms, mescaline, THC)
- Protect self and staff; call for security. Pt may be hostile.
- Minimize sensory stimulation. Provide supportive care as indicated.
- Common antidote:Diazepam.
Narcotics/Opioids (heroin, methadone, meperidine [Demerol], oxycodone)
- Protect self and staff; call for security. Pt may be hostile.
- Be prepared to support airway and ventilations as indicated.
- Common antidote:Naloxone or nalmefene.
Sedative-Hypnotics (benzodiazepines, flunitrazepam [Rohypnol])
- Be prepared to support airway and ventilations as indicated.
- Common antidote:Flumazenil..
Tricyclic Antidepressants (nortriptyline, amitriptyline)
- Watch for tachycardia with widened QRS complex.
- Be prepared to support airway and ventilations as indicated.
- Common antidote: Sodium bicarbonate 8.4%