The April 2014 International Teaching Course held a Slide Redesign Competition, hosted by Dr. Stacey Poznanski

1. BEFORE

2. ED Approach to theED Approach to the
Overdose PatientOverdose Patient

3. HistoryHistory
 Often unreliableOften unreliable
 Rely on EMS, bystanders, family members andRely 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

4. Physical exam: Vital signsPhysical 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)

TachycardiaTachycardia

bradycardia (Clonidine, Organophosphates)bradycardia (Clonidine, Organophosphates)

HypoxemiaHypoxemia

Blood glucose (hypoglycemia from sulfonylureas,Blood glucose (hypoglycemia from sulfonylureas,
insulin overdose)insulin overdose)

5. 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)

6. 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 barbituratesTreat with benzodiazepines or barbiturates
not phenytoinnot phenytoin

7. 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

8. AFTER

9. ED Approach to TheED Approach to The
Overdose PatientOverdose Patient

10. HistoryHistory
Paramedics
Empty bottles
Psychiatric Files
Bystanders/ Family
Environment

11. Physical exam: Vital signsPhysical exam: Vital signs

12. Glucocheck!Glucocheck!
Glucocheck!Glucocheck!
Glucocheck!Glucocheck!

13. Physical Exam (Neuro)Physical Exam (Neuro)

14. Examine the PUPILSExamine the PUPILS

15. Muscular rigidity
FOCUS ON
Myoclonus
Seizures