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