Obtain history of incident and substance involved; transport any bottles or containers with patient to medical facility.
Obtain vital signs and repeat at regular intervals until arrival at medical facility.
Perform a focused physical examination including:
a. Baseline neurologic status
b. Lung sounds
c. Abdominal examination (including bowel sounds)
d. Skin assessment
Mandatory interventions:
a. Cardiac monitoring
b. Oxygen
c. IV access
d. Rapid glucose testing
If poisoning/overdose is via INHALATION, administer high-flow oxygen and transport. Check for CO poisoning with RAD-57, if suspected.
If poisoning/overdose is via INGESTION with any of the following substances, follow the appropriate protocol below.
a. Beta blocker
b. Calcium channel blocker
c. Cocaine/amphetamines
d. Narcotic/opiate
e. Tricyclic antidepressants
If poisoning/overdose is via DIRECT CONTACT, brush any powder substances from skin and flush with water.
DO NOT administer ipecac syrup to any patient.
If DYSRHYTHMIA is present, refer to appropriate protocol.
If RESPIRATORY DEPRESSION is present, administer NALOXONE (Narcan)
2 mg IV/IN. If + response, it may be repeated every 5 – 10 minutes as needed.
Any significantly poisoned/overdosed patient should be transported emergently to appropriate medical facility.
If overdose is suspected to be intentional, notify law enforcement.
BETA BLOCKER
If HYPOTENSION or BRADYCARDIA is present:
a. Start IV of Isotonic Solution (NS or LR) 0.9% NORMAL SALINE at a wide-open rate
b. Administer ATROPINE 0.5 mg IV every 5 minutes to keep HR > 50 bpm.
CALCIUM – CHANNEL BLOCKER
If HYPOTENSION or BRADYCARDIA is present, administer CALCIUM CHLORIDE 10% 10 mL IV.
Start IV of Isotonic Solution (NS or LR) 0.9% NORMAL SALINE at TKO rate.
COCAINE / AMPHETAMINES
If patient is in a hyper-sympathetic state (HR > 120; SBP > 160 mm Hg; severe agitation), administer MIDAZOLAM (Versed) 2.5 – 5 mg IV.
NARCOTIC / OPIATES
If RESPIRATORY DEPRESSION or HYPOTENSION is present, administer NALOXONE (Narcan) 2 mg IV/IN. This may be repeated as needed enroute to medical facility.
Start IV of Isotonic Solution (NS or LR) 0.9% NORMAL SALINE at TKO rate.
ORGANOPHOSPHATES (Pesticides)
Observe for the symptoms of SLUDGE syndrome:
a. Salivation
b. Lacrimation
c. Urination
d. Defecation
e. Gastrointestinal cramping
f. Emesis
Administer ATROPINE 2 mg rapid IV. Repeat every 5 minutes until symptoms controlled.
EMS providers MUST protect themselves, especially if due to direct contact.
TRICYCLIC ANTIDEPRESSANTS
Examples include amitriptyline (Elavil), imipramine (Tofranil), nortriptyline (Pamelor), and amoxapine (Asendin).
Drugs such as trazadone (Desyrel), nefazodone (Serzone), bupropion (Wellbutrin), mirtazapine (Remeron), and venlafaxine (Effexor) ARE NOT tricyclic antidepressants and as such, do not have equivalent toxicity as the TCA’s. If unsure, contact Medical Control immediately.
If HYPOTENSION or HEART RATE > 150 BPM or QRS > 0.10 present, administer SODIUM BICARBONATE 1 mEq/kg IV.
Start IV of Isotonic Solution (NS or LR) 0.9% NORMAL SALINE at wide-open rate.