Master the board step 3

Section 10
Emergency Medicine/
Toxicology
General Management of Overdose Patient
A 46-year-old woman is brought to the emergency department by her husband
after a suicide attempt. She is confused, lethargic, and disoriented. Her respiratory
rate is 8 per minute, and her blood pressure is 120/80 mm Hg. What is the
most important step?
a. Oxygen
b. Bolus of normal saline
c. Naloxone, thiamine, dextrose
d. Endotracheal intubation
e. Gastric emptying
f. Urine toxicology screen
Answer: C. The most important step for an acute change in mental status of unclear
etiology is to administer antidotes such as naloxone, dextrose, and thiamine. Oxygen
does not make a specific difference. Gastric emptying is not as useful as a specific antidote
and should only be used if it is very clear that the overdose occurred during the
last hour. When you have an acute change in mental status, hypoglycemia is a very
common cause, as is an opiate overdose. On a CCS case, give naloxone, thiamine, and
dextrose and give oxygen and saline while checking the toxicology screen—all at the
same time.
When do I answer “gastric emptying”?
This response is almost always wrong. Gastric emptying is only useful in the
first hour after an overdose.
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1 hour: 50 percent of pills can be removed
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1–2 hours: 15 percent of pills can be removed
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2 hours: It is useless
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