Pharmacological Overdose Resources

Question#: 685

Question:

I was just wondering if the RPPEO would have any resources for something like a quick reference for pharmacological overdoses? I understand we can call poison control, but that takes time and details on the patient which you may or may not have (especially on route to the call). Additionally trying to find quality information online is difficult, inconsistent, and sometimes not available.

Answer:

The best resource for you on this challenging call would be the base hospital physicians. They are all emergency medicine physicians that have significant training in toxicology. They will be able to discuss further treatments, such as bicarb, that may benefit the patient. They will also be able to highlight important ECG findings and discuss potential complications such as seizures. Also worth noting, further administration of medications should be cautioned unless necessary (ex. Midazolam for seizure) to avoid further exacerbation of polypharmacy.

As you mentioned, calling the poison center can sometimes be a lengthy and frustrating process and is not ideal in the prehospital setting. The poison center is also not always familiar with our scopes of practice, the equipment and medications paramedics carry, and ultimately paramedics are unable to accept orders from them. Their website is a good reference as is life in the fast lane if you are looking for further reading on various toxicological poisonings.

Lastly, the most important thing to remember about overdoses in the prehospital setting are the management of the ABCs, supportive care, and rapid transport. As mentioned in the Medical Cardiac Arrest medical directive, consider very early transport after a minimum of one analysis in the setting of non-opioid drug overdose/toxicology.

Thank you for your MedicASK question. We appreciate your ongoing diligence towards patient care and safety.

References:
https://www.ontariopoisoncentre.ca/health-care-professionals/patient-care-resources/
https://litfl.com/tox-library/