1. Drug Intoxication
Leenard Michael A. Sajulga, RN

2. Substance abuse
• Includes the use of specific substances
that are intended to alter mood or behavior

3. Drug abuse
• The use of drugs for other than legitimate
medical purposes
• There is a growing tendency among drug
users to take a variety of drugs
simultaneously (polydrug abuse), including
alcohol, sedatives, hypnotics, and
marijuana, which may have additive
effects.

4. Drug abuse
• The clinical manifestations may vary with
the drug used but the underlying principles
of management are essentially the same.

5. PRIMARY ASSESSMENT AND
INTERVENTIONS

6. Overdose
• Refers to the toxic effects that occur when
a drug is taken in a larger-than-normal
dose.

7. • Assess the presence and adequacy of
respirations
• Attain control of the airway, ventilation,
and oxygenation
• Intubate and provide assisted
ventilation in severe respiratory-
depressed patients or in patients
lacking gag or cough reflexes

8. • If possible, intubation should be held off
until a trial dose of naloxone (Narcan) is
given
• Begin external cardiac compression
and ventilation in the absence of
heartbeat

9. SUBSEQUENT ASSESSMENT

10. • Do a thorough physical examination to
rule out insulin shock, meningitis, head
injury, stroke, or trauma.
• If the patient is unconscious, consider
all possible causes of loss of
consciousness.
• Monitor LOC continuously.

11. • Monitor vital signs frequently—some
drugs will cause depressed vital signs;
others will elevate the vital signs.
• Monitor the pupils: Extreme miosis
(pinpoint pupils) may indicate opioid
overdose.
• Look for needle marks and external
evidence of trauma.

12. • Perform a rapid neurologic survey:
Level of responsiveness, pupil size and
reactivity, reflexes, and focal neurologic
findings.
• Keep in mind that many drug abusers
take multiple drugs simultaneously.
• Be aware that there is a high incidence
of HIV and infectious hepatitis among
drug users.

13. • Examine the patient's breath for
characteristic odor of alcohol, acetone,
and so forth.
• Try to obtain a history of the drug
experiences (from the person
accompanying the patient or from the
patient).

14. GENERAL INTERVENTIONS

15. • Goals:
– Support the respiratory and cardiovascular
functions.
– Give definitive treatment for drug
overdose.
– Prevent further absorption, enhance drug
elimination, and reduce its toxicity.
• Measure ABGs for hypoxia due to
hypoventilation or for acid-base
derangements.

16. • Continuously monitor ECG.
• Draw blood samples for testing
glucose, electrolytes, BUN, creatinine,
and appropriate toxicologic screen.
• Initiate I.V. fluids.
• Administer oxygen.

17. • Pharmacologic interventions:
– Give specific drug antagonist if drug is
known.
– Naloxone (Narcan) for CNS depression due
to opioids.
– Dextrose 50% I.V. to rule out hypoglycemic
coma.
• If the drug was taken by mouth, the
primary method for preventing or
minimizing absorption is to administer
activated charcoal.

18. – Multiple doses may be administered
– A routine NG tube may be inserted to
facilitate emptying of stomach contents
(without lavage) within 30 minutes of
ingestion; or, charcoal may be instilled if
the patient is unable to drink.

19. • In unconscious or semi-conscious
patients who are or may be lacking gag
or cough reflexes, use an NG tube only
after intubation with cuffed
endotracheal tube to prevent aspiration
of charcoal stomach contents.
• Take rectal temperature—extremes of
thermoregulation
(hyperthermia/hypothermia) must be
recognized and treated.

20. • Treat seizures with diazepam (Valium).
• Assist with hemodialysis/peritoneal
dialysis for potentially lethal poisoning.
• Catheterize the patient because the
drug or metabolites are excreted in
urine.

21. • Do not leave the patient alone because
there is a potential for the patient to
harm self or emergency department
staff.
• Anticipate complications—sudden death
from cerebral hypoxia, dysrhythmias,
seizures, respiratory arrest, MI.
• Always suspect mixtures of medications
and alcohol.