Protocol 2-638 - Overdose / Toxic Ingestion

CMH EMS & MIH Protocols

EMD:

• Dispatch a non-dedicated standby ambulance to all hazmat releases where emergency response is required by other agencies.

EMR:

• Consider hazmat and DECON. Refer to Protocol 2-924 - Universal Patient Care for decontamination protocols.
• Caustic material or chemical burns: Refer to Protocol 2-176 - Burns.
• Excited delirium or anxiety due to recreational medication or overdose: Refer to Protocol 2-110 - Behavioral.
• Identify possible causes and substance(s) involved.
• Consider Oxygen 100%.
• Paraquat poisoning: Only administer Oxygen if SpO2 is less than 88%.
• Consider applying Cardiac Monitor limb leads.
• Narcotic overdose with respiratory depression and unable to ventilate:
• Note: Narcan administration should be limited to "last resort" situations and only after risk/benefit has been assessed regarding potential violent patient after administration.

• Adult:	Pediatric:
  Narcan 0.2-0.4 mg IN. Repeat as necessary to maintain airway, SpO2, and ETCO2	Narcan 0.1 mg/kg IN. Repeat as necessary to maintain airway, SpO2, and ETCO2 Click "calculate" to get dose.

EMT:

• Ensure completion of applicable items above.
• Perform Blood Sugar Check.
• Consider assisting ALS with Capnography.

AEMT:

• Ensure completion of applicable items above.
• Consider IV NS/LR.
• Narcotic overdose with respiratory depression and unable to ventilate: Narcan IV/IM/SQ same doses as EMT above.

RN:

• Ensure completion of all applicable items above.
• Contact POISON CONTROL at 888-268-4195.
• Consider IO NS/LR.
• If suspected intentional poisoning or overdose: MANDATORY ALS patient and pre-hospital IV or IO access is REQUIRED.
• Consider Protocol 2-044 - Airway: RSI.
• Beta-blocker overdose:
• Refer to Protocol 2-154 - Bradycardia.
• Consider contacting MEDICAL CONTROL for:

• Adult:	Pediatric:
  Glucagon 2-5 mg IV/IO. Repeat at 10 mg if Bradycardia or hypotension occur.	25-40 kg: Glucagon 1 mg IV/IO (max 20 mg/kg or 1 g). Less than 25 kg: Glucagon 0.5 mg IV/IO (max 20 mg/kg or 1 g).

• Calcium channel blocker overdose:
• Consider contacting MEDICAL CONTROL for:

• Adult:	Pediatric:
  Calcium Chloride 50 mg/min (max 1 g).	NA.

• Caustic substance ingestion:
• Consider contacting MEDICAL CONTROL for water or milk ingestion within a few minutes immediately after ingestion.

• Adult:	Pediatric:
  Max 8 oz.	Max 4 oz.

• Monoamine Oxidase Inhibitor (MAOI) overdose:
• Hyperthermia: Contact MEDICAL CONTROL for Versed 0.1 mg/kg in 2 mg increments slow IV/IO (max 5 mg). Half dose if over 65 years old.
• Click "calculate" to get dose.
• Click "calculate" to get dose.
• Narcotic overdose:
• Narcan IV/IO/IM/SQ same doses as EMR above.
• Selective Serotonin Reuptake Inhibitor (SSRI) overdose:
• Aggressively control Hyperthermia with active cooling measures.
• Hypotension: LR IV/IO 20 ml/kg.
• Click "calculate" to get dose.
• Contact MEDICAL CONTROL.
• Tricyclic Antidepressant overdose:
• Hypotension: LR IV/IO 20 ml/kg.
• Click "calculate" to get dose.
• QRS greater than 100 ms: Contact MEDICAL CONTROL for Sodium Bicarbonate 1-2 mEq/kg IV/IO. Repeat as necessary to narrow QRS and improve BP.
• Click "calculate" to get dose.

Medic:

• Ensure completion of all applicable items above.

CP:

• Ensure completion of all applicable items above.

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