Makindo Medical Notes

Initial Assessment and Emergency Management

• Primary Survey (ABCs):
  • A: Ensure the airway is clear and patent.
  • B: Monitor breathing and administer oxygen if needed.
  • C: Check circulation; manage hypotension or shock with IV fluids.
• Vital Signs Monitoring: Continuous monitoring of blood pressure, heart rate, respiratory rate, and oxygen saturation.
• Neurological Examination: Assess Glasgow Coma Scale (GCS) to determine consciousness level.
• Blood Tests:
  • Complete blood count (CBC), liver and renal function tests
  • Serum electrolytes, glucose, and arterial blood gases (ABGs)
  • Toxicology screening to identify ingested substances
• ECG: Electrocardiogram to check for any arrhythmias, especially for substances affecting cardiac function (e.g., tricyclic antidepressants).
• Decontamination:
  • Activated Charcoal: If the patient presents within 1 hour of ingestion and it is deemed safe.
  • Gastric Lavage: Rarely used, only in cases of life-threatening overdoses within 1 hour of ingestion.

Drugs that need a level measured

Specific Medical Management Based on the Drug Type

• Paracetamol Overdose:
  • Administer N-acetylcysteine (NAC) as an antidote to prevent liver damage.
  • Monitor liver function and clotting factors.
• Opioid Overdose:
  • Administer naloxone as a reversal agent for opioid toxicity.
  • Monitor respiratory function and provide airway support if necessary.
• Benzodiazepine Overdose:
  • Administer flumazenil as an antidote, with caution to avoid withdrawal seizures.
  • Monitor for signs of respiratory depression.
• Tricyclic Antidepressant (TCA) Overdose:
  • Treat arrhythmias with sodium bicarbonate if QRS is prolonged.
  • Administer benzodiazepines for seizures.

Drugs and antidotes

Psychiatric Assessment and Management

• Psychiatric Evaluation:
  • Assess the patient's mental health status and the intent behind the overdose.
  • Establish any underlying psychiatric disorders (e.g., depression, anxiety, bipolar disorder).
  • Evaluate the risk of suicide or further self-harm.
• Involvement of Mental Health Professionals: Referral to a psychiatrist or mental health crisis team for a comprehensive psychiatric assessment.
• Support and Counseling: Immediate psychological support and counseling to address underlying issues and prevent future incidents.
• Risk Assessment: Assess the need for hospital admission based on the patient's mental state, support system, and risk of repeated overdose.
• Inpatient Care:
  • Admit to a psychiatric facility if there is high risk of recurrent overdose or suicidal intent.
  • Implement a safety plan, including constant monitoring if necessary.

Follow-Up Care and Discharge Planning

• Discharge Criteria:
  • Stabilized medical condition.
  • Completed psychiatric evaluation with appropriate follow-up care planned.
• Follow-Up Psychiatric Care:
  • Arrange outpatient psychiatric follow-up for ongoing mental health support.
  • Provide contact information for crisis intervention services and mental health hotlines.
• Substance Use Treatment:
  • Referral to addiction services if overdose was related to substance misuse.
  • Consider rehabilitation or therapy for long-term recovery.
• Family and Social Support:
  • Involve family members or caregivers in the patient’s recovery plan.
  • Educate the patient and family about warning signs of relapse or further self-harm.