This micro lecture is about drug overdose (OD), and managing overdose patients and forms part of the blended learning materials available to all enrolled students.
In today’s micro lecture we’re going talk about managing the overdose patient. Now, overdoses are extremely common. There are certain populations who are more vulnerable to overdoses than others, but regardless of the population you’re serving, it’s the paramedic’s role to work out quite a few different things, including what the patient has taken, when they took it, why they took it. And to work out if there’s anything you as a paramedic you can do to be able to help resolve that situation temporarily in an acute manner
So, when you arrive on scene at an overdose, of course you have to follow your primary survey, because you have to be mindful that it might not be a safe environment. In the cases that I’ve been to, there’s generally been two types of overdose. There are those patients who have taken illegal drugs such as heroin, cocaine, street drugs, and there have been those cases whereby people have taken pharmaceutical drugs that have been prescribed by their GP.
So there are at least two different cases where you’re going to present, and regardless of each one, you have to make sure it’s safe. And in my experience, generally speaking, they have been safe on all occasions but I’m sure there are anecdotal experiences whereby permits have not been set, so safety is paramount.
You follow in your primary survey. Really, that is the key to managing the situation, danger, response, “Hello, can you hear me,” “Open your eyes,” because at this point, it doesn’t matter what drug they’ve taken. Airway, what’s the airway doing? Head tilt chin lift. While you’re doing all this, you’re listening to the bystanders who are telling you, “Look, they’ve taken this, they’ve taken it then and they’re taking so much, there’s a suicide note.” Maybe there’s not a suicide note.
And again, you gotta use this to help you to determine what you’re gonna do next, whilst at the same time not be distracted by what you’re doing, which is tipping their head back, getting the tongue off the back of the airway, checking to see if they’re breathing.
Because if they’re not breathing, you’re gonna need to do bag-valve-mask ventilation for them, and of course, establishing cardiac arrest is really, really important, too, because if they’re not breathing, they look like they’re hypoxic, no signs of life, not moving, then of course you would establish cardiac arrest and get on to the chest, according to the Australian Resuscitation Council Guidelines.
Once you’ve established the A, Bs, and Cs, at some point in that situation, dependent on whether they’re conscious or unconscious, just depend on what you do next. If they’re unconscious, and you know that they’ve taken sedatives, for example, let’s just go with heroin or codeine or morphine, because they all come from the same family, you can actually give Narcan according to your guidelines.
Let’s say, for example, someone’s is conscious and breathing and they’re taking these drugs, again, you still need Narcan but you need to manage it in a slightly different way, because they’re not …
..Unlikely they’re gonna let you go near them because they’ve paid a lot of money for that fix and they don’t want you to ruin it. If your patient’s taken stimulants, for example, cocaine, some of the services will allow you to give sedatives, such as benzodiazepines to try and relax the patient and to try and sedate them, others don’t.
So it very much does determine on the scope of practice indicated by your ambulance service, but regardless of what’s occurring in terms of which drug and what scope of practice you’ve got, the way of managing an overdose is do your primary survey, listen to the history, work out the nature of the drug, work out if the patient’s got an ABC problem.
If they have, deal with that first, if they haven’t, you can move on to the secondary survey, and try and convey to hospital if it’s indicated.
You can see how the primary survey and the secondary survey and mnemonic, which is something we keep talking about time and time again, is so important for you guys as paramedics and early practitioners, and even experienced practitioners.
So, that’s drug overdose. I hope you’ve enjoyed this session and I look forward to speaking to you again shortly, Take care, bye-bye.