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Ottawa Inner City Health December 2008 Suspected Drug Overdose TIPS Background the majority of clients/patients who are admitted to OICH are living with concurrent disorder. The staff may expect that clients will suffer periods when their mental health and/or substance use will be unstable as indicated by behaviors which range from excessive sleeping to aggression. 1) When staff observes behavior which they find concerning they should try to assess the patient and gather information about recent events which might contribute to a better understanding of what is occurring. 2) When there is reason to suspect that recent drug or alcohol use may be the cause of the behavior staff should try to find out as much as possible about the substance and the quantity used. Assessment Tips Depressants (Opiates, benzodiazapams and alcohol) If the person has taken too many opiates they tend to be sedated, pupils are often pinpoint size. The greatest danger from opiate overdose is respiratory arrest so it is important to count how many times a minute they are breathing, if they are a normal skin colour and if you can get them to wake up. Opiates can be very slow acting so the person may seem ok at first and then slip deeper and deeper. People who are at highest risk are those who are not used to taking opiates and those who have been off them (ie in jail) for a while. These people have poor capacity to tolerate high doses of opiates. Valium and other benzodaizapines like Ativan also have a sedating effect and it can be hard to know what people have taken when you assess them however, the assessment and the danger signs are the same. Alcohol is also a depressant however; there are special concerns when people have been drinking that they may vomit and then breath vomit into their lungs. For any situation where the client appears to under the influence of some depressant you should be concerned when you observe: Stupor, coma or the person cannot be roused-call nurse on call Slow Breathing (less than 8 times per minute) or irregular breathing (more than 10 seconds between breaths)-call nurse on call Bluish skin colour, paleness-call nurse on call Vomiting when unconscious-call 911 Seizures-refer to emergency plan and if unexpected for this client, call 911 In any situation where you are concerned you can give the client oxygen at 1.5 L per minute while waiting for other help. Ottawa Inner City Health December 2008 It is never a good idea to recommend to a client who has a long term problem with the use of any depressant that they stop “cold turkey” without having a medical person assess their risk and planning for their care. When the depressant effect is removed abruptly from the body, the brain may become over stimulated leading to seizures and even death. Methadone is particularly dangerous because it is so long acting and hard to reverse. A dose of 50 mg of Methadone could kill an adult who has not taken opiates before. It is normal for people to be much sleepier than usual when their Methadone dose is adjusted and you may even see them sleeping when they are sitting up or eating. This is not a concern as long as they are breathing well and you can rouse them when you need to. This effect wears off in a day or so. Stimulants (Crack, Cocaine etc) The signs and symptoms of cocaine or crack overdose are quite different from depressant overdose. These drugs are powerful stimulants so the signs of overdose include both the psychological and stimulant effects of the drug on the brain. The classic signs are high blood pressure with a fast heart rate and increased breathing. A high temperature can occur. Normally you will also see agitation, confusion, irritability, and sweating. Seizures can occur. Cocaine overdose can also look like a heart attack with chest pain. They think this is because the drug causes a spasm in the heart and the heart cannot cope because it is so stimulated. Stroke is rarer but can occur. If you are concerned you need to call the nurse on call. Sometime sedation is given with valium or another medication to reduce the agitation, irritability, and prevent seizures. Tylenol can be given for elevated body temperature. For any situation where the client appears to under the influence of some stimulant you should be concerned when you observe: Heart rate greater than 110 beats per minute-call nurse on call Fever greater than 38.0 C-Call nurse on call Seizures-refer to emergency plan and if not expected for this client call 911 prior to notifying the nurse on call Complaints of chest pain-call 911