Drug overdose situation.....

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Specializes in New Grad.

You enter a patients room to find him lying on the floor semi-comotose with pin-point pupils, shallow respirations and diaphoretic. His HR 142, RR, 10, BP 100/60. What would you do? What would you expect the doctor to do? What medications and actions would you expect to be given?

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Specializes in ER, LTC, IHS.

What is your guess? Is this homework?

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Specializes in Anesthesia.
You enter a patients room to find him lying on the floor semi-comotose with pin-point pupils, shallow respirations and diaphoretic. His HR 142, RR, 10, BP 100/60. What would you do? What would you expect the doctor to do? What medications and actions would you expect to be given?

Is there a reason for all the different clinical scenarios you are posting? Are these real patients?

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seems like someone is either trying to get help with homework or is looking for answers for potential board questions

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Specializes in Pediatrics.

3 postings on clinical senarios = time to read your textbook

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Specializes in New Grad.

No it's not a HW question....none of them are. I have already graduated and have my RN. The problem is I graduated a couple years ago and I am just now looking for a nursing job and I'm rusty so I need help. I already took one refresher course that did not have clinicals. I am going to take a course with clinicals in February. But in the meantime, I am reading up on nursing scenarios and trying to get help with my critical thinking skills....

I am rusty on hospital policies and procedures, what the standing orders might be, and things of that nature as I have not been in a hospital in awhile.....can I find that in a book somewhere? I will be glad for the recommendations....

I will post MY answer to this later, and if anyone would like to respond and help me make my answers BETTER, that would be great :)

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How about a WAG from a nursing student? Narcan IM?

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
You enter a patients room to find him lying on the floor semi-comotose with pin-point pupils, shallow respirations and diaphoretic. His HR 142, RR, 10, BP 100/60. What would you do? What would you expect the doctor to do? What medications and actions would you expect to be given?

You're not going to find one "right" answer, or even truly consistent answers to any of these (beyond the obvious, like ABCs). If you are interested in general ED nursing information, etc., your best bet would be to check out the ENA's Core Curriculum or Sheehy's Guide to Emergency Nursing. An NCLEX review book might also help you. Good luck.

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Specializes in Anesthesia.
You enter a patients room to find him lying on the floor semi-comotose with pin-point pupils, shallow respirations and diaphoretic. His HR 142, RR, 10, BP 100/60. What would you do? What would you expect the doctor to do? What medications and actions would you expect to be given?

The intial actions never really change in an emergency:

Airway: How is the person's airway? They are breathing 10bpm, so you assume the airway is patent.

Breathing: Slow but adequate, but there isn't an SaO2 so how is cap refill/skin color etc.

Circulation: BP is low normal, but this may or may not be adequate for this particular patient.

1. Can the person maintain their own airway, if not it needs to be secured by artifical means...ie. intubated. If the patient is moaning, coughing, mumbling, talking then the airway is probably ok for the moment.

2. Need to check labs ASAP: 1st lab you need to check is blood glucose, and at the same time an IV should be started with a full "rainbow" for labs (chemistry, drug panel, CBC, coags. etc.).

3. Depending on your blood glucose results....I would expect the APN or physician to go ahead and titrate in a small amount of narcan if there is a positive response (pt gets better) you have a good idea that it is an opioid overdose.

If there was no response to narcan then you would expect to titrate in romazicon to treat for benzodiazepine overdose. The two most likely causes are opioid and benzodiazepine overdose. Note: hypoglycemia will usually result in dilated pupils not miosis, but since the patient might be on drugs that constrict the pupils (ie. eye drops for glaucoma) then you always have to rule out severe changes in blood glucose.

Things could change depending on further information you receive.

Other causes of miosis:

Horner's syndrome

Benzodiazepines

Opoids

Myotic drugs

Neurosyphillus

Uveitis

Pontine infarct

Inflammatory adhesions between iris and lens

http://www.wrongdiagnosis.com/symptoms/pupil_constriction/causes.htm

Just remember the plan never really changes prioritize (ABCs/life threatening emergencies 1st and then work from there).

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Specializes in Anesthesia.
How about a WAG from a nursing student? Narcan IM?

When at all possible narcan should be titrated in to effect. Usually, we dilute in 10ml of NS and give 1ml or 40mcg at a time.

Here are some of the side-effects of narcan (mostly d/t not titrating it in):

Adverse events associated with the postoperative use of NARCAN are listed by organ system and in decreasing order of frequency as follows:

Cardiac Disorders: pulmonary edema, cardiac arrest or failure, tachycardia, ventricular fibrillation, and ventricular tachycardia. Death, coma, and encephalopathy have been reported as sequelae of these events.

Gastrointestinal Disorders: vomiting, nausea

Nervous System Disorders: convulsions, paresthesia, grand mal convulsion

Psychiatric Disorders: agitation, hallucination, tremulousness

Respiratory Thoracic and Mediastinal Disorders: dyspnea, respiratory depression, hypoxia

Skin and Subcutaneous Tissue Disorders: nonspecific injection site reactions, sweating

Vascular Disorders: hypertension, hypotension, hot flushes or flushing.

http://www.rxlist.com/narcan-drug.htm

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

As a NEW nurse you really ought to:

1. BLS -If you can't get the airway tubed, do PPV with an ambu. But you ought to actually call a Code Rescue/Blue/Help. (And put in an airway adjunct in case patient does have adequate respiratory status).

2. Get the nurse who is the patient's nurse. You need to know ALL the history.

You can assume OD, but I would never assume anything.

3. To also very that the patient was in narcotized, advanced care would involve a stat ABG.

Just a couple of extra things....

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Specializes in New Grad.

hank you very much for the help :)

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