Poisoning & Overdose — Emergency Nursing Guide

Initial Assessment — ABCDE Primary Survey

A — Airway

Assess patency; suction secretions
GCS <8 or inability to protect — consider intubation
Position: recovery position if semi-conscious
Corrosive ingestion: avoid NG tube until assessed

B — Breathing

RR, SpO2, auscultation bilaterally
Opioid: bradypnea/apnoea — naloxone
Salicylate: tachypnoea/Kussmaul breathing
Apply 15L O2 via NRB if CO suspected

C — Circulation

HR, BP, capillary refill, ECG — 12 lead stat
QTc prolongation: TCA, antipsychotics, antihistamines
Wide QRS (>120ms): TCA — give NaHCO3
Bradycardia: beta-blocker, CCB, digoxin, organophosphate
IV access x2 large bore; bloods including paracetamol/salicylate levels

D — Disability (Neuro)

GCS — document fully (E/V/M)
Pupils: pinpoint (opioid/organophosphate) vs dilated (anticholinergic/sympathomimetic)
BM — hypoglycaemia common (ethanol, insulin, salicylate)
Seizures: benzodiazepine first-line

E — Exposure & Environment

Full skin exam — patches, injection sites, burns
Temperature: hyperthermia (serotonin/NMS/anticholinergic) vs hypothermia (opioid/ethanol)
Decontaminate skin if organophosphate exposure (PPE for staff)
Remove contaminated clothing

Bloods to Request

FBC, U&E, LFTs, coagulation, glucose, lactate, ABG
Paracetamol + salicylate levels (all deliberate overdoses)
Ethanol level, urine drug screen
ECG, CXR if aspiration risk

Toxidrome Recognition Guide ▼

Sympathomimetic

Agents: cocaine, amphetamines, MDMA

HR: Tachycardia BP: Hypertensive

Pupils: Dilated (mydriasis)

Temp: Hyperthermia Skin: Diaphoretic

Mental: Agitation, psychosis

Bowel: Hyperactive

Rx: Benzo for agitation, cooling

Cholinergic (SLUDGE/DUMBELS)

Agents: Organophosphates, carbamates

HR: Bradycardia BP: Hypotension

Pupils: Pinpoint (miosis)

Secretions: Salivation, lacrimation, urination, defecation, emesis, bronchospasm

Muscle: Fasciculations, weakness

Rx: Atropine + Pralidoxime

Anticholinergic

Agents: TCA, antihistamines, atropine, hyoscine

HR: Tachycardia BP: Variable

Pupils: Dilated Skin: Dry/flushed

Temp: Hyperthermia Bowel: Ileus

Mental: Confusion, delirium, hallucinations

Mnemonic: "Blind as a bat, dry as a bone, red as a beet, mad as a hatter"

Opioid

Agents: Morphine, codeine, heroin, fentanyl, tramadol

HR: Bradycardia BP: Hypotension

Pupils: Pinpoint (miosis)

RR: Decreased/apnoea Temp: Hypothermia

Mental: CNS depression, coma

Rx: Naloxone — titrate to RR

Sedative-Hypnotic

Agents: Benzodiazepines, barbiturates, GHB, ethanol

HR: Normal/slow BP: Normal/low

Pupils: Normal RR: Decreased

Mental: Sedation, ataxia, amnesia

Note: Pupils normal distinguishes from opioid

Rx: Supportive; flumazenil (caution)

Serotonin Syndrome

Agents: SSRIs, SNRIs, MAOIs, tramadol, fentanyl, linezolid

Triad: Mental status change + autonomic instability + neuromuscular abnormality

Key features: Clonus (especially lower limb), hyperreflexia, diaphoresis, hyperthermia, diarrhoea

Note: Rapid onset (hours) — distinguishes from NMS

Rx: Cyproheptadine, cooling, benzo

Neuroleptic Malignant Syndrome

Agents: Antipsychotics (haloperidol, olanzapine), metoclopramide

Onset: Days to weeks (slower than serotonin)

Features: Hyperthermia, "lead-pipe" rigidity, autonomic instability, elevated CK

Labs: Raised CK, leukocytosis, elevated LFTs

Rx: Stop antipsychotic, dantrolene, bromocriptine

History Taking — AMPLE + Tox

Agent

Name, formulation (IR vs modified-release)
Prescription vs OTC vs illicit
Any packaging available — bring to ED

Amount & Time

Estimated dose/number of tablets
Time of ingestion (single event vs staggered)
Staggered overdose: paracetamol nomogram unreliable

Route

Oral, IV, inhalation, transdermal, rectal

Co-ingestion

Alcohol commonly co-ingested — increases toxicity
Multiple agents alter clinical picture

Intent & Context

Deliberate self-harm vs accidental vs occupational
Witness history if patient unable to give history

Resources & Monitoring

TOXBASE / Poisons Information

TOXBASE (UK): toxbase.org — primary clinical resource
UAE: National Poison Control Centre — integrated into DHA/MOH systems
GCC hospitals should have 24hr poisons info access
Call toxicology/pharmacy for complex cases

ECG Monitoring — Key Findings

Finding	Consider
QTc >500ms	TCA, antipsychotic, antihistamine, methadone
Wide QRS >120ms	TCA, flecainide — give NaHCO3
Bradycardia/AV block	Beta-blocker, CCB, digoxin, organophosphate
Tall T waves	Digoxin toxicity pattern
Ventricular arrhythmia	TCA, cocaine — assess QTc

Decontamination Indications

Activated charcoal: within 1 hour of significant ingestion
Whole bowel irrigation: body packers, iron, lithium, SR preparations
Skin decontamination: organophosphate, chemical exposure

Activated Charcoal — Indications & Contraindications ▼

Indications

Toxic ingestion within 1 hour (occasionally up to 2hrs for modified-release)
Adult dose: 50g orally or via NGT
Paediatric: 1g/kg (max 50g)
Effective for: paracetamol, aspirin, most drugs
Multiple-dose AC: carbamazepine, phenobarbitone, quinine, theophylline

Contraindications (CAUTION)

Unconscious — aspiration risk (unless intubated)
Corrosive — acid/alkali ingestion (obscures endoscopy)
Hydrocarbons — petrol, turpentine (aspiration pneumonitis)
Iron — not adsorbed by charcoal
Lithium — not adsorbed by charcoal
Cyanide/Alcohols — poor adsorption
Unprotected airway — ensure GCS adequate or intubate first

Nursing: Give with antiemetic (ondansetron) — charcoal causes nausea. Document exact time given vs time of ingestion. Slurry via NGT if patient refuses. Black stools expected. Monitor for aspiration.

Whole Bowel Irrigation (WBI)

Indications

Body packers — concealed drug packets
Iron overdose — not adsorbed by charcoal
Lithium — SR formulations
Modified-release preparations (SR opioids, SR CCB)
Large ingestions where charcoal contraindicated

Protocol

Agent: Polyethylene glycol (PEG) — Klean-Prep / GoLytely
Rate: 2L/hr via NGT (adults); 500ml/hr (child)
Continue until rectal effluent clear
Position: upright 45° minimum

Contraindications

Bowel obstruction, perforation, ileus
Haemodynamically unstable
Compromised airway or unprotected airway

Body packer: Do NOT attempt forceful extraction. CT abdomen to count packets. Surgical team on standby. If packet ruptures: immediate life-threatening emergency.

Gastric Lavage

Rarely Used

Indications (Narrow)

Massive potentially fatal ingestion within 1 hour
No adequate alternative (agent not charcoal-responsive)
Discuss with toxicologist before proceeding

Procedure Requirements

GCS <8: cuffed ETT must be in place first
Left lateral, head-down position
36-40Fr orogastric tube
Aliquots 250ml warm water, aspirate, repeat
Total lavage fluid: 10-15L until clear

Complications

Aspiration (most serious)
Laryngospasm, oesophageal perforation
Electrolyte imbalance, hypothermia

Ipecac Syrup & Cathartics

Ipecac Syrup: NOT RECOMMENDED — no evidence of improved outcomes, delayed charcoal administration, aspiration risk, cardiac toxicity (emetine). Withdrawn from use in most countries.

Cathartics (sorbitol/magnesium sulphate): No evidence of clinical benefit. Associated with dehydration and electrolyte imbalance. Not recommended as routine adjunct.

Paracetamol NAC Protocol — Full Detail ▼

Assessment & Nomogram

Take paracetamol level at 4 hours post-ingestion (earliest reliable time)
Plot on Rumack-Matthew nomogram
Treatment line: 150mg/L at 4 hours
If <4 hours: treat empirically if >150mg/kg or 7.5g ingested
Staggered overdose: nomogram unreliable — if any dose interval >1hr, treat if total dose >150mg/kg

Risk Factors for Increased Toxicity

Chronic alcohol use, malnutrition, eating disorders
Enzyme-inducing drugs (phenytoin, rifampicin, carbamazepine)
HIV on enzyme-inducing ART
Depleted glutathione stores

3-Bag NAC Protocol (Traditional)

Bag 1: 150mg/kg in 200ml 5% dextrose over 1 hour
Bag 2: 50mg/kg in 500ml 5% dextrose over 4 hours
Bag 3: 100mg/kg in 1000ml 5% dextrose over 16 hours
Total dose: 300mg/kg over 21 hours

SNAP Protocol (Simplified NAC)

2-bag: Loading 200mg/kg over 4 hours, then 100mg/kg over 16 hours
Reduced anaphylactoid reactions vs traditional 3-bag
Check local/regional protocol — both in use

Monitoring During NAC

LFTs, INR, U&E, creatinine at 0, 4, 16, 21 hours
If ALT rising or INR >2: extend NAC and refer hepatology
Anaphylactoid reaction: stop infusion, give antihistamine, restart at slower rate

King's College Criteria (liver transplant referral): Arterial pH <7.3 after resuscitation, OR all three of: INR >6.5 + creatinine >300 + grade III-IV encephalopathy.

Opioid Overdose

Naloxone Dosing

Route	Dose	Onset
IV	0.4–2mg, repeat q2–3min	~2 min
IM/SC	0.4–0.8mg	~5 min
Intranasal	2mg (1mg per nostril)	~8 min
Infusion	2/3 effective dose/hr	Continuous

Key Principles

Titrate to RR >12, NOT full reversal — avoids precipitating acute withdrawal
Half-life of naloxone (~60-90min) often shorter than opioid — re-dosing or infusion required
Long-acting opioids (methadone, buprenorphine, SR morphine): extended monitoring 12-24hrs
Tramadol: partial response to naloxone; also lowers seizure threshold
Fentanyl analogues: may need higher doses

Withdrawal precipitated by naloxone: agitation, tachycardia, vomiting, diaphoresis — supportive management. Withdrawal is rarely life-threatening but opioid toxicity is.

Benzodiazepine Overdose

Flumazenil — Use with Extreme Caution

Indications

Pure benzodiazepine overdose for reversal of sedation
Procedural reversal in known patients

Dose

0.2mg IV over 15 seconds, then 0.1mg q60sec up to 1mg
Short-acting: 1-2 hours — repeat dosing may be needed

CONTRAINDICATIONS: Mixed overdose (TCA co-ingestion — seizure risk), chronic benzodiazepine users (withdrawal seizures), raised ICP, known seizure disorder. Most ED overdoses: flumazenil is NOT routinely used.

Organophosphate Poisoning

Atropine Protocol

Goal: dry secretions (not pupil size or HR)
Initial: 2–4mg IV, double dose every 5 minutes until secretions controlled
Severe cases: up to 20–100mg may be required
Infusion: 10–20% of loading dose per hour
Endpoint: dry lungs on auscultation, secretions reduced

Pralidoxime (PAM)

Reactivates acetylcholinesterase — give within 24-48 hours (before ageing)
Dose: 1–2g IV over 15-30min, then 500mg/hr infusion
Effective for nicotinic (muscle weakness) effects
Does not replace atropine

Staff PPE essential. Organophosphate absorbed dermally — remove patient's clothing, wash skin with soap and water. Avoid contaminating resuscitation room.

Tricyclic Antidepressant (TCA) Overdose

Features

Anticholinergic + sodium channel blockade + alpha-blockade
Wide QRS >100ms: high-risk for arrhythmia
R wave in aVR >3mm: predictive of seizures/arrhythmia
Rapidly deteriorating — can arrest within minutes

Sodium Bicarbonate Indications

QRS >100ms or arrhythmia
Hypotension refractory to fluids
Dose: 1–2mmol/kg IV bolus, repeat to pH 7.45–7.55
Infusion: 150mmol in 1L 5% dextrose

Avoid: physostigmine (seizures), flumazenil (seizure risk), fluids alone for hypotension. Seizure: benzodiazepine first-line. Avoid phenytoin (cardiac toxicity). Early intubation if deteriorating.

Beta-Blocker & CCB Overdose

High-Dose Insulin Euglycaemia Therapy (HIET)

Dose: Insulin 1 unit/kg bolus, then 0.5–2 units/kg/hr
Dextrose 50%: 50ml bolus, then 10% dextrose infusion to maintain BM 8-14
BM every 15-30 min; K+ every 30-60 min
May take 20-30min to see effect

Additional Agents

Calcium: Calcium chloride 10ml 10% IV (CCB preferred) — repeat q10-20min
Glucagon: 5-10mg IV bolus, then 2-5mg/hr infusion (beta-blocker)
Lipid emulsion (intralipid 20%): refractory cardiac toxicity — 1.5ml/kg bolus
Atropine: Bradycardia (limited efficacy)
Pacing: Transcutaneous/transvenous if pharmacotherapy fails

Digoxin & Iron Toxicity

Digoxin — Fab Fragments (Digibind/DigiFab)

Indications: life-threatening arrhythmia, K+ >5.5mmol/L with toxicity, haemodynamic instability
Dose calculation: based on digoxin level or estimated ingestion
Empirical: 10 vials if massive OD; cardiac arrest: 20 vials
Post-Fab: digoxin levels unreliable; monitor K+ (may fall rapidly)

Iron Overdose — Desferrioxamine

Indications: serum iron >500mcg/dL, severe symptoms, acidosis
Dose: 15mg/kg/hr IV infusion (max 80mg/kg/day)
Urine: pink/rose "vin rose" colour = free iron present
Abdominal XR: radiopaque tablets visible
WBI for significant iron ingestion

Cyanide — Hydroxocobalamin

Hydroxocobalamin (Cyanokit): 5g IV over 15 min — first-line in smoke inhalation/suspected cyanide
Sodium thiosulphate: 12.5g IV — adjunct
Skin/urine turns red — warn patient
Do NOT use dicobalt edetate unless diagnosis certain (cardiac toxicity if no cyanide)

Carbon Monoxide Poisoning Protocol ▼

Pathophysiology & Presentation

CO binds haemoglobin with 240x affinity of O2 → left shift of O2-Hb curve
Symptoms vary with COHb level:

COHb %	Symptoms
10-20%	Headache, nausea, exertional dyspnoea
20-40%	Severe headache, syncope, confusion
40-60%	Seizures, coma, cardiopulmonary compromise
>60%	Fatal

Pulse oximetry UNRELIABLE — reads COHb as OxyHb. Use co-oximetry ABG for true saturation.

Treatment

100% Oxygen via NRB

Reduces COHb half-life: room air ~4-5hr → 100% O2 ~60-90min
Continue until COHb <5% and symptoms resolved

Hyperbaric Oxygen (HBO) Indications

COHb >25% at any time
Cardiac effects (arrhythmia, ischaemic ECG changes)
Pregnancy — any symptomatic CO poisoning (lower threshold)
Neurological symptoms (seizure, syncope, focal deficit)
Age >36, or COHb >25 in children

Late Neurological Sequelae

Delayed neuropsychological syndrome: 10-30% of serious poisonings
2-4 weeks after apparent recovery
Features: cognitive impairment, personality change, Parkinsonism
HBO may reduce incidence

Alcohol Poisoning

Ethanol Toxicity

CNS depression, respiratory depression, aspiration risk
Hypoglycaemia (inhibits gluconeogenesis) — BM stat
Hypothermia — monitor temperature actively
Co-ingestion common — thorough history required

Wernicke's Encephalopathy Prevention

Risk in: chronic alcohol use, malnourished, any vomiting
Give IV Pabrinex BEFORE glucose — glucose alone may precipitate Wernicke's
Pabrinex: 2 pairs (4 ampoules) IV in 100ml NaCl over 30min
Classic triad: confusion + ophthalmoplegia + ataxia (often incomplete)
If in doubt: give thiamine — it is safe

Methanol / Ethylene Glycol

High anion gap metabolic acidosis, raised osmolar gap
Methanol: visual disturbance, papilloedema
Antidote: Fomepizole (4-methylpyrazole) — blocks alcohol dehydrogenase
Ethanol infusion if fomepizole unavailable
Haemodialysis for severe acidosis or visual loss

Lithium Toxicity

Features

Acute: GI (nausea/vomiting/diarrhoea) — relatively protected from CNS
Chronic: neurological features dominate — tremor, confusion, seizures, nephrogenic DI
Acute on chronic: mixed picture, most dangerous

Levels & Management

Level (mmol/L)	Action
1.5–2.0	Mild toxicity — monitoring, fluids
2.0–2.5	Moderate — IV fluids, WBI if SR tablets
>2.5 or symptomatic	Haemodialysis consideration

Haemodialysis Indications

Level >4 mmol/L regardless of symptoms
Level >2.5 with severe symptoms (seizures, coma)
Renal failure preventing excretion
Rebound rise after HD — repeat sessions may be needed

Salicylate (Aspirin) Poisoning

Clinical Features

Early: tinnitus, deafness, nausea, vomiting
Hyperventilation → respiratory alkalosis → metabolic acidosis
Hyperthermia, diaphoresis, dehydration
Severe: confusion, pulmonary oedema, CNS depression — very high mortality

Key Investigations

Serial salicylate levels (q2h) — levels may rise with SR formulations
Levels >700mg/L (symptomatic) or >900mg/L: haemodialysis
ABG: respiratory alkalosis + metabolic acidosis
Glucose (hypoglycaemia in CNS despite normal plasma glucose)

Urinary Alkalinisation

Target urine pH 7.5–8.5 — ionises salicylate, prevents renal reabsorption
Sodium bicarbonate 225mmol in 500ml 5% dextrose over 3hrs
Add 40mmol KCl — hypokalaemia prevents alkalinisation
Monitor urine pH hourly; serum K+ 2 hourly

Haemodialysis Indications

Salicylate level >900mg/L (6.5mmol/L)
Severe metabolic acidosis not responding
Acute kidney injury
Pulmonary oedema, CNS toxicity
Unable to tolerate alkalinisation (heart failure)

Risk Assessment After Overdose

Immediate Medical Assessment

Medical stability must be established before psychiatric assessment
Paracetamol level in all deliberate overdoses regardless of stated dose
Document time of ingestion, agent, amount, circumstances

Suicide Risk Factors

Previous attempts (strongest predictor)
Male sex, age >45, social isolation
Mental illness (depression, psychosis, substance use)
Lethal method, planning, leaving note
Expressed intent to die; no regret
Access to means (stockpiling, weapons)

Protective Factors

Social support, family engagement
Future orientation, reasons for living
Help-seeking behaviour, ambivalence
Religious/cultural beliefs against suicide

Capacity Assessment for Treatment Refusal

Mental Capacity Assessment (4-Stage Test)

Understand the information provided
Retain it long enough to make decision
Weigh up the information
Communicate a decision

Key Principles

Capacity is decision-specific and time-specific
Assume capacity unless proven otherwise
Impaired capacity from drugs/alcohol/medical condition: treat in best interests
Document assessment fully including reasoning
Involve senior clinician and legal/ethics if contentious

Refusing NAC for paracetamol overdose: assess capacity; if lacking, treat. If patient has capacity, document refusal, explore reasons, contact psychiatry. Never abandon patient.

Psychiatric Assessment & Referral

Collaborative Approach

Psychiatric liaison team involvement: all deliberate self-harm
Assessment should not be rushed due to ED pressures
Private, quiet space — trauma-informed communication
Avoid judgement; use open questions
Paracetamol with intent vs impulsive: risk stratification differs

MHAA Referral (Mental Health Act Assessment)

Indicated when patient poses imminent risk and lacks capacity or refuses
Involves Approved Mental Health Professional (AMHP) + 2 doctors
Section 5(2): nurse holding power (up to 6 hours in inpatient)
Document all observations, clinical reasoning, communication

Safe Prescribing Post-Discharge

Limit quantities: paracetamol 16 tablets OTC; prescription limited quantities
Blister packs rather than bottles — reduces impulsive access
Safety plan with patient before discharge
Crisis line numbers provided

Safeguarding & CAMS Framework

Safeguarding Vulnerable Adults

Older adults, those with learning disability, domestic abuse victims
Coercion or control by others (forced ingestion)
Refer to safeguarding team before discharge
Document: who was present, who accompanied patient

Children & Adolescents (CAMHS/CAMS)

CAMS (Collaborative Assessment and Management of Suicidality) framework
Age-appropriate communication; involve parents/carers appropriately
Gillick competence for 16+ or mature minor
School-age: safeguarding referral, liaise with paediatric team
Never discharge a child at risk without CAMHS review

Psychological First Aid in ED

Look, Listen, Link — immediate psychosocial support
Normalise distress; non-judgmental language
Avoid repeated retelling of traumatic history in ED
Ensure physical privacy; offer food/water
Peer support workers valuable in some settings

GCC-Specific Poisoning Contexts

Organophosphate Poisoning

Significant in South Asian migrant agricultural workers across GCC states
Common agents: chlorpyrifos, malathion, diazinon (crop pesticides)
Occupational exposure + accidental self-poisoning
Language barrier may delay history — use interpreters
Cultural stigma may delay seeking care

Domestic Workers & Medication Overdose

Paracetamol and TCA overdose reported in domestic worker populations
Social isolation, labour exploitation, limited healthcare access as risk factors
Human rights and safeguarding considerations
Notify social work / embassy liaison as appropriate

Carbon Monoxide from Gas Heaters

CO poisoning from unventilated gas heaters in workers' accommodation
Multiple casualties possible — co-workers affected simultaneously
Winter months: highest risk in GCC states
Mass casualty protocol if group presentation

GCC-Specific Clinical Considerations

Heat Stroke vs Drug Hyperthermia

Feature	Heat Stroke	Drug Hyperthermia
Context	Exertion, hot environment	Drug ingestion history
Sweating	Absent (classic)	Present (serotonin/sympathomimetic)
Skin	Hot, dry	Variable (anticholinergic: dry)
Neuromuscular	Absent clonus	Clonus/rigidity (serotonin/NMS)
CK	Elevated	Elevated (NMS, serotonin)

Ramadan Fasting & Medication Error

Timing confusion with dose schedule during fasting hours
Insulin: hypoglycaemia risk from missed meals
Twice-daily medications taken together at Iftar or Suhoor
Modified-release: doubling of doses
Proactive patient education before Ramadan — pharmacist-led medication review
Nurse's role: identify unintentional overdose presentation during Ramadan

TOXBASE Access & Poison Control in GCC

UAE Resources

UAE National Poison Control Centre — DHA/MOH integrated
24hr telephone toxicology advisory available in major UAE hospitals
TOXBASE (UK) accessible in many GCC hospital formularies via subscription
Clinical pharmacist toxicology support in tertiary centres

Regional Contacts

Saudi Arabia: King Faisal Specialist Hospital Poison Control Centre
Kuwait: Kuwait Poison Control Centre
Qatar: Hamad General Hospital Emergency Toxicology

Nursing Documentation in GCC Context

Document capacity assessment and consent in all overdose cases
Psychiatric referral pathway — note local HAAD/DHA protocol
Immigration/visa status does not affect right to emergency care
Interpreter services: document language used and interpreter ID
Cross-border medications: unfamiliar formulations — use TOXBASE

DHA / DOH / SCFHS Exam Preparation

NAC Protocol — Exam Key Points

Take paracetamol level at 4 hours minimum
Treatment line: 150mg/L at 4 hours
3-bag protocol total dose: 300mg/kg over 21 hours
Bag 1: 150mg/kg over 1 hour
Staggered OD: treat if >150mg/kg regardless of level
King's College Criteria: pH <7.3 OR INR >6.5 + Cr >300 + encephalopathy grade III-IV

Antidote Matching — High Yield

Paracetamol → NAC (acetylcysteine)
Opioid → Naloxone
Organophosphate → Atropine + Pralidoxime
TCA → Sodium bicarbonate
Digoxin → Fab fragments
Benzo → Flumazenil (with caution)
CO → 100% O2 / HBO
Iron → Desferrioxamine
Cyanide → Hydroxocobalamin
Beta-blocker/CCB → HIET / Calcium / Glucagon

Activated Charcoal — Exam Traps

NOT for: iron, lithium, alcohols, corrosives, hydrocarbons
Dose: 50g adults, 1g/kg children
Within 1 hour of ingestion
Unconscious = contraindicated unless intubated

Flumazenil Cautions

Never give in mixed overdose with TCA
Seizure risk in chronic benzo users
Short-acting — re-sedation possible

Naloxone Key Points

Titrate to RR not full reversal
Long-acting opioids: infusion needed
Half-life shorter than most opioids

Interactive Antidote Matcher

Select a poisoning agent to view the specific antidote, dosing, monitoring, and key nursing actions.