OPIOIDS

ICP IM naloxone AP

ICP Follow with IV naloxone

CARDIO-ACTIVE MEDICATIONS (anti-arrhythmics; β blockers; antipsychotics; anti-depressants)

ICP 12 lead ECG AP

ICP Treat seizures first with midazolam AP

ICP Treat wide QRS with sodium bicarbonate 1mMol/kg until QRS narrows

ICP Decreased LOC – consider hyperventilation AP

ICP Cardiac arrest associated with these agents is prolonged – always administer sodium bicarbonate

ICP Consider the risks associated with transport without ROSC

ORGANOPHOSPHATES

ICP Take care not to become contaminated AP

ICP Consider the possibility of other affected workers, occupants or first-aiders

AP

ICP Where feasible – remove contaminated clothing, wash skin with soap and water

AP

If cholinergic effects are present (salivation, sweating, nausea, bradycardia):

ICP administer IM atropine (no upper limit on doses) or

AP

ICP administer IV atropine – doubling each repeat dose (1mg → 2mg → 4mg → 8mg)

(no upper limit on doses)

ICP Ensure hospital is notified of contaminated patient AP

continues over

CMG 35 – POISONING, ENVENOMATION AND OVERDOSE (Revised: January 2010)

ACT Ambulance Service Clinical Management Guidelines Uncontrolled when printed. The latest version of this document is available on the ACT Ambulance Service internet site.

ENVENOMATION

ICP Do not wash bite site AP

ICP Utilise pressure / immobilisation technique if appropriate, using wide elasticised bandage

AP

ICP Treat signs and symptoms as they arise (e.g. cholinergic symptoms with some

spider bites)

AP

ICP Identification – the creature should be brought to the hospital, but only if this can be done

safely

AP

ICP DO NOT rely on non-expert identification AP

ICP With the positive identification of a red back spider, pressure immobilisation is not required. Iced compresses should be applied to the area

(but not directly onto the skin)

AP

CARBON MONOXIDE / SMOKE INHALATION

ICP Beware of hazards – self-asphyxiation and/or explosion. Remove patient from danger

AP

ICP Treat according to respiratory distress or upper airway obstruction guideline

AP

ICP 100% oxygen with PEEP if carbon monoxide is suspected

AP

ICP Consider the possibility of other affected workers, occupants or first-aiders

AP

ICP Any person who has suffered an inhalation injury of toxic substances is to be

transported to hospital (pulmonary oedema may be a late complication)

AP

ICP Urgently transport if there is a decreased level of consciousness

AP

CMG 35 (cont) – POISONING, ENVENOMATION AND OVERDOSE

ACT Ambulance Service Clinical Management Guidelines Uncontrolled when printed. The latest version of this document is available on the ACT Ambulance Service internet site.