Emergency Medicine at HCMC
History and Physical Exam
A. Obtain ingestion history including amount and type of pills, time
of ingestion, other drugs involved including alcohol, any access to
over the counter medication.
B. History of depression or prior suicide attempts.
C. If the patient is not cooperative or gives a vague history, try calling
their house or friends and you may be able to get better information.
Often the paramedics can give you a good history of what they found at
the residence.
D. On physical exam pay special attention to vital signs and mental status.
Pupils should be checked for size and reactivity. It is important to
continue to reevaluate the patients mental status.
Work-up
A. Read Dr. Ling’s packet on approach to an overdose which is in
your orientation packet.
B. Involve poison center early and they can give you recommendations
and valuable information about the drugs taken.
C. Charcoal should be given early. If the patient refuses they may need
a NG tube. If you think they are too sleepy to protect their airway when
they take the charcoal be sure to let staff or a senior know.
D. These people need to be on a hold and in restraints. The staff or
senior can sign the hold.
E. Often we obtain a Tylenol and Salicylate level/ Panel 3 on these patients.
F. They need to be on a cardiac monitor and pulse ox.
G. Continue to reassess their vital signs and mental status.
Disposition
A. If after observation the decision is made that they are stable then
the patient should be transferred to CIC. Call crisis at 73161 then
fill out the CIC transfer form.
B. Admitted for monitoring – most patients go to the MICU, discuss
with staff or the senior resident.
For more information contact Richard
O. Gray MD.
Emergency
Medicine main page
Copyright © 2000 HCMC Emergency Medicine. All rights reserved.
Manual last modified: Wednesday May 07, 2003.
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