ASA OD

[Shelbmedic]

My first post So here we go.

Called for a 55y/o F. Intentional OD on ASA. Being told by dispatch that scene is safe no need to stage, but we sent PD due to location is 45 min from the main town. Arrived on scene @ 11:45 hrs to find a 55 y/o female inital scene safe PD on scene

Pt took 100tabs of ASA ES 500mg/tab ingested at 19:00hrs.

Pt is CAO x 4 vitals P-120 reg strong B/P 130/90, Resp-24 shallow reg, Spo2 94 on R/A C/S of 8.1mmol,Skin Pale cool sweaty.

Only other C/O of abd pain going across abd left to right 8/10. No abd distension noted no pulsating masses,Lungs clear equal bilat. no JVS no TD no CP, No N/V/D. pupils E/R @ 5mm hand and feet strong. 12 lead shows sinus tach no ectopy noted.

We were on scene with the pt 10min then transported code 1 to local hospital which is 45 min away. While in route pt states she needs to pee as she put it. The pt goes to the voids out 350cc of bright foul smelling urine and now c/o of a H/A 9/10 across her forehead. Vitals now are Hr-126 reg/strong ,Resp 24 shallow reg. B/P 188/96, Spo2 100% on 15L/min.

Pt is very restless and needs to pee every 10 min pupils are E/R 5mm. Pt was still CAOx4

we treated this pt. with Vitals o2, via nrb@15L/min, 12lead x2, 2 large bore IV 14RT AC and 16 Rt arm Heplock, Rapid transport as well we called for life flight but it was on a mission.

How would you treat?

[whit72]

How much does she weigh?

Oops guess it dosent really matter considering she took 50,000 mg. I guess she meets the 150/300mg per kg moderate toxicity theory. She fits nicely into the possibly lethal category of 500mg or over per kg

Monitor ABC's Be prepared to assist ventilations.

Call for ALS. However transport immediately.

Activated charcoal 1gm/kg if not altered.

Notify hospital.

What was her outcome.

[Lithium]

As there isn't much we could do for this patient here in Ontario, I believe your care is right on. However, why both IVs in the right arm?

Im curious ... ingestion was at 1900 hrs the previous evening? She took 100 500 mg tabs of ASA? I don't think her outlook is too good, especially with a 16 hour window. I'm actually surprised she was still conscious and alert.

Other then the care you mentioned, I'd be preparing for a full code, or at the minimum, preparing to intubate when she goes into respiratory arrest. That and renal failure, although not much we can do.

I was thinking about activated charcoal, but I think that it's way too late for her. We don't have access to it here in EMS, so I really have no idea.

If you have the abilities for a foley catheter, that may be beneficial instead of letting her micturate in a urinal.

Heh ... if she starts to develop chest pain, would you give her the standard ASA dose along with other 'MONA' drugs?

[MedicRN]

My first post So here we go.

Called for a 55y/o F. Intentional OD on ASA. Being told by dispatch that scene is safe no need to stage, but we sent PD due to location is 45 min from the main town. Arrived on scene @ 11:45 hrs to find a 55 y/o female inital scene safe PD on scene

Pt took 100tabs of ASA ES 500mg/tab ingested at 19:00hrs.

Please verify..... ingestion at 7PM (1900)?? On scene at 11:45 PM (2345) or AM (1145 the next day?). Don't think this would make much difference with a potentially lethal dose ingested.

Pt is CAO x 4 vitals P-120 reg strong B/P 130/90, Resp-24 shallow reg, Spo2 94 on R/A C/S of 8.1mmol,Skin Pale cool sweaty.

Only other C/O of abd pain going across abd left to right 8/10. No abd distension noted no pulsating masses,Lungs clear equal bilat. no JVS no TD no CP, No N/V/D. pupils E/R @ 5mm hand and feet strong. 12 lead shows sinus tach no ectopy noted.

We were on scene with the pt 10min then transported code 1 to local hospital which is 45 min away. While in route pt states she needs to pee as she put it. The pt goes to the voids out 350cc of bright foul smelling urine and now c/o of a H/A 9/10 across her forehead. Vitals now are Hr-126 reg/strong ,Resp 24 shallow reg. B/P 188/96, Spo2 100% on 15L/min.

Pt is very restless and needs to pee every 10 min pupils are E/R 5mm. Pt was still CAOx4

we treated this pt. with Vitals o2, via nrb@15L/min, 12lead x2, 2 large bore IV 14RT AC and 16 Rt arm Heplock, Rapid transport as well we called for life flight but it was on a mission.

How would you treat?

Since this is an intentional OD, scene safety is mandatory. PD should do a quick pat down.

Primary assessment = ABCs (per scenerio - airway patent, breathing (though probablly not optimally), circulation present (rapid pulse)). VS = as noted in scenerio (would have expected the BP to be HYPOtensive). Since pupils are still midsize (or larger), I'd suspect that something additional (or entirely different) was ingested.

Additional questions would include presence of hearing and vision deficits, ringing in the ears, hallucinations, dizziness, extreme thirst. Does she have a fever (despite the ASA)?

Continue to confirm level of consciousness (would anticipate a decrease in status (confusion) if it hasn't happened already).

Treatment would consist of highflow O2, large bore IV, monitor for cardiac arrhythmias and get the heck out!! What is her blood sugar?

After consult with my medical control (or your protocols may cover it), I'd consider an amp of NaHCO3 and a liter bolus of NS (provided her lungs will handle it - be on the look out for pulmonary edema).

Regardless of the elapsed time, because she apparently took 50 GRAMS of ASA (usually lethal dose depending on body weight), I'd have my intubation roll handy (with blade ready and tube selected/prepped) and be prepared for vomiting, seizures and/or coding.

In my opinion, her prognosis is rather grim............

[whit72]

I heard that sodium bicarb could be used in an salicylate overdose?

[Shelbmedic]

The Pt is 75kgs. I was ordered to give nothing in the field other than to support abc and be ready for Seizure and to intubate. Pt was becoming dizzy and had extreme thirst. 5 min out from the hospital pt became very hypotensive on me 80/0 weak radial pulse. opened IV wide open. For the medic that wondered about the time was 23:45hrs that evening that she took the od.

The pt was intubated and rushed to ICU she spent 3 weeks in ICU and was released she is now on dialysis. But has since thanked myself and my partner.

The IV's in same arm is a Protocol because the local hospital has a fit for lab work. The MCP is the head Dr. for the hospital.

The Dr. on call couldn't belive that this lady was even alive after the first night in ICU. He said another hr at home she would have been DOA.

[MedicRN]

The Dr. on call couldn't belive that this lady was even alive after the first night in ICU. He said another hr at home she would have been DOA.

Yes, she is quite lucky.

[Doczilla]

Sodium bicarb CAN be used in salicylate OD, but I would be reluctant to use it without a serum pH unless the patient is patently unstable (i.e., arresting). Bicarb alkalinizes the urine to enhance excretion and helps moderate metabolic acidosis. Salicylates cause a metabolic acidosis along with a respiratory alkalosis (central hyperventilation). They also cause hyperthermia by uncoupling oxidative phosphorylation (essentially, the electron transport chain spins its wheels producing heat instead of ATP).

Treatment is largely supportive in the prehospital environment. Prepare for respiratory failure, GI hemorrhage, and shock. Establish large bore venous access and give isotonic crystalloid if needed. MedicRN brings up a good point about noncardiogenic pulmonary edema, so be cautious about fluid. Facilitate appropriate body temperature by cooling if necessary. As they burn through their energy stores, hypoglycemia may occur, so watch this and manage it. Dialysis is the most effective way to get rid of the salicylate.

'zilla

[AZCEP]

16 hours post ingestion, I would expect her kidneys to be coming out with the urine. The metabolic acidosis should have created a Kussmaul respiratory pattern, and she should have been producing urine by the gallon. With those signs absent, it would be tough to justify giving bicarb. It's used to alkalinize the urine to help the kidneys with the acid load.

Since they weren't working too well, at this point, you would need to know the pH and PCO2 before giving it.

Rough call.

[windsong]

Her reason for taking so many? I have heard ppl who live in my best friend's appt, stories to make you ill.

One guy took windex and drank it because his wife wouldnt let him watch football.

One lady who goes by the name, Susan, drank dishwashing liquid, because she didnt get her cheque on time.

Steven is 40 something, lives with his elderly mother, he took I guess there was about 70 tablets in this bottle, it was to help with the swelling that his mother suffers with, the mg in each tablet was 20 x 70 =1400 (he's dead now). Shortly there after they buried him, his mother OD.

Henry who has schizophrenia, went off his medication when him and my best friend were living together, he said that the voices in his head told him to OD her on her meds. When I came to visit my friend and couldnt wake her, I called 911. He was taken in for questioning and released into the custody care of the medics and taken to hospital. She's alive today had I not gone over that day.

She no longer lives with him, but now he lives in the same building as her, 2 floors above and because he is a danger to himself and others, even the cops wont do a dam thing.

so what do you do with people like him?