1. Immediate ABCDE Assessment — Never Wait for Toxicology

When faced with a suspected or confirmed overdose on a ward, mental health unit, or ED, do not waste precious time trying to identify the exact substance before stabilizing the patient. Always perform an immediate ABCDE assessment:

• Airway (A): Is the airway compromised? Sedated or unconscious patients lose muscle tone. Prepare suction and position in the recovery position if breathing spontaneously but unresponsive.
• Breathing (B): Check respiratory rate and oxygen saturations. Respiratory depression is the classic danger sign — common with opioids and sedatives (RR < 8 breaths/min). Give high-flow oxygen via non-rebreathe mask if needed; prepare BVM ventilation.
• Circulation (C): Pulse, BP, CRT. Overdoses cause hypotension, bradycardia (beta-blockers, opioids), or dangerous tachycardia (tricyclics, stimulants). Attach ECG monitoring immediately.
• Disability (D): AVPU or GCS. Check pupils — pinpoint suggests opioids; dilated suggests stimulants or anticholinergics. Always check blood glucose — hypoglycaemia mimics or coexists with toxicity.
• Exposure (E): Look for patches (fentanyl, buprenorphine), needle marks, empty packaging, chemical burns, or unusual odours.

2. What Kind of Overdose? — Know the Scenario

3. Critical Toxins & Key Antidotes

Specialists lead definitive care — but you must recognise these high-risk presentations:

• Paracetamol: Most common deliberate overdose in the UK. Often asymptomatic initially — liver damage develops over 24–72 hours. Treatment: timed levels + IV N-acetylcysteine (NAC). Time is liver function.
• Opioids: Coma, shallow breathing, pinpoint pupils. Reversal: Naloxone — short-acting, so patient may re-narcotise. Monitor continuously; infusion often needed.
• Benzodiazepines: Drowsiness, ataxia, respiratory depression. Flumazenil reversal is possible but high-risk — may trigger seizures in tolerant users. Usually managed supportively.
• Tricyclic Antidepressants: Fast deterioration, dangerous arrhythmias, hypotension, seizures. ECG monitoring is vital — this is a medical emergency.

4. SBAR — What to Say When You Call for Help

▶ Citing This Information & Guidance Notes