Primary Survey (ABCDE):
- 🫁 A – Airway: Clear airway; protect cervical spine if trauma suspected.
- 🌬️ B – Breathing: Assess rate, SpO₂; give oxygen if hypoxic.
- ❤️ C – Circulation: BP, HR, IV access; give IV fluids if shocked.
- 🧠 D – Disability: GCS/AVPU; check blood glucose.
- 👕 E – Exposure: Look for needle marks, rashes, burns, tablets.
📊 Vital signs: Continuous ECG, BP, RR, SpO₂.
🧠 Neurology: GCS or AVPU assessment.
🧪 Bloods: CBC, U&E, LFT, glucose, ABG, toxicology screen.
📈 ECG: Check QRS/QT (esp. TCAs, digoxin, hyperkalaemia).
🧴 Decontamination:
- Activated charcoal if <1 hr post-ingestion & airway safe.
- Gastric lavage – rare, only life-threatening ingestion within 1 hr.

📏 Drugs that Need Serum Levels

💊 Substance	🔎 What it shows	⚠️ Why it matters	🩺 Use/Indication
Carboxyhaemoglobin	Hb bound to CO	Carbon monoxide poisoning	CO poisoning diagnosis/monitoring
Digoxin	Cardiac glycoside	Narrow therapeutic index → arrhythmias	AF, heart failure
Ethanol	Competitive ADH substrate	Antidote in methanol/ethylene glycol poisoning	Toxic alcohol ingestion
Iron	Essential mineral	Toxic in overdose → shock, liver failure	Iron OD, haemochromatosis
Lithium	Mood stabiliser	Neuro-renal toxicity if high	Bipolar disorder
Methanol	Toxic alcohol	Blindness, metabolic acidosis	Industrial/antifreeze poisoning
Paracetamol	Analgesic	Dose-dependent hepatotoxicity	Pain, fever
Salicylate	Aspirin	Mixed acid–base disorder, tinnitus	Pain, antiplatelet

💊 Specific Medical Management

Paracetamol: N-acetylcysteine (NAC) within 8 hrs; monitor INR, LFTs.
Opioids: Naloxone (IV/IM); repeat if needed; monitor airway/respiratory rate.
Benzodiazepines: Flumazenil (caution – can trigger seizures in mixed OD).
TCA overdose: Sodium bicarbonate if QRS >100 ms; benzodiazepines for seizures.

🧯 Poisons & Antidotes (Key Examples)

☠️ Poison	🛡️ Antidote
Paracetamol	N-acetylcysteine
Opioids	Naloxone
Benzodiazepines	Flumazenil
Digoxin	Digoxin Fab fragments
Iron/Aluminium	Deferoxamine
Beta-blockers	Atropine, glucagon
CCBs	Atropine, calcium gluconate, high-dose insulin
Organophosphates	Atropine + pralidoxime
Cyanide	Hydroxocobalamin, sodium thiosulfate
Methanol / Ethylene glycol	Fomepizole or ethanol
Warfarin	Vitamin K1 (phytomenadione)

🧠 Psychiatric Care

⚡ Risk assessment: intent, method, support system.
👩‍⚕️ Crisis team/psychiatry referral for suicide/self-harm risk.
💬 Counselling & safety plan (remove access to meds/means).
🏥 Admit if: high risk of repetition, unsafe home environment, severe psychiatric illness.

📅 Follow-Up & Discharge

✅ Criteria: Medically stable + psychiatric plan in place.
📞 Follow-up: Crisis team, GP, outpatient psychiatry.
🧑‍🤝‍🧑 Family support: Involve relatives, educate on relapse signs.
🚭 Substance use: Refer to addiction services if alcohol/drug-related.

💡 Exam Pearl: Always think ABCDE first, then drug-specific antidotes. A negative paracetamol level does not rule out staggered ingestion → always treat if uncertain.

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Drug Overdose Adults

🚨 Initial Assessment and Emergency Management

📏 Drugs that Need Serum Levels

💊 Specific Medical Management

🧯 Poisons & Antidotes (Key Examples)

🧠 Psychiatric Care

📅 Follow-Up & Discharge

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