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By Kevin Thomas Collopy, BA, CCEMT-P, NREMT-P, WEMT Over-the-Counter Th y’re asy to btain and can have ngerous effects. r They’re easy to obtain and can have dangerous eff cts. H ’ to look for and d Here’s what t l r do… We were called at 2 a.m. to a university apartment for a 21-year-old female who had overdosed. We arrived on scene to ﬁnd a very distraught woman. After a ﬁght with her boyfriend earlier in the evening, she had swallowed several handfuls of ibuprofen. She insisted she was ﬁne now, that she didn’t take that many countries. Hundreds of different nonprescription medicines and that it was “just ibuprofen,” and she had no interest in are available. This article discusses assessment and treatment going to the hospital. However, when I assessed the young considerations for overdoses of four of the most commonly woman, her vitals were elevated, and she was slightly diapho- abused OTC drugs. retic. Was she just worked up from her ﬁght, or was there something medically wrong? Was she right that ibuprofen RISK FACTORS wouldn’t hurt her? Could we safely sign her off? Nonprescription medications are easy to obtain. Thus, they Over-the-counter (OTC) drug abuse is on the rise. Since are appealing to youth: Adolescents are the most common 2000 there has been a fourfold increase in abuse of cold over-the-counter drug abusers, and they often combine OTC medicine. Nonsteroidal anti-inﬂammatory drugs (NSAIDS) drugs with street drugs and alcohol. Teen OTC drug abuse are the third most commonly intentionally overdosed medi- often occurs in fads, as groups of teens discover the effects cine. Acetaminophen overdose is responsible for the greatest of the drugs together. number of drug overdose hospital admissions in developed Not all overdoses are intentional. Some are accidental, and 78 OCTOBER 2009 EMS www.emsresponder.com drug overdoses many patients are at risk of greater prevents effective function. As a result, phase 4. Fortunately, most patients’ adverse effects from regular doses a toxic metabolite forms, which binds symptoms are completely resolved in of OTC drugs. For example, alcohol with proteins in the liver, resulting in roughly three weeks. consumption creates a synergistic cellular death, which eventually leads effect with many medications, espe- to liver necrosis. CASE #2: AMS cially NSAIDs. Patients over 60 addi- Patients with acetaminophen You receive a midmorning call tionally risk gastrointestinal bleeding toxicity go through four phases. for a child with an altered mental from even regular doses of NSAIDs. GI Phase 1 occurs during the first 24 state. The patient’s mother tells you bleeding can also develop from NSAID hours following ingestion. During her 8-year-old son stayed home from overdose when a patient is on blood this time the patient may be asymp- school because his allergies were thinners or has a history of ulcers. As with many medical problems, the very young and very old suffer the worst tomatic, but may also have loss of appetite, malaise, diaphoresis, pallor and complain of nausea and making him sick. Although he’s been taking Benadryl, he seems to be getting worse. The boy began complaining of “toxicity, of In cases consequences. Nearly half (46%) of all vomiting. blurred vision 15 minutes ago. He is antihistamine overdoses involve chil- Phase 2 occurs 18–72 hours after confused and resists help. His skin is half-life dren under 6. ingestion. During this time, patients very hot and dry to the touch, and you doubles, often complain of right upper quadrant notice a half-empty box of Benadryl CASE #1: SEVERE PAIN pain with tenderness upon palpation. on the ﬂoor nearby. You start supple- keeping A nervous mother calls you for her Nausea, vomiting and appetite loss mental oxygen and obtain vitals: son, who recently broke his leg. Your worsen. Patients may also present with pulse 142, BP 86/62, respirations 28 the drug in 16-year-old patient is lying on the couch, tachycardia and hypotension. and shallow. The child has acciden- the system complaining of
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