[Patriot007]

Great case and good overview Sdiver!

To clarify treatment as far as recent literature is concerned:

Controversial but generally, induced vomiting is no longer recommended due to the risk of aspiration.

Gastric lavage and aspiration ("stomach pumping") is only recommended if the ingestion has been within 1 hour of ingestion. Typically use a 28 French Ewald tube(Big honkin' tube!) that can only go down if patient is intubated- aspirate flush with saline then aspirate for pill fragments if you get pill fragments rinse and repeat.

Charcoal is nasty thick stuff and due to risk of dangerous aspiration is only recommended if patient has normal neurologic function or is intubated.

In the field it is important to gather evidence of co-ingestions,OTC or prescription bottles, and as much bystander info as possible so that doses can be estimated.

Lastly- aspirin in one of the drugs that can be dialyzed so mistriage to a small department where dialysis will not be possible may cost valuable time. If you have good evidence of a particular overdose discuss with medical control early. They may also give you a contingency treatment plan if the patient decompensates en route in addition to standard ACLS.