# Overdose & poisoning

Support ventilation first, then identify the opioid, stimulant, cholinergic, or smoke-exposure pathway.

Population: Adult / adolescent. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See linked source for document revision and implementation dates..
Canonical page: https://www.ocmedic.com/guides/poisoning/
Official source: [SO-M-050 — Substance Overdose / Poisoning - Adult / Adolescent](https://www.ochealthinfo.com/sites/hca/files/2021-10/SO-M-50%20Poisoning%20OD.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Key cautions & base contact

- Protect rescuers from exposure and use the exposure-specific source.
- Do not mistake successful opioid reversal for resolution of all toxicologic risk. Pediatric poisoning uses different doses and SO-P-085.

## Source documents

- [SO-M-050 — Substance Overdose / Poisoning - Adult / Adolescent](https://www.ochealthinfo.com/sites/hca/files/2021-10/SO-M-50%20Poisoning%20OD.pdf)

## Initial support

- Assist ventilation with BVM and suction as needed. Give oxygen for room-air SpO₂ below 95% using the source’s mask or cannula options.
- Check glucose and treat qualifying hypoglycemia with the source’s oral glucose, D10, or glucagon pathway. For systolic BP below 90 with clear lungs, give 250 mL saline boluses up to 1 L.
- The detailed poisoning order has condition-specific access and treatment exceptions; do not treat this overview as an exposure-specific toxicology protocol.

## Suspected opioid toxicity

- With respiratory depression at 12/min or fewer, give naloxone 0.8, 1, or 2 mg IN/IM, or 0.4–1 mg IV. Repeat every 3 minutes as needed to maintain breathing; the source also lists a 4 mg preloaded nasal spray.
- Continue respiratory support and reassess after every dose.

## Stimulant or organophosphate exposure

- For stimulant toxicity, monitor breathing, oxygenation, temperature, and perfusion. Cool when hyperthermia is suspected and use the relevant seizure/sedation instructions with airway readiness.
- For suspected organophosphate toxicity, SO-M-050 lists atropine 2 mg IV or IM, repeating once as needed. Bronchospasm, seizures, and DuoDote use have additional source-specific pathways.

## Smoke, cyanide & dystonic reactions

- Suspected CO toxicity requires high-flow oxygen. For suspected cyanide toxicity, including concerning plastic/hydrocarbon smoke, hydroxocobalamin 5 g IV/IO over 15 minutes requires a base order.
- For an extrapyramidal/dystonic reaction, diphenhydramine 50 mg IM/IV once is listed.
- Provide ALS escort to the nearest ERC or contact base as needed; communicate exposure details, treatment, and response.