Medical

Overdose / aspiration risk

Before / During / After / Pitfalls

Before

• Assess reversible tox causes and naloxone/glucose as appropriate.
• Prepare suction x2, lateral positioning if vomiting, and BVM/airway adjuncts.
• Preoxygenate despite poor cooperation when possible.

During

• Suction aggressively before and during laryngoscopy.
• Avoid gastric insufflation; gentle BVM if needed.
• Confirm placement and protect against aspiration during transition.

After

• Ventilate based on tox physiology; avoid unnecessary hyperoxia.
• Treat aspiration, toxidrome, hypothermia, rhabdo, or co-ingestions.
• Plan sedation carefully; intoxication does not equal analgesia/sedation.

Pitfalls

• Dirty airway without suction.
• Assuming all obtunded patients need the same ventilator plan.
• No post-intubation sedation because patient was “overdosed.”