SAQ 437 – Paediatrics – GHB overdose with attempted absconding

Paediatrics – GHB overdose with attempted absconding.

a. Complications

• Coma or marked sedation.
• Agitation, confusion, behavioural disturbance, or fluctuating conscious state.
• Respiratory depression, hypoxia, or respiratory failure.
• Loss of airway reflexes or airway obstruction.
• Vomiting and aspiration.
• Hypotension.
• Secondary injury, trauma, or sexual assault.

b. Intubation indications

• Inability to maintain the airway, stridor, or loss of airway reflexes with obstruction.
• Hypoxia.
• Respiratory failure or inadequate ventilation.
• Aspiration.
• Severe agitation or behavioural disturbance that cannot be safely managed otherwise.
• Concern for head injury requiring CT or definitive airway control.

c. Sequential response

• Call security/Code Grey early to maintain safety.
• Use verbal de-escalation and attempt to redirect the patient.
• Enlist family or friends if immediately available and appropriate.
• Use physical restraint if needed to prevent harm.
• Use chemical restraint if less restrictive measures fail or are unsafe.