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Toxicology > 1. Management of the poisoned patient I. Mechanisms of death due to poisoning, initial management of the poisoned patients > Flashcards

1. Management of the poisoned patient I. Mechanisms of death due to poisoning, initial management of the poisoned patients Flashcards

1
Q

Give some examples of drugs and side effects (cause of death) in intoxicated patients?

A
  1. Sedative-hypnotics and opioids can cause respiratory depression, coma and aspiration of gastric contents.
  2. Cocaine, phencyclidine (PCP), tricyclic antidepressants, theophylline can cause seizures that can lead to vomiting and aspiration of gastric contents.
  3. Tricyclic antidepressants, cardiac glycosides can cause dangerous arrhythmias.
  4. Acetaminophen, mushroom (Amanita phalloides), certain inhalants, heavy metals directly damage the liver and kidney.
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2
Q

What are the management procedures of poisoned patients?

A
  1. Maintenance of vital functions:
    • Airway
    • Breathing
    • Circulation (Rhythm, Blood pressure)
    • Dextrose (Intravenous 50% dextrose, because of the danger of brain damage from hypoglycemia, Thiamine should be administered to prevent Wernicke’s syndrome) or Decontamination
  2. Identification of the toxic substance: toxic syndromes, physical examination, certain laboratory examinations
  3. Decontamination
  4. Enhancement of elimination
  5. Administration of a specific antidote: substance that counteracts the effect of a poison.
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3
Q

You find someone face down on the floor, or slumped over in bed or in his chair, he doesn’t respond you shake his shoulder, he doesn’t rouse. You quickly begin assessing ABCD and start to Stabilize the patient and determine the cause…List the different causes of this type of situation? (Hint: the H’s and the T’s)

A

The H’s include: (6)

  1. Hypovolemia
  2. Hypoxia
  3. Hydrogen ion (acidosis)
  4. Hyper-/hypokalemia
  5. Hypoglycemia
  6. Hypothermia

The T’s include: (5)

  1. Toxins
  2. Tamponade (cardiac)
  3. Tension pneumothorax
  4. Thrombosis (coronary and pulmonary)
  5. Trauma
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4
Q

What is the ABCD assessment?

A

A - Airway

B - Breathing

C - Circulation

D - Disability

*E - Exposure

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5
Q

What are the toxic features of Acetaminophen?

A
  1. Mild anorexia
  2. Nausea
  3. Vomiting
  4. delayed jaundice
  5. heptic failure
  6. renal failure
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6
Q

What are the toxic features of Botulism?

A
  1. Dysphagia
  2. dysarthria
  3. ptosis
  4. ophthalmoplegia
  5. muscle weakness
  6. incubation period: 12-36h
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7
Q

What are the toxic features of carbon monoxide poisoning

A
  1. coma
  2. metabolic acidosis
  3. retinal hemorrhages
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8
Q

what are the toxic features of cyanide poisoning?

A
  1. Bitter almond odor
  2. seizures
  3. coma
  4. abnormal ECG
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9
Q

What are the toxic features of Ethylene glycol

A
  1. Renal failure
  2. crystals in urine
  3. increased anion and osmolar gap
  4. initial cns excitation
  5. eye examination normal
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10
Q

What are the toxic features of iron?

A
  1. Bloody diarrhea
  2. coma
  3. radioopaque material in gut (seen on x-ray)
  4. high leukocyte count
  5. hyperglycemia
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11
Q

What are the toxic features of lead?

A
  1. abdominal pain
  2. hypertension
  3. seizures
  4. muscle weakness
  5. metallic taste
  6. anorexia
  7. encephalopathy
  8. delayed motor neuropathy
  9. changes in renal and reproductive function
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12
Q

What are the toxic features of Lysergic Acid (LSD)?

A
  1. Hallucinations
  2. dilated pupils
  3. hypertension
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13
Q

What are the toxic features of Mercury poisoning?

A
  1. Acute renal failure (AKI)
  2. tremor
  3. salivation
  4. gingivitis
  5. colitis
  6. erethism (fits of crying, irrational behaviour)
  7. nephrotic syndrome
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14
Q

What are the toxic features of Methanol intoxication?

A
  1. Rapid respiration
  2. visual symptoms
  3. osmolar gap
  4. severe metabolic acidosis
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15
Q

What are the toxic features of Mushroom poisoning (Amanita phalloides type)?

A
  1. Severe nausea and vomiting 8h after ingestion; delayed hepatic and renal failure
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16
Q

What are the toxic features of Phencyclidine (PCP)?

A
  1. Coma with eyes open
  2. horizontal and vertical nystagmus
17
Q

What are the clinical features of Antimuscarinic drugs ( anticholinergics)?

A
  1. delirium, hallucinations, seizures, coma
  2. tachycardia
  3. hypertension
  4. hyperthermia
  5. mydriasis
  6. decreased bowel sounds
  7. urinary retention
18
Q

What are the clinical features of Cholinomimetic drugs (Carbamate or organophosphate cholinesterase inhibitors)?

A
  1. Anxiety, agitation, seizures, coma
  2. bradycardia or tachycardia
  3. pinpoint pupils
  4. salivation
  5. sweating
  6. hyperactive bowel
  7. muscle fasciculations
  8. then paralysis
19
Q

What are the clinical features of Opioids (eg, morphine, heroin, methadone)?

A
  1. lethargy, sedation, coma
  2. bradycardia
  3. hypotenison
  4. hypoventilation
  5. pinpoint pupils
  6. cool skin
  7. decreased bowel sounds
  8. flaccid muscles.
20
Q

What are the clinical features of Salicylates (eg, aspirin)?

A
  1. confusion, lethargy, coma, seizures
  2. hyperventilation
  3. hyperthermia
  4. dehydration
  5. hypokalemia
  6. anion gap metabolic acidosis.
21
Q

What are the clinical features of Sedative-hypnotics (barbiturates, benzodiazepines, ethanol)?

A
  1. Disinhibition initially, later lethargy, stupor, coma.
  2. nystagmus is common
  3. decreased muscle tone
  4. hypothermia
  5. small pupils
  6. hypotenison
  7. decreased bowel sounds in severe overdose.
22
Q

What are the clinical features and key interventions of Stimulants (amphetamines, cocaine, phencyclidine (PCP))?

A
  1. CNS: Agitation, anxiety, seizures
  2. hypertension
  3. tachycardia, Arrhythmias.
  4. Mydriasis, vertical and horizontal nystagmus with PCP.
  5. skin warm and sweaty, hyperthermia
  6. increased muscle tone, possible rhabdomyolysis
23
Q

What are the clinical features of Tricyclic Antidepressants?

A
  1. Antimuscarinic effects.
  2. The 3 C’s of coma, convulsions, cardiac toxicity (widened QRS, arrhytmias, hypotension).
24
Q

What are the key interventions of Cholinomimetic drugs (Carbamate or organophosphate cholinesterase inhibitors)?

A
  1. Support respiration.
  2. Treat with atropine and pralidoxime.
  3. Decontaminate.
25
Q

What are the key interventions of Antimuscarinic drug (anticholinergics) overdose?

A
  1. Control hyperthermia
  2. Physostigmine may be helpful, but not for tricyclic overdose.
26
Q

What are the key interventions of Opioids (eg, morphine, heroin, methadone)?

A
  1. Provide airway and respiratory support.
  2. Give naloxone as required.
27
Q

What are the key interventions of Salicylates (eg, aspirin)?

A
  1. Correct acidosis and fluid and electrolyte imbalance.
  2. Alkaline diuresis or hemodialysis to aid elimination.
28
Q

What are the key interventions of Stimulants (amphetamines, cocaine, phencyclidine (PCP))?

A

Control seizures, hypertension and hyperthermia

29
Q

What are the key interventions of Sedative-hypnotics (barbiturates, benzodiazepines, ethanol) overdose?

A
  1. Provide airway and respiratory support.
  2. Avoid fluid overload.
  3. Consider flumazenil for benzodiazepine overdose.
30
Q

What are key interventions for Tricyclic Antidepressant overdose?

A
  1. Control seizures.
  2. Correct acidosis and cardiotoxicity with ventilation, sodium bicarbonate, and norepinephrine (for hypotension).
  3. Control hyperthermia.

Toxicology (20 decks)

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