11. Toxin/Drug Exposure

Question 1

(1 question may be included in exam r/t toxin/drug exposure.)

Toxin/Drug exposure may be accidental or intentional.

Answer 1

***Initial Management – always assess ABCs (airway, breathing and circulation)

Question 2

If the pt is comatose, be prepared to give:

Answer 2

-50% dextrose 50 mL

-thiamine 50-100 mg

-naloxone 2mg IV

Question 3

To prevent absorption of the toxin/drug,

Answer 3

give activated charcoal 1 gm/kg via gastric lavage.

-Contraindicated with hydrocarbon or corrosive
ingestions
-Not necessary for the ingestion of iron, lithium, or
alcohols.

Question 4

Facilitate the removal of the drug–

Answer 4

urine alkalization, hemodialysis

Question 5

Administer:

Answer 5

an antidote, (e.g. naloxone)

Question 6

Monitor for:

Answer 6

arrhythmias

Also monitor the urine output

Question 7

If there is a CHEMICAL EXPOSURE:

Answer 7

give an antidote (if possible), remove the chemical (if it is a powder, brush it away; if it is a liquid, flush it with saline or water).

-DO NOT RUB the affected area.

-cover the affected area with a sterile damp dressing

Question 8

Drug: Acetaminophen (Tylenol)

Signs/Symptoms:

Treatment:

Answer 8

Signs/Symptoms:
-Nausea, Vomiting, perhaps none early on
-Later RUQ pain, abnormal liver function test results,
mental status changes.

Treatment:
-N-acetylcysteine dosing is effective for 8 hours after ingestion
-140 mg/kg loading dose, then
-70 mg/kg q4h for 17 doses
-Give ALL drug doses, regardless of drug level

Question 9

Drug: Benzodiazepines

Signs/Symptoms:

Treatment:

Answer 9

Signs/Symptoms:
-Drowsiness, confusion, slurred speech, respiratory depression, hypotension, aspiration

Treatment:
-Support the airway
-Flumazenil (Romazicon)
0.2 mg slow IVP;
then 0.3 mg IV;
then 0.5 mg IV at 1-min intervals; total 3 mg.
-Flumazinal has short half-life; watch for
reoccurrence of symptoms

-Gastic lavage with activated charcoal
-Fluid resuscitation

Question 10

Drug: Beta Blockers

Signs/Symptoms:

Treatment:

Answer 10

Signs/Symptoms:
-Bradycardia
-hypotension
-CV collapse

Treatment:
-Glucagon, epinephrine, insulin plus dextrose, sodium bicarbonate

Question 11

Drug: Calcium Channel Blockers

Signs/Symptoms:

Treatment:

Answer 11

Signs/Symptoms:
-Bradycardia
-hypotension
-CV collapse

Treatment:
-Calcium glutinate, epinephrine, insulin + dextrose, sodium bicarbonate

Question 12

Drug: Cocaine

Signs/Symptoms:

Treatment:

Answer 12

Signs/Symptoms:
-Seizure activity, agitation, hyperthermia, rhabdomyolysis

Treatment:
-Activated charcoal
-Fluids, glucose, thiamine IV
-Benzodiazepines for sedation, seizures
-Vasopressin is preferred over epinephrine in full
arrest
-Vasodilators for hypertension
-Nitrates, calcium channel blockers for ischemia;
NO beta blockers
-Cooling for hyperthermia

Question 13

Drug: Ethylene Glycol

Signs/Symptoms:

Treatment:

Answer 13

Signs/Symptoms:
-Intoxication behavior ^
-Vomiting ^^
-Metabolic acidosis, anion gap ^^^
-Renal Failure ^^^^

Treatment:
-Gastric lavage ^
-Sodium bicarbonate ^^
-Antidotes: ethanol or fomepizole ^^^
-Dialysis ^^^^

Question 14

Drug: ETOH

Signs/Symptoms:

Treatment:

Answer 14

Signs/Symptoms:
-Stupor, Respiratory Depression, aspiration risk^

-Intermittent agitation ^^

Treatment:
-Support, protect the airway^
-Fluid resuscitation^
-Multivitamin and thiamine 100 mg IV^
-Electrolyte replacement PRN (Mg++, Ph++, K+)^

-Prevention of delirium tremens: benzodiazepines, CIWA protocol ^^

Question 15

Drug: Methamphetamine

Signs/Symptoms:

Treatment:

Answer 15

Signs/Symptoms:
- Fever, tachycardia, hypertension, seizure, agitation, renal failure

Treatment:
-Fluids, cooling
-Benzodiazepines, haloperidol
-physical restraints: protect self and others

Question 16

Drug: Opioids

Signs/Symptoms:

Treatment:

Answer 16

Signs/Symptoms:
-Drowsiness, hypoventilation, hypotension, hypothermia, deep sedation, pinpoint pupils

Treatment:
-Support the airway
-Naloxone (Narcan) 0.4 - 2 mg IV every 2 minutes until effect to a maximum of 10 mg
-Gastric lavage with activated charcoal

Question 17

Drug: Phencyclidine (PCP)

Signs/Symptoms:

Treatment:

Answer 17

Signs/Symptoms:
-Blank stare, rapid involuntary eye movement, hallucinations, severe mood disorder, flushing, sweating, hypertension, tachycardia, seizure, coma

Treatment:
-Support the airway
-Provide a calm environment; do not leave the pt alone due to a high possibility of harm to self and others
-Benzodiazepines for agitation
-Fluids, cooling, monitor renal fxn

Question 18

Drug: Salicylates

Signs/Symptoms:

Treatment:

Answer 18

Signs/Symptoms:
-Vomiting, Tinnitus, confusion, hyperthermia, respiratory alkalosis, metabolic acidosis, multiple organ failure

Treatment:
-activated charcoal
-urine alkalization
-Dialysis, regardless of admission renal function, to PREVENT acute kidney injury

Question 19

Drug: Tricyclic Antidepressants

Signs/Symptoms:

Treatment:

Answer 19

Signs/Symptoms:
-CV signs: arrhythmias, shock
-Neurological signs: drowsiness, delirium, seizures, coma
-Anticholinergic signs: blurred vision, fever, twitching

Treatment:
-Sodium bicarbonate, activated charcoal, fluids, cardiac monitoring