23.3 Toxicology Flashcards
one pill can kill, dangerous ingestions?
amphetamines beta blockers CCBs digoxin opioids sulphonylureas TCA
pesticides which ones?
paraquat: 1 mouthful
what is the acronym DEAD?
decontamination
elimination
antidotes
deposition
after ABCs what to watch out for?
full neuro exam
urinary retnetion
skin
bowel sounds
which drug levels are helpful?
paracetamol if indicated phenytoin carbamazepine valproate phenobarbitone
anticholinergic toxidromes?
blind as a bat mad as a hatter red as a beet hot as a hare dry as a bone bowel and bladder lose their tone, Retention heart runs alone
anticholinergic toxidromes, which causes agitated delirium?
plants
pills that cause anticholinergic toxidromes present?
usually partially sedated
anticholinergic toxidromes pupils?
dilated
anticholinergic toxidromes bladder?
retention usually, IDC can be beneficial
common causes of anticholinergic toxidromes?
anti-histamines TCA phenothiazine plants: datura, brugmansia benztropine (for dystonia)
Cholinergic crisis classically think?
secretions
organophosphates
Cholinergic crisis acrynoym for secretions?
DUMBELS
diarrhoea urination miosis bradycardia, bronchorrea emesis lacrimation salivation
sympathomimetic syndrome is?
hot, sweaty patient hypertension tachy dilated pupils agitation sweating hyperthermia - treat
sympathomimetic toxidrome causes?
- cocaine
- methamphetamines
- ecstasy, MDMA
- synthetic ‘marijuana’
serotonin toxicity key examination findings?
hyperreflexia, clonus
sweating
hypertension
dilated pupils
serotonin toxicity causes?
usualyl a combo of:
SSRIs/SNRIs MAOIs tCAs tramadol opiates amphetamines/MDMA
opioids toxidrome
- respiratory depression
- sedation
- pinpoint pupils
opioids toxidrome when give naloxone indication?
the resp rate and the sats
supportive care of poisoned patient sedation ?
benzodiazepines
supportive care of poisoned patient seizures?
- IV benzos
- not phenytoin
supportive care of poisoned patient body temp?
warm
cool control quickly
supportive care of poisoned patient renal function?
hydration
dialysis
GI decontamination main use?
activated charcoal
why not GI decontamination with vomiting?
tears and ruptures
how much GI decontamination activated carcoal measurement?
1g/kg
mix with water, orally or NGT
indications for charcoal?
- within 1 hour of ingestion, or if slow release
- cooperative patient
- alert and protected airway
contraindications for charcoal?
-Metals: LI, K, alcohols, hydrocarbons, corrosives
““MACH””
-low GCS
-ileus
whole bowel irrigation indications?
- lots of slow release
- body packers
- metals
enhanced elimination, 3 kinds?
- multi dose activated charcoal
- urinary alkalinisation (ion trapping, mainly for aspirin)
- haemodialysis
when to use enhanced elimination?
- methanol/antifreeze
- lithium
- aspirin - severe only
- theophylline
- alproic acid severe
- carbamazepine
what is toxic dose of paracetamol?
> 200mg/kg
paracetamol when to take the measurement?
4 hours post to get peak
paracetamol antidote?
NAC
redback spider bite treatment?
mainly analgesia
antivenom rare
funnelweb spider bites?
- most uncommon bite
- needs ANTIVENOM
- look at tongue for fasciculation (can’t fake it)
brown snake characteristic of bite?
- early collapse
- consumptive -coagulopathy
- most common cause of death
Do’s for envenomation?
remove from danger
immobilise
keep still
apply pressure bandage
dangers of antivenom?
equine-derived, allergenic, can get anaphylaxis
treatment of box jelly fish?
remove tentacles, vinegar
anti-venom available
bluebottle sting treatment?
hot water without burning?
put both feet in the bucket of water as control to prevent burns
