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Year 4 > Acute 4 (OD and poisoning) > Flashcards

Acute 4 (OD and poisoning) Flashcards

1
Q

What are examples of anticholinergics?

A
  • Tricyclic antidepressant (amitryptiline)
  • All the “anti’s”
  • Antihistamine
  • Antipsychotic
  • Antispasmodic
  • Antimuscarinic (atropine)
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2
Q

What is the toxidrome of anticholinergic OD?

A
  • HR increase
  • RR normal
  • Temp warm
  • Pupils dilated
  • Bowel sound absent
  • Sweat dry
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3
Q

What is the presentation of anticholinergic OD?

A
  • Toxidrome
  • Urinary and bowel retention
  • Dry mouth
  • Hypereflexia and ataxia
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4
Q

What is the mental presentation of anticholinergic OD?

A
  • Hypervigilant
  • Agitated
  • Hallucinating
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5
Q

What is the management of anticholinergic overdose?

A
  • IV bicarb
  • Amiodarone if VT (can’t give in TCA overdose, give lignocaine instead)
  • Dialysis has no effect
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6
Q

What are examples of cholinergic agents?

A
  • Sarin and tabun
  • Pesticides (organophosphates)
  • These are acetylcholinesterase inhibitors
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7
Q

What is the toxidrome for cholinergic OD?

A
  • HR normal
  • RR normal
  • Temp normal
  • Pupils pinpoint
  • Bowel sounds present
  • Sweaty
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8
Q

What is the presentation of cholinergic OD?

A
  • Toxidrome
  • Weakness, fasciculations and tremor
  • Cardiac arrest
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9
Q

What is the management of cholinergic OD?

A
  • Atropine
  • Pralidoxime chloride
  • Benzos
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10
Q

What is the toxidrome for opioid overdose?

A
  • HR down
  • RR down
  • Temp down
  • Pupils pinpoint
  • Bowel sound absent
  • Sweat dry
  • (everything reduced)
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11
Q

What is the management of opioid overdose?

A
  • Naloxone
  • If pulmonary oedema then ventilate
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12
Q

What are examples of sympathomimetic drugs?

A
  • MDMA agonists (amphetamines and ecstasy)
  • Cocaine
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13
Q

Biochemistry of sympathomimetic drug OD?

A
  • Increase in adrenaline, dopamine and 5HT
  • Hyponatraemia
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14
Q

What is the toxidrome for sympathomimetic drug OD?

A
  • HR increased
  • RR increased
  • Temp increased
  • Pupils dilated
  • Bowel sounds present
  • Sweaty
  • (effectively everything increased)
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15
Q

Presentation of sympathomimetic OD?

A
  • Toxidrome
  • Hyperreflexia
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16
Q

Mental change in sympathomimetic OD?

A
  • Agitated
  • Paranoid
  • Euphoric hallucination
17
Q

Management of sympathomimetic OD?

A
  • BZD
  • Ischemic chest pain -> GTN
  • Hyperthermia -> dantrolene
    -Hypertension -> sodium nitroprusside, B blocker 2nd line (can cause unreglualted alpha stimulation)
  • Acidosis -> bicarb
18
Q

Cocaine specific risks?

A
  • Stroke
  • Aortic dissection
  • QRSS widened and QT prolonged
19
Q

Ecstasy specific risks?

A
  • Can cause serotonin syndrome
  • Hypoglycemia
  • Metabolic acidosis
20
Q

Examples of sedatives?

A
  • Benzos
  • Barbituates
  • Alcohol
21
Q

What is the toxidrome for sedative overdose?

A
  • HR down
  • RR down
  • Temp down
  • Pupils normal
  • Bowel sounds absent
  • Sweat dry
  • (everything down except pupils)
22
Q

What is the presentation of sedative OD?

A
  • Toxidrome
  • CNS depression
  • Benzos: nystagmus and diplopia
  • Alcohol: hypoglycaemia
23
Q

Treatment of benzodiazepines overdose?

A
  • Flumenazil (cures reso depression)
  • Can’t give if had TCA or have epilepsy
  • Causes seizure and cardiac arrest
    -Only given in life threatening or iatrogenic OD and never out of hospital
24
Q

Treatment of alcohol overdose?

A
  • IV Glucose as causes hypo
  • Never give glucose before pabrinex or u cause wernickes
  • Chlordiazepoxide
25
Q

Which patients are at risk from paracetamol poisoning?

A
  • Those on CYP450 inducers (St John’s wort, carbamazepine, rifampicin, alcohol (chronic), phenytoin)
  • Malnourished
26
Q

Management of paracetamol poisioning?

A
  • Activated charcoal (Od in last hour and not staggered)
  • N-acetylcysteine (>1 hour, staggered OD, level >100 at 4 hours and 15 at 15 hours)
27
Q

Aspirin OD?

A
  • Mixed respiratory alkalosis and metabolic acidosis
  • Tinitus and hyprventilation
  • Causes hypoglycaemia which can lead to coma or seizure
  • Treated with charcoal in 1 hour, IV bicarb, or dialysis if severe
28
Q

Digoxin overdose?

A
  • Main trigger is hypokalaemia
  • Present with gynaecomastia and yellow-green visual loss
29
Q

ECG changes of digoxin overdose?

A
  • Downsloping ST (reverse tick sign)
  • Flat or inverted T waves
  • Short QT
  • AV block and bradycardia
30
Q

Features of lithium OD?

A
  • Thirst and polyuria
  • Coarse tremor (fine tremor seen normally)
  • Severe: acute confusion and hypereflexia
31
Q

Precipitating factors for lithium OD?

A
  • Dehydration, AKI, renal failure
  • Drugs that cause the above: ACEi, ARB, NSAIDs, thiazide, metronidazole
32
Q

Features of beta blocker OD?

A

Exaggerated effects of beta blockers (bradycardia, heart block etc)

33
Q

Features of iron OD?

A
  • Hard to do (need a lot)
  • Grey black vomit and melena
  • GI symptoms
  • Severe: liver necrosis and metabolic acidosis
34
Q

Features of CO poisoning?

A
  • Exposure to poor ventilation system
  • Headache and nausea most common
  • Severe: pink skin, hyperpyrexia, extrapyramidal symptoms
35
Q

Features of cyanide poisoning?

A
  • Initial resp symptoms and palpitations
  • Bitter almond smelling breath
36
Q

What are the 3 stages of ethylene glycol poisoning?

A

1) Drunk
2) Metabolic acidosis with high ion gap
3) AKI and convulsion

Year 4 (16 decks)

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