Acute Care/Toxidromes Flashcards
Management of stable polymorphic VT?
Magnesium 2g over 10 minutes
Management of fast AF if stable
Beta blocker
Consider digoxin or amiodarone if evidence of heart failure
Anticoagulate if over 48 hours
What to give in regular SVT if amiodarone ineffective
Beta blocker or verapamil
What to give in regular SVT if beta blocker or verapamil ineffective
Cardioversion
Stable VT management
300mg amiodarone
What strength and volume of adrenaline is given for anaphylaxis?
1:1000 (1mg in 1ml), 0.5ml (500micrograms)
What strength of adrenaline is given in cardiac arrest?
1:10000
When can you take a first paracetamol level?
4 hours
When should NAC ideally be administered in paracetamol overdose?
Within 8 hours
When would you start NAC before getting blood results back?
Massive overdose
Staggered overdose
Uncertain timeframe
Describe the opiate toxidrome
Reduced RR
Can be bradycardic/hypotensive
Reduced GCS
Pinpoint pupils
Often hypothermic
Opiate antidote
Naloxone
What drugs cause a hypnotic toxidrome?
Benzodiazepines
Z drugs
Describe the hypnotic toxidrome
Decreased resp rate
May have bradycardia/ hypotension
Decreased GCS
Pupils normal or dilated
Often hypothermic
What is the difference between the hypnotic and the opiate toxidrome?
Hypnotic pupils normal or dilated
Opiate pin point pupils
What is the antidote for benzodiazepines, and would you give it in a recreational overdose?
Flumenazil
No as need to make sure it is pure benzo use
Examples of sympathomimetics
Caffeine
Cocaine
Amphetamines incl meth
MDMA/ecstasy
Describe the sympathomimetic toxidrome
RR increase
HR and BP increase
Dilated pupils
Agitated
Hyperthermic and diaphoretic
Sympathomimetic toxidrome management
Supportive
Maybe benzos (no specific antidote)
Management of coronary artery vasospasm secondary to cocaine
As per ACS
Add in IV benzo
What drugs cause an anti-cholinergic toxidrome?
Atropine
Glycopyrronium Aka glycopyrrolate
Antihistamines
TCAs
Describe the anticholinergic toxidrome
Normal or increased RR
HR and BP increased
Dilated pupils
General agitation/restlessness
Hyperthermic
DRY skin
What is the difference between a sympathomimetic and anticholinergic toxidrome?
Sympathomimetic increased sweating
Anticholinergic reduced sweating
What ECG abnormalities can anticholinergic drugs cause?
Increased PR, QRS and QTc
What are the potential effects of tricyclic overdose
QT prolongation with ventricular arrhythmia
Depressed cardiac contractility and hypotension
High risk of seizures and comas
Tricyclic overdose management
IV sodium bicarbonate
Fluids for hypotension and arrhythmia
AVOID antiarrhythmics
Benzos for seizures
What drugs cause the cholinergic toxidrome?
Organophosphates
Nerve agents
Pyridostigmine
Describe the cholinergic toxidrome
No change to RR/HR/BP
Pinpoint pupils
Salivation, diaphoresis, lacrimation
Urination
Defaecation
Emesis
GI distress
Cholinergic toxidrome management
Atropine
Supportive management
Remove toxic agent
PPE
