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PT 2 > Block 6 - Toxicology > Flashcards

Block 6 - Toxicology Flashcards

1
Q

What are the ABCDs of acute management and stabilization of the poisoned patient?

A
  1. Airway
  2. Breathing
  3. Circulation
  4. Dextrose
  5. Decontamination
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2
Q

Discuss the A of acute management and stabilization of the poisoned patient.

A

Airway - position the patient to open the airway, suction any secretions or vomitus, evaluate airway-protective reflexes, consider endotracheal intubation

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3
Q

Discuss the B of acute management and stabilization of the poisoned patient.

A

Determine adequacy of ventilation, assist ventilation if needed, assess oxygenation and give supplemental oxygen if needed

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4
Q

Discuss the C of acute management and stabilization of the poisoned patient.

A

Evaluation perfusion, BP, cardiac rhythm, determine QRS complex and QT interval, attach continuous cardiac monitor

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5
Q

Discuss the D (x2) of acute management and stabilization of the poisoned patient.

A

Dextrose - quickly determine blood glucose by finger-stick test, give dextrose if patient is suspected of having hypoglycemia

Decontamination - perform surface and gastric decontamination to limit absorption of poisons

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6
Q

List the common mechanisms underlying drug-induced hypotension.

A
  1. Hypovolemia, vomiting and diarrhea, sweating, venodilation
  2. Depressed cardiac contractility
  3. Reduced peripheral vascular resistance
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7
Q

What are common causes of drug-induced seizures?

A
  1. Tricyclics/other antidepressants
  2. Cocaine and amphetamines
  3. Theophylline
  4. Diphenhydramine
  5. Isoniazid
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8
Q

What are the 4 methods of GI decontamination?

A
  1. Emesis
  2. Gastric lavage
  3. Activated charcoal
  4. Whole bowel irrigation
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9
Q

What method of GI decontamination should be used in rare circumstances with a potentially lethal ingestion when medical care is more than 60 minutes away?

A

Emesis

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10
Q

What method of GI decontamination is useful in ingestions of iron, lithium, sustained-released or enteric-coated pills, and drug packets or other foreign bodies?

A

Whole bowel irrigation

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11
Q

What method of GI decontamination is the most useful, broadly?

A

Activated charcoal

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12
Q

When is activated charcoal not effective?

A

Iron, lithium, potassium, sodium, alcohol

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13
Q

What method of GI decontamination is useful in obtunded or comatose patients, in recent ingestions, or in ingestion of anticholinergic agents or salicylates?

A

Gastric lavage

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14
Q

Treatment for acetaminophen overdose?

A

NAC

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15
Q

Treatment for anticholinergic and antihistamine overdose?

A

Activated charcoal and a cathartic agent (lavage for large ingestions)

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16
Q

Treatment for anticoagulant overdose?

A

Oral activated charcoal, vitamin K if PT prolongation occurs

17
Q

Treatment of beta block overdose?

A

Aggressive gut decontamination (gastric lavage + activated charcoal), high doses of glucagon

18
Q

Treatment of calcium antagonist overdose?

A

Aggressive gut decontamination before onset of ileus

19
Q

Treatment of carbon monoxide poisoning?

A

Remove from exposure, given supplemental O2 in the highest available concentration

20
Q

Treatment of cocaine, amphetamine, and other stimulant overdose?

A

Sedative agent

21
Q

Treatment of copper poisoning?

A

Penicillamine + dimercaprol (chelating)

22
Q

Treatment of cyanide poisoning?

A

Prevent further exposure, oral activated charcoal, give B12 or sodium thiosulfate

23
Q

Treatment of digitalis glycoside poisoning?

A

Gut decontamination

24
Q

Treatment of ethanol, methanol, and ethylene glycol poisoning?

A

Ethanol - supportive care

Methanol/ethylene glycol - ethanol or fomepizole (prevents metabolism) + folic acid, B1, and pyridoxine

25
Q

Treatment of gold poisoning?

A

BAL

26
Q

Treatment of iron poisoning?

A

Gut decontamination, choleation with deforoxamine

27
Q

Treatment of lead poisoning?

A

Acute - abdomen X-ray (if in stomach, get it out; if past pylorus, should be fine)
IV EDTA or oral succimer DMSA, also dimercaprol

28
Q

Treatment of lithium poisoning?

A

Gut decontamination

Sodium polystyrene sulfonate

Fluid therapy is essential

29
Q

Treatment of methemoglobinemia-inducing agent poisoning?

A

Resolves spontaneously (mild)

Methylene blue (severe)

30
Q

Treatment of organophosphate poisoning?

A

Wash exposed areas with soap and water, atropine, 2PAM

31
Q

Treatment of salicylate poisoning?

A

Alkalinization of the urine

32
Q

Treatment of sedative hypnotic agent poisoning?

A

Flumazenil (reverse coma)

33
Q

Treatment of tricyclic antidepressant poisoning?

A

Treat symptoms

PT 2 (15 decks)

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