chapter 12 pt3

Question 1

clinical presentation of opioid poisonings ?

Answer 1

pinpoint pupils
resp depression

Question 2

antagonist for opioid poisonings

Answer 2

naloxone

non iv routes quicker as time saved in not finding IV access which can be extremely difficult in IV drug user - IM , IN , SC

initial dose 400mcg IV
800mcg IM
800mcg SC
2mg IN

large opioid overdoses needs a naloxone titration to total 10mg

give increments of naloxone till patient is breathing properly and breathing reflexes are illicit

Question 3

why can giving naloxone still can give persistent resp depression

Answer 3

duration of action of naloxone is 45-70min

respiratory depression in opioid over dose persist for 4-7hrs

Question 4

complication of acute withdrawal of opioids ?

Answer 4

sympathetic excess = pulmonary edema , ventriloquist’s arrythmia , severe agitation

Question 5

cause of cardiac arrest in opioid intoxication ?

Answer 5

respiratory depression and arrest leading to severe brain hypoxia = prognosis poor

Question 6

clinical manifestation of benzodiazepine overdose

Answer 6

loss of consciousness , respiratory depression and hypotension

Question 7

antidote for benzodiazepine

Answer 7

FLUMANZIL - can b used if NO history of seizures risk of seizure

CONTRAINDICATED - benzodiazepine independence and co-ingestion of pro cnvulasant medications scubas tricyclic antidepressants
not routinely used in comatose

Question 8

complication of flumanzil ?

Answer 8

reversing benzodiazepine toxicity with flumanzil can cause significant toxicity - leading to seizure , arrhythmia , hypotension , and withdraws symptom

Question 9

what are the tricyclic antidepressants and cyclic drugs ?

Answer 9

amitriptyline
desipramine
imipramine
nortriptyline
doxepin
clomipramine

Question 10

ECG of tricyclic antidepressants ?

Answer 10

cardiac toxicity due to anti cholinergic and sodium channel blocking effects produce broad complex tachycardia

Question 11

clinical presentation of cyclic drugs?

Answer 11

alpha 1 receptor blockers - hypotension

anticholinergic drugs - dilated pupils, fever , dry skin
delirium
tachycardia
ileus
urinary retention

Question 12

treatment for cyclic drugs?

Answer 12

consider sodium bicarbonate for tricyclic induced ventricular contraction abnormalities

ph of 7.45-7.55 accepted

Question 13

local anaesthesia clinical manifestations ?

Answer 13

severe agitation
loss of consciousness
tonic clonic seizures

Question 14

ECG changes of local anaesthesia ?

Answer 14

bradycardia
conduction block
a-systole
v-tach

Question 15

local anaesthesia cardiac arrest management ?

Answer 15

ALS
with
IV 20 percent lipid emulsions of 1.5ml /kg

follow by 15ml/kg/hr

give up to 3 boluses of lipid at 5 mins interval - until max of 12ml/kg lipid emulsion reached

Question 16

what are examples of stimulants ?

Answer 16

cocaine and amphetamines

Question 17

clinical manifestation of stimulants ?

Answer 17

hypertension
agitation
tachycardia
hyperthermia
myocardial ischemia

Question 18

treatment for stimulants

Answer 18

sell doses of IV benzodiazepines - first line

glyceryl trinitrate and phentolamine can reverse cocain induced coronary vasoconstriction
Nitrates only second line therapy

Question 19

treatment for drug induced bradycardia

Answer 19

severe bradycardia from poisoning to drug overdose may be refectory from ALS protocol due to prolonged receptor binding

= atropine

Question 20

atropine most beneficial in which toxins ?

Answer 20

organophosphate
carbamate
nerve agent
acetylcholinervse inhibiting substance

Question 21

what is used in refractory bradycardia caused by beta blockers

Answer 21

isoprenaline

Question 22

if isoprenaline does nit work what do we do ?

Answer 22

transcutaneous pacing