Chapter 16- Emergency Poisoning Flashcards
What drug overdose is repeated doses of activated charcoal given?
Carbamazepine Dapsone Phenobarbital Quinine Theophylline
What’s aspirin overdose treated with
Activated charcoal
What’s opioid overdose treated with
Repeated doses of Naloxone (short half life)
What’s paracetamol overdose treated with
Acetylcysteine
What is used in lidocaine toxicity?
Intralipid
What is used for benzodiazepine toxicity?
Flumazenil
What is used for digoxin toxicity?
Digoxin-specific antibody
What is used for heparin toxicity?
Protamine sulphate
What is used for opioid toxicity?
Naloxone
What is used for paracetamol toxicity?
Acetylcysteine
What is the MHRA advice surrounding the use of acetylcysteine?
Reminder for possible need to continue treatment even after the recommended 3 dose regimen over 21 hours
This is on an individual patient case-by-case basis
What two places can you find information on poisoning?
ToxbaseUK National Poisons Information Service
Within how much time of poisoning should activated charcoal ideally be taken?
Within 1 hour
Activated charcoal should not be used in the poisoning of what substances?
Petroleum distillates, corrosive substances, alcohols, malathion, cyanides and metal salts including iron and lithium salts
What is the treatment of choice for severe aspirin poisoning?
Haemodialysis
In opioid poisoning, are the patient’s pupils pinpoint or dilated?
Pinpoint
What is the disadvantage of naloxone administration in opioid poisoning?
Has a shorter duration of action of many opioids so may require repeated doses Can however be given via continuous infusion
When would you consider the use of activated charcoal in paracetamol overdose?
If paracetamol in excess of 150 mg/kg is thought to have been ingested within the previous hour.
In what situations would you give acetylcysteine in paracetamol overdose?
- If on the treatment line on the paracetamol overdose graph-Who present 8–24 hours after taking an acute overdose of more than 150 mg/kg of paracetamol- Staggered overdose if ingested more than 150mg/kg, if patient’s risk of toxicity is uncertain- Patients with features of hepatic injury, jaundice
When is a paracetamol overdose classed as staggered?
If they have taken a toxic dose over more than 1 hour
The paracetamol treatment graph is unrelieable in what kind of overdose?
Staggered
What is the dosing regimen for acetylcysteine in paracetamol overdose?
1st infusion for 1 hour 150mg/kg
2nd infusion for 4 hours 50mg/kg
3rd infusion for 16 hours 100mg/kg
Does TCA overdose result in dilated or pinpoint pupils?
Dilated
What is used to treat bradycardia in acute overdose of beta blockers?
Atropine
What lithium level is associated with serious toxicity?
> 2 May need treatment with haemodialysis
Oxygen should be administered to patients with what types of poisoning?
Cyanide, Carbon monoxide
Sodium thiosulphate is used for what type of poisoning?
Cyanide
How do you treat convulsions caused by overdose/poisoning?
If over 5 minutes in duration must give IV Diazepam or Lorazepam. If IV not available give buccal midazolam or rectal diazepam.
How can you treat toxicity from carbamazepine, phenobarbital, quinine, theophylline or dapsone?
Repeated doses of charcoal
Symptoms of aspirin poisoning?
Hyperventilating, tinnitus, deafness, sweating.
How do you treat aspirin and antidepressant poisoning?
Treat using charcoal and sodium bicarbonate to increase the urinary excretion (make sure to correct the K+ concentration before)
Symptoms of paracetamol poisoning?
Nausea and vomiting
What is used to treat benzodiazepine overdose?
Flumazenil
What is used to treat a betablocker overdose?
Atropine IV (reverses bradycardia)
What is used to treat calcium channel blocker overdose? (HINT-4)
Charcoal, calcium chloride, calcium gluconate, atropine (for bradycardia)
How do you treat iron poisoning?
Desferrioxamine mesilate (deferoxamine)
Signs of theophylline toxicity?
Agitation, tachycardia, hyperglycemia, hypokalaemia
How do you treat theophylline toxicity?
Repeated doses of activated charcoal, manage hypokalaemia with IV KCL, short acting beta blocker e.g esmolol for severe tachycardia
How do you treat heparin toxicity?
Protamine sulphate IV
What is more likely to occur in poisoning, hypertension or hypotension?
HypotensionTreat by elevating foot of bed and giving IV sodium chloride or a colloid to increase plasma volume.
If someone is having a convulsion as a result of an overdose/ poisoning, what can be done?
Leave if under 5 minsIV diazepam or lorazepam (NB benzo’s should NOT be given by IM route)If IV not available:Buccal midazolam (not licensed for adults or children unfer 3 months)Rectal diazepam
Somebody has been stung by a bee and has had a severe anaphylactic reaction to it. How should this be managed?
EpipenIM adrenaline/ epinephrine
