CLIPP 24 Flashcards
uremia can cause
AMS
type of AMS seen in seizures
alternating agitation and unresponsivness
AMS in metabolic disorders
in a 2yo, would likely have shown some sx previously, or would have hx of recent illness that triggered it
AMS in intracranial mass
gradual not abrupt onset
organophosphates / Insecticides
cholinergic Miosis and blurred vision Increased gastric motility (nausea, vomiting, diarrhea) Excessive tearing, salivation, sweating and urination Bronchorrhea and bronchospasm Muscle twitching and weakness Bradycardia Seizures and coma
Mnemonic: “SLUDGE” (salivation, lacrimation, urination, defecation, GI motility, emesis)
diphenhydramine, TCAs
anti cholinergic Mydriasis (dilated pupils) "blind as a bat" Dry skin "dry as a bone" Red skin (flushed) "red as a beet" Fever "hot as Hades" Delirium and seizures "mad as a hatter" Tachycardia Urinary retention Ileus
benzos, barbs
sedative hyponotics Blurred vision (miosis or mydriasis) Hypotension Apnea and bradycardia Hypothermia Sedation, confusion, delirium, coma
opioids
codinee, morphine heroin Miosis (constricted pupils) Respiratory depression Bradycardia and hypotension Hypothermia Depressed mental status (sedation, confusion, coma)
sympathommimetics
cocaine, pseudoephedrine, amphetamiens Mydriasis Fever and diaphoresis Tachycardia Agitation and seizures
Mydriasis
Fever and diaphoresis
Tachycardia
Agitation and seizures
sympathomimetics
Miosis (constricted pupils) Respiratory depression Bradycardia and hypotension Hypothermia Depressed mental status (sedation, confusion, coma)
opiods
Blurred vision (miosis or mydriasis) Hypotension Apnea and bradycardia Hypothermia Sedation, confusion, delirium, coma
benzos,barsbs
Miosis and blurred vision
Increased gastric motility (nausea, vomiting, diarrhea)
Excessive tearing, salivation, sweating and urination
Bronchorrhea and bronchospasm
Muscle twitching and weakness
Bradycardia
Seizures and coma
chlinergic
Mydriasis (dilated pupils) "blind as a bat" Dry skin "dry as a bone" Red skin (flushed) "red as a beet" Fever "hot as Hades" Delirium and seizures "mad as a hatter" Tachycardia Urinary retention Ileus
anti chol
miosis vs mydriaiss
mydraiais = dilated pupils
pupillary changes of benzos
nystagmus
pupillary changes of acetaminophen and aspirin
none
effect of cholinergics on VS, skin, neuro, abd
lower HR, sweaty skin, constrict pupils, hyperactive BS
effect of ANTIcholinergics on VS, skin, neuro, abd
incr HR/hyperthermia i.e. fever?, dry skin, dilate pupils, hypoactive BS
effect of sedatives/hyponotic on VS, skin, neuro, abd
HR, BP, RR depressed, altereted sensory exam, hypoactive BS
effect of opiods on VS, skin, neuro, abd
HR, BP, RR depressed / hypothermia, constricted, hypoactievs BS
effect of sympathomimetics on VS, skin, neuro, abd
HR, BP, RR eelvated, hyperthermia, diaphoretic, dilated and hyperreflexia , hyperactiv BS
key cardio finding in TCA ingestion
hypotension
SSRI ingesiton
serotinin syndrome like - diarrhea, myoclonus, hyperfelxia, shivering, ataxia **not carcinoid!?
presentation of anti histamine OD
anti cholinergic similar to TCA but TCA has more cardiac issue
decongestant OD
sympathomimmetic picture
agitation and tachycardia but there is no mydriasis. what is the OD of?
aspirin
TCA pathophys and most common cause of deaht with this OD
blocks mAch R and periephal alpha receptors(?). refractory hypotension. is antichol.
octreotide use with respect to insulin
blocks insulin release thus can e used in sulfonylurea OD refractory to dextrose
AG metabolic acidosis suggests what OD
salicylate (nsaid, aspirin) toxicity
most common accidental ingestion
tylenol
methods to enhance toxin elimination
Syrup of ipecac Activated charcoal Gastric lavage Cathartics Hemodialysis Hemoperfusion.
-could also do things like urinary alkalization for things like salicylate intox
what antidote for ingestions NOT due to small molecules or heavy metals and what contraindications
activated charcoal , stops absorption o fpoison by pooping out- contraindicated if loss of protected airway reflexes due to aspiration risk thus consider selective intubation
-if antichol used, additional doses of charcoal needed due to further decr GI motility as a result of anti chol activity
cathartic agent use
in OD, increases bulk of feces/laxativey
NG lavage
has not demo’d a good consistent effect
syrup of ipecac
not first line due to side effects - can aspirate the vomit if AMS like pt does in this case. also has potential for cardiac and seizures.
EKG findings in TCA OD
The EKG shows an irregularly irregular rhythm.
P waves are not distinctly seen.
There is a wide QRS.
The QT interval is prolonged.
life threatening dysrhythmia seen in severe TCA toxicity is? what is the wide complex tachycardia seen in general TCA fox?
A wide-complex tachycardia is the characteristic life-threatening dysrhythmia seen with severe TCA toxicity. The wide-complex tachycardia seen with TCA toxicity, however, is often not ventricular tachycardia, but sinus tachycardia with a wide QRS / aberrant conduction
tx appraoch to TCA toxicity
cardiac monitoring, alkalinaation w Nabicarb of serum, antiarrhthmics (not 1a like quinidine, dispyramide, procainamide or 3), tx hypotension, tx seizures
peak time effects of TCA and glipizde
7-8h for tca, 2-3h for glipize after ingestion
tca vs decongestant overdose differnces in terms of BP, pupils and presence or absence of fever and sweating
unlike TCA overdose, decongestant overdose will cause hypertension, constricted pupils, fever/sweating
