CLIPP 24 - TCA tox

Question 1

DDX toddler AMS

Answer 1

A,E,I,O,U + TIPS

• Alcohol (ingested toxins)
• Epilepsy, encephalitis, endocrine, electrolytes
• Infection (meningitis/sepsis)
• Overdose, opiates, oxygen deprivation
• Uremia (renal failure)
• Trauma, temperature
• Insulin
• Psychosis
• Stroke, shock, space occupying lesions

Question 2

Toxidrome classes (5)

Answer 2

• cholinergic (organophosphates)
• Anticholinergic (diphenhydramine, TCAs)
• Sedative-hypnotic (benzos, barbiturates)
• Opioids (codeine, morphine, heroin)
• Sympathomimetics (cocaine, amphetamines, pseudoephedrine)

Question 3

management of iron and acetaminophen ingestions

Answer 3

• Iron: whole bowel irrigation (PEG electrolyte solution), IV deferoxamine
• Acetaminophen: activated charcoal, N-Acetyl-Cysteine

Question 4

Poison Control Center

Answer 4

800-222-1222

Question 5

Cholinergic toxidrome

Answer 5

• miosis/blurred vision, N/V/D, tearing/salivation/sweating/urination, bronchospasm, muscle twitching/weakness, bradycardia, seizure/coma
• SLUDGE (salivation, lacrimation, urination, defecation, GI motility, Emesis)

Question 6

Anticholinergic toxidrome

Answer 6

• mydriasis, dry skin, flushing, fever, delirium/seizures, tachycardia, urinary retention, ileus
• blind as a bat, dry as a bone, red as a beet, hot as Hades, mad as a hatter

Question 7

Sedative-hypnotic toxidrome

Answer 7

-blurred vision, hypotension, apnea/bradycardia, hypothermia, sedation/confusion/delirium/coma

Question 8

Opioids toxidrome

Answer 8

-miosis, respiratory depression, bradycardia/hypotension, hypothermia, depressed mental status

Question 9

sympathomimetics toxidrome

Answer 9

-mydriasis, fever/diaphoresis, tachycardia, agitation/seizure

Question 10

Stages of Iron toxicity (5)

Answer 10

• GI/Local Toxic effects
• Latent phase
• Shock
• Hepatic failure
• Gastric outlet obstruction

Question 11

Stages of acetaminophen ingestion (3)

Answer 11

• asymptomatic (N/V/D)
• hepatotoxicity onset
• hepatic failure

Question 12

Stabilization of patient in shock

Answer 12

• NS bolus
• O2
• D10 or D25 bolus

Question 13

Toxic ingestion labs (6)

Answer 13

• glucose
• electrolytes
• ABG
• EKG
• Tox screen
• Acetaminophen level

Question 14

Decontamination Methods (4)

Answer 14

• activated charcoal: increases surface area for absorption of toxins (NOT strong acids, alkalis, or heavy metals)
• cathartic agent: induces defecation
• Nasogastric lavage: removes pill fragments from stomach (not recommended)
• Ipecac: induces vomiting (not recommended)