DIAGNOSIS AND DECONTAMINATION Flashcards
While taking a _____ may be a more direct method of the determination of the toxin, is it reliable or not?
MANAGEMENT OF POISONED PATIENT
history; Not reliable
Perform a carefully directed examination emphasizing key _______ that may uncover one of the common ______ syndromes.
physical findings; autonomic
Important variables in the autonomic physical examination includes?
- Blood pressure
- Pulse rate
- Pupil size
- Sweating
- Peristaltic activity
- Vital signs
- Sensorium (Determine whether the patient is comatose, stuporous, lethargic, confused, or alert)
Disoriented to surroundings, may have impaired judgement, may need cues to respond to commands
Confused
Drowsy, needs gentle verbal or touch stimulation to initiate response
Lethargic
Responds slowly to external stimulation and needs repeated stimulation to maintain attention and response
Obtunded
Responds only minimally with vigorous stimulation, may only moan as a verbal response
Stuporous
No observable response to any external stimuli
Comatose
REMEMBER
With the clinician focusing on the patient’s
* Vital signs
* Sensorium (Determine whether the patient is comatose, stuporous, lethargic, confused, or alert)
* Motor signs
* Ocular findings, and other clinical abnormalities (eg, odor on breath, discoloration of urine),
* Clinical toxin-pattern recognition can be achieved and an initial treatment plan formalized.
These clues can be specific symptom complexes associated with certain toxins and can be referred to as toxidromes
is a constellation of findings, either from the physical examination or from ancillary testing, which may result from any poison.
Toxidromes
The term toxidromes was originated by _______ in 1974 to assist the clinician in identifying the classification of toxins by toxin-specific symptom complexes.
Howard Mofensen
NOTE
Often, the hallucinatory pattern of the patient can be specific for certain drugs
Causes the patient to experience Lilliputian hallucinations
Atropine
Lilliputian hallucinations are a rare type of visual hallucination where imaginary objects, persons or animals of diminutive size are perceived. These small images are usually described as brightly coloured mobile creatures.
With _____, there is a simple visual hallucinatory pattern with objects appearing in the periphery of vision
Cocaine
With _______, complex hallucinations are often indistinguishable clinically from a paranoid psychosis
Phencyclidine
With ____, the patient experiences a combination of illusions, hallucination, and pseudohallucinations
- illusions - seeing objects in altered forms
- hallucination - experiencing sensations without external stimuli
- pseudohallucinations - knowing when one is hallucinating
LSD
Lysergic acid diethylamide
Seeing objects in altered forms
Illusions
Experiencing sensations without external stimuli
Hallucination
Knowing when one is hallucinating
Pseudohallucinations
REMEMBER
Tremors, hyporeflexia and hyperreflexia, and even the nature of seizures can be useful diagnostic tools
* Like hallucinations, seizures caused by specific toxins can exhibit certain specific properties
MOTOR SIGNS
______ is unique in that it can cause generalized seizures while the patient is alert
This can be referred to as a ‘‘spinal seizure”
Strychnine
NOTE
Other drug-induced seizures will respond only to specific antidotal therapies and not to conventional antiseizure medication.
Drug-induced seizures will respond only to specific antidotal therapies.
Examples of this property include:
Anticholinergic-induced seizures, which may respond to _____
physostigmine
Drug-induced seizures will respond only to specific antidotal therapies.
Examples of this property include:
Isoniazid-induced seizures, which respond to ______.
pyridoxine
Drug-induced seizures will respond only to specific antidotal therapies.
Examples of this property include:
Theophylline-induced seizures rarely respond to ____ alone and often only to _____ therapy.
phenytoin; multidrug
_________ and _________ essentially cause an increase in all of the vital signs parameters
VITAL SIGNS
Sympathomimetics ; anticholinergics
From [An increase in all of the vital signs parameters]
This is particularly true for cocaine intoxication, where it has been noted that _____ may be a particularly sign for mortality.
VITAL SIGNS
hyperthermia
Conversely, organophosphates, opiates, barbiturates, beta blockers, benzodiazepines, alcohol, and clonidine toxicities result in ____-thermia, respiratory depression, and bradycardia
hypothermia
OCCULAR FINDINGS can be divided into 2 categories:
1) pupillary size and reactivity
2) demonstration of nystagmus
Nystagmus is a condition where the eyes move rapidly and uncontrollably. They can move: side to side (horizontal nystagmus) up and down (vertical nystagmus) in a circle (rotary nystagmus)
Pupillary signs:
Both anticholinergic, sympathomimetic substances, and LSD can result in mydriasis.
But in cocaine intoxication, the pupils will respond to light (miosis), whereas with anticholinergics, the pupils will not.
OCCULAR FINDINGS
Mydriasis refers to the dilation of the pupil, which normally occurs in response to low amounts of light in the environment.
Miosis refers to a constricted pupil or a narrower pupil.
NOTE
Agents that contribute to miosis include:
- Organophosphate insecticides,
- Narcotics,
- Bromide, acetone, clonidine, and nicotine.
- Phencyclidine has been known to cause either mydriasis or miosis.
Nystagmus: ______ are probably the most common etiology of horizontal nystagmus.
Alcohols
Although solvents, lithium, meprobamate, carbamazepine, quinine, phenytoin, alcohol, barbiturates, and primidone can also result in ______ nystagmus.
horizontal
Phencyclidine, phenytoin, and sedative hypnotics can cause a ___(long answer)___ nystagmus.
combination of vertical, horizontal, and even rotary
