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Critical Care Test #3 > Drug Overdose and Poisoning > Flashcards

Drug Overdose and Poisoning Flashcards

1
Q

Where does toxic exposure of fumes most commonly occur?

A

THE HOME, can be from improper mixing of household cleaners or malfunctioning appliances that release carbon monoxide

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2
Q

What are the most common routes of exposures to toxins?

A

Ingestion, inhalation, and injection.

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3
Q

What is the most common form of poisoning that occurs in the home?

A

Children ingest medications or household cleaners

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4
Q

What can go hand-in-hand with substance abuse in a lot of cases?

A

Metal illness

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5
Q

What are some commonly abused substances?

A

nicotine, alcohol, heroin, mary-j, narcotics, amphetamines, benzos, cocaine

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6
Q

What is the reversal agnet for opioids?

A

Naloxone (narcan)

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7
Q

Reversal agent for benzos?

A

Flumazenil (romazicon)

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8
Q

What is the reversal agent for tylenol?

A

Acetylcystine (mucomyst)

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9
Q

What is the reversal for warfarin?

A

Vitamin K

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10
Q

What is the reversal for heparin?

A

Protamine sulfate

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11
Q

What is the risk of using flumazenil to reverse an overdose on benzos?

A

The potential to unmask contolled seizures, ESPECIALLY IF THEY ARE TAKING MEDICATIONS THAT LOWER THE SEIZURE THRESHOLD ALREADY, ALSO IF THEY ARE DEPENDENT ON BENZOS ALREADY

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12
Q

What are the two questions that should be asked when triaging an overdosing or poisoned client, IN ORDER?

A

Is the patents life in immediate danger?

Is the patients life in potential danger?

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13
Q

If the clients life is in immediate danger from poisoning or overdose, what should IMMEDIATELY be done?

A

Stabilization through ABCs.

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14
Q

What are the things to assess when obtaining patient history regarding overdose or poisoning?

A

Identify the drug or toxin

The time and duration of exposure

Treatment given before arrival at hospital

allergies

underlying disease processes or related injuries

THIS INFO CAN BE OBTAINED FROM: PATIENT, FAMILY MEMBER, FRIENDS, RESCUERS, BYSTANDERS

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15
Q

What is a toxidrome and what are the four that are listed in the book?

A

A group of signs and symptoms associated with overdose or poisoning to a particular group of drugs or toxins.

Anticholinergic, Cholinergic, opioids, sympathomimetic

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16
Q

What are the signs of a anticholinergic toxidrome?

A

delirium

dry, flushed skin

dilated pupils

elevated temperature

decreased bowel sounds

urinary retention

tachycardia

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17
Q

What are some common causes of anticholinergic toxicity?

A

antihistamines

atropine

jimson weed

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18
Q

What are some signs of a cholinergic toxindrome?

A

excessive salivation, lacrimation, urination, diarrhea, and emesis

diaphoresis

bronchorrhea

bradycardia

faciculation

CNS depression

constricted pupils

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19
Q

What are some agents that may cause a cholinergic overdose or poisoning?

A

organophosphate insecticides, carbamate insecticide

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20
Q

What are some signs of an opioid toxindrome?

A

CNS depression

respiratory depression

constrited pupils

hypotension

hypothermia

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21
Q

What are some signs of a sympathomimetic toxindrome?

A

agitation

tachycardia

HTN

seizures

metabolic acidosis (Rhabdo!!)

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22
Q

What are some things that can cause a sympathomimetice overdose or poisoning?

A

amphetamines, cocaine, theophylline, caffeine

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23
Q

What are some things that can cuase an opioid toxindrome?

A

opiates (codeine, morphine, propxyphene, heroin)

diphenoxylate (diphenoxylate/atropine sulfate (lomotil))

24
Q

Other than the physical examination and history. What is another important item in the assessment of a poinsoned or overdosed patient?

A

LABS: electrolytes, hepatic function, UA, ECG, serum osmolality

ALWAYS GET AN ACETAMINOPHEN LEVEL ON OVERDOSED CLIENT

25
Q

What are the eight things that are involved in the stabilization of the client experiencing an overdose or poisoning?

A

Airway patency

Breathing

Circulation

cardiac function

acid-base balace, electrolyte homeostasis

mentation

injuries associated with toxic exposure and underlying disease process

vitals and temperature

26
Q

What are some concerns with ABCs in regards to stabilization of an overdosing or poisoned client?

A

Airway patency - protection may be required through endotracheal of nasotracheal intubation

breathing - many drugs or toxins can suppress the respiratory drive, mechanical respirations may be necessary

circulation - shock can occur from fluid loss as well as fluid overload, all of this depends on the hearts ability to deal with these changes as well as the hydration status of the client (examples: some snake bites cause third spacing around the area of the bite, leading to hypovolemia, some drugs impair myocardial contractility leading to fluid volume overload)

27
Q

What are some concerns when it comes to cardiac function and overdose or poisoning, specifically electrically?

A

ECG monitoring may be necessary to monitor for cardiotoxic effects, some drugs cause conduction delays or abnormalities.

Monitoring ECG is crucial, unconscious patients often lead to unreliable information about drugs that are involved

28
Q

What type of acidosis commonly occurs with overdose or poisoning?

A

Metabolic

29
Q

What lab tests would be ordered to assess for salicylate poisoning?

A

electrolytes -

ABGs

salicylate levels

30
Q

What two things can also change the mental status of a client other than an overdose of drugs or poisoning?

A

HYPOGLYCEMIA AND HYPOXEMIA

31
Q

After ocular exposure, what is the initial way of decontaminating?

A

flushing to remove the agent with lukewarm water or NS for 15 minutes while blinking eyes open and closed

32
Q

What is an initial wat to decontaminate after a dermal exposure?

A

flood the skin with lukewarm water for 15-30 minutes, removing all contaminated clothing beforehand, after flooding skin for 15-30 minutes wash the area gently with soap and water and rinse thoroughly.

33
Q

What changes in protocol are made for organophosphate insecticides with dermal exposure?

A

three separate soap and water washings or showers are recommended.

34
Q

Is neutralization of agent recommended?

A

NO, this can cause chemical burns.

35
Q

What is the initial way to decontaminate from inhalation exposure?

A

Go to fresh air as fast as possible

36
Q

How do you initially decontaminate from ingestion exposure?

A

use milk or water (8oz) to dilute the agent

37
Q

When is dilution of ingested agent not recommended?

A

seizures, depressed mental status, loss of gag reflex

38
Q

Is neutralization recommended for ingestion exposure?

A

NO NO NO NO

39
Q

When is chelation indicated, what is chelation? What are some examples of chelating agents? (enhanced elimination)

A

Chelation is the use of binding agents to remove toxic levels of metals from the body, such as mercury, lead, iron, and arsenic.

dimercaprol, calcium disodium edetate, succimer, and deferoxamine

40
Q

Is chelation a simple procedure?

A

NO, there are several concerns regarding this procedure.

41
Q

What are some different ways to decontmainate the GI tract more extensively?

A

Gastric lavage - NS administered in bolus through large NG to stomach and then drained.

adsorbents - activated charcoal (often mixed with 70% sorbitol), attracts and holds agents, contraindicated in decreased bowel sounds or bowel obstruction

cathartics - substance that promotes bowel movement, usually an adjunctive therapy, magnesium citrate or 70% sorbitol are commonly used.

whole-bowel irriagtion - large volumes of polyethylene glycol with electrolytes rapidly (1-2L/H) to mechanically irrigate the bowel without electrolyte disturbance, this is also used as bowel prep for colonoscopy.

42
Q

What does alteration of urine pH do? (enhanced elimination)

A

alkalinizing the urine increases the excretion of weak acids by increasing the amount of ionized rug in the urine. also called ION trapping.

43
Q

What is multiple dose activated charcoal usually reserved for? (enhanced elimination)

A

aspirin, valproic acid, and theophllyine

44
Q

When is hemodialysis indicated for overdoses or poisonings? (enhanced elimination)

A

When more conservative methods (gastric lavage, activated charcoal, antidotes) have failed, or when the client has decreased renal function.

45
Q

What things are easily removed through hemodialysis?

A

ethylene glycol (antifreeze), methanol, lithium, salicylates, theophylline

46
Q

Describe hyperbaric oxygen (HBO) therapy and when it is indicated.

A

oxygen is administered at a pressure higher than sea level, commonly used in carbon monoxide poisoning

47
Q

How does HBO therapy effect carbon monoxide elimination?

A

RA half-life is 5-6 hours

100% O2 half-life is 90 minutes

HBO therapy half-life is 20 minutes

48
Q

What are some complications found in HBO therapy?

A

otalgia

sinus pain

tooth pain

tympanic membrane rupture

confinement anxiety

convulsions

tension pneumo

49
Q

What is the difference between an antagonist, antivenin, and antitoxin?

A

antagonist - counteracts action of another drug

antitoxin - neutralize a toxin

antivenins - antitoxin that neutralize the venom of offending snake or spider

50
Q

What is a popular antivenin used in the US? What does it do?

A

CroFab - removes Fc fragments and leaves only fab fragments of immunoglobulin

51
Q

How do you administer CroFab?

A

4-6 vials over 60 minutes within 6 hours of bite if possible

THEN

4-6 additional vials if no initial control of envenomation syndrome

THEN

2 vials every 6 hours for up to 18 hours (3 doses) after initial control has been established

52
Q

What are some side effects of CroFab?

A

anaphylaxis - contraindicated in papaya or papain allergy, start slowly over the first 10 minutes with a rate of 20-25 ml/hr and observe closely for reaction

DO NOT LEAVE BEDSIDE IN THIS SITUATION

53
Q

How would we continuously monitor a poisoned or overdosed client? Why? Examples?

A

ECG - TCAs for example can cause dysrhythmias or conduction delays

Radiology - some substances are radiopague and can be visualized with contrast CT (heavy metals, button batteries, modified release tablets or capsules, aspirin concretions, cocaine or heroin containers), also show evidence of aspiration or pulmonary edema

electrolytes, ABGs, labs - can effect electrolytes, ventilation and oxygenation changes effects ABGs and pulse oximetry, also CK, glucose, CBC, and UA should be monitored

Anion gap (8-16 mEq/L) - elevation indicates toxic exposure possible metabolic acidosis (iron, isoniazid (INH), lithium, lactate, carbon monoxide, cyanide, toluene, methanol, metformin, ethanol, ethylene glycol, ASA, DKA, uremia, seizures, starvation

osmolal gap - difference between measured and calculated osmolality, increased (>10) is abnormal. ethanol, ethylene glycol, methanol

toxicology screens - tests for specific drugs or toxins, some may not be cuaght on screen due to how they are metabolized, some are measured through metabolites (like cocaine - benzoylecgonine in urine), these tests can be done through saliva, hair, and spinal fluid, but are more commonly used through blood and urine. drug abuse screens screen for common street drugs while a coma panel checks for CNS depressive drugs.

54
Q

What are some patient teaching points for toxic exposures?

A

Childproofing home

carbon monoxide detectors

Lead poisoning

55
Q

What are some lead poisoning teachings that are given in the book?

A

commonly found in old homes, paint, plumbing, and dinnerware

excreted slower than absorbed, buildup occurs easily

high level accumulation is often found too late, after learning disabilities and other poor effects are diagnosed because of lack of blood level screening

children can be tested for lead by their health care providers

the local health department can provide lead poisoning treatment and information about lead abatement programs

Critical Care Test #3 (6 decks)

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