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Elaina: Emergency 2 > ED 2 Toxicology > Flashcards

ED 2 Toxicology Flashcards

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1
Q

what does the mnemonic MUDPILES stand for?

A 
Methanol
Uremia
DKA
Propylene Glycol
Infection/Isoniazid (TB drug)
Lactic Acidosis
Ethylene glycol/ethanol
Salicylates
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2
Q

which 2 key features will clue you into an aspirin overdose?

A

Kussmal breathing

Tinnitus

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3
Q

serum levels of what level represent potentially life threatening aspirin toxicity?

A

over 500 mg/kg

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4
Q

what lab values will change first with aspirin ingestion?

A

LFT

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5
Q

how often should you draw serum salicylate levels when monitoring potential overdose? why?

A

every 2 hours in acute, single dose OD

we don’t know when the full impact will be

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6
Q

at ____ hours post ingestion, your patient likely has fully absorbed the ASA

A

6 hours

careful with serum levels less than 6 hours post ingestion

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7
Q

what lab is essential to order in an ASA overdose? why?

A

arterial blood gases

will often see sever metabolic acidosis

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8
Q

what are the two treatments of choice in aspirin overdose?

A

DIALYSIS

alkalinize urine to 7.5-8 (give bicarb)

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9
Q

when can you perform gastric lavage in an ASA overdose until?

A

60 minutes post ingestion

someone correct me i wasn’t listening and i don’t know if we still do this

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10
Q

what is the max daily dosage for an adult taking acetaminophen?

A

4 grams

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11
Q

why do children under 5 fare better in terms of acetaminophen overdose?

A

they have more glutathione in their liver

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12
Q

describe the symptoms seen in phase 1 of acetaminophen OD. how long will these occur for?

A

asymptomatic to N/V, subclinical bump in LFT

lasts 0-24 hours

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13
Q

describe the symptoms seen in phase 2 of acetaminophen OD. how long will these occur for?

A

RUQ pain, N/V, continued increase in LFT

18-72 hours

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14
Q

describe the symptoms seen in phase 3 of acetaminophen OD. how long will these occur for?

A

jaundiced, coagulopathy, liver necrosis, renal failure, fatality

72-96 hours

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15
Q

what is the KEY thing to keep in mind when worrying about an acetaminophen overdose?

A

these patients will get sick DAYS later

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16
Q

when do you draw levels when monitoring an acetaminophen overdose?

A

immediately and at 4 hours

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17
Q

when does max absorption of acetaminophen occur?

A

4 hours

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18
Q

what level should you draw continuously throughout a patient’s stay to monitor mortality in a suspected acetaminophen overdose?

A

lactate level

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19
Q

how should ABG of an acetaminophen overdose look?

A

normal! normal pH

if its not normal, assume other ingestion

20
Q

what is the TOC for acetaminophen overdose? when should you give it by?

A

n-acetylcystine loading and maintenance dose

give within 8 hours or ANYTIME when pregnant

21
Q

what are the 4 criteria for liver transplant in an acetaminophen overdose?

A

1) pH less than 7.3
2) grade 3+ encephalopathic
3) PT greater than 100
4) serum creatinine over 3.4

22
Q

who do we use the rumack-matthew nomogram for?

A

tool to monitor probable acetaminophen serum levels vs. time in our OD patient

23
Q

patient presents with tremor rigidity, hyperreflexia, anxiety, and agitation. you suspect serotonin syndrome – what levels should you draw?

A

creatinine kinase levels to check for rhabdomyolysis

24
Q

how do we treat serotonin syndrome?

A

benzodiazepines
BP control
fluid for rhabdomyolysis control
cooling

25
Q

when is peak absorption for tricyclic antidepressants? what is a toxic dose?

A

peak absorption 1 hour

toxic dose 10-20mg/kg

26
Q

most common TCA that we see overdose in? who should you avoid this med in?

A

amitriptyline

avoid in pt with uncontrolled mental illness or HX of suicide attempts

27
Q

what signs should make you worry about impending TCA overdose?

A

anticholinergic toxidrome

hyperthermia, confusion, dry mouth, urinary retention, grabbing invisible objects, dilated pupils, flushed skin, tachycardia, shaking

28
Q

what does the SALT toxidrome of TCA overdose look like?

A

shock
altered mental status
wide QRS
terminal R wave in AVR

29
Q

what is the TOC for TCA overdose?

A

give bicarb until serum pH is 7.4+

intubation in severe OD: can hyperventilate patient on vent!

30
Q

which three ODs cause severe metabolic acidosis?

A

ethylene glycol, TCA, ASA

31
Q

TCA overdose will be initially _____ but will crash very shortly after

A

initially asymptomatic

32
Q

when is the peak effect with the following routes of opiate administration?

1) IV
2) IM
3) PO

A

IV: 10 minutes
IM: 30-45 minutes
PO: 90 minutes

33
Q

which routes of ingestion do we worry most about with opiate overdose, as they are very hard to control with narcan?

A

dilaudid and methadone (long acting)

narcan’s half life is very short

34
Q

key finding of opiate overdose?

A

respiratory depression, bradypnea, hypoxia

should NOT see cardiac issues unless down for a LONG time

35
Q

what lab should you draw in any patient who presents to the ER unresponsive?

A

finger stick blood sugar

36
Q

_____ promotes aggression and may require restraining the patient upon administration

A

narcan

37
Q

if your patient had an oral OD of opiates, what should you consider?

A

GI decontamination

38
Q

if opiate OD patient is still altered after administration of narcan, what must you assume?

A

other ingestion vs. anoxic brain injury

39
Q

OD on CCB verapamil will cause what two physiologic responses?

A

vasodilation (hypotension) and bradycardia

40
Q

which verapamil formulation is most dangerous? how will these patients present?

A

extended release – VERY sick, one of worst ODs you will see

41
Q

onset of OD overdose in verapamil?

A

15 minutes - 2 hours

OD with over 1 gram

42
Q

what are the 3 treatments you give for verapamil overdose?

A

1) CaCl 10 percent
2) pacing
3) pressor support

43
Q

which substance is relatively benign until it is metabolized into glycolic acid?

A

ethylene glycol

44
Q

how will an ethylene glycol OD present?

A

1) initially no abnormalities
2) altered mental status
3) kussmal breathing
4) very sick

45
Q

what should your workup of your ethylene glycol OD consist of?

A

look at serum osmolality vs. calculated anion gap

serum osmol should be equal to calculated osmol, if its not you’re in trouble

46
Q

what is the conversion factor for ethylene glycol?

A

6.2

47
Q

what is the treatment of choice for ethylene glycol overdose?

A

1) bicarb to correct acidosis (7.4+)
2) fomepizole TOC
3) end game is dialysis

Elaina: Emergency 2 (11 decks)

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