ED

Question 1

When is gastric lavage indicated? Does it work?

Answer 1

no evidence for the pactice
used for life-trheatening ingestions within 1 hr of ingestions. not used in caustic, hydrocarbon, or non-toxic exposures

Question 2

When is activated charcoal considered/used? Does it work?

Answer 2

always consider. improves outcomes within 1 hr. ineffective for many poisons, including iron arsenic, alcohols, lithium (among others). not used for caustic ingestions.

Question 3

Whole bowel irrgation

Answer 3

Polyethylene glycol + electrolyte solution.

Question 4

Acetaminophen poisoning: pathophys and tx

Answer 4

glutathione is depleted (needed for metab by P-450 system), and toxic intermediates that can’t be broken down cause hepatic damage.

1. gastric lavage if life-threatening
2. charcoal
3. serum acetaminophen level 2-4 hrs after ingestion. Plot on matthew rumack nomogram
4. N-acetylcystine, esp. in first 8 hrs (but may have benefit even 72 hrs later)

Question 5

stages of acetaminophen toxicity

Answer 5

30 min- 1 day: asymptomatic (or vomiting/diarrhea)
24-72 hr: GI symptoms better; transaminitis around 36 hr
42-96 hrs: hepatic necrosis and liver failure
4 days-2wks: improvement, death, or progressive failure

Question 6

Pathophys of salicylate poisoning

Answer 6

1. stim of resp. centers. casues hyperventilation (resp. alkalosis)
2. uncoupled oxidative phosphorylation- lactic acidosis and ketosis
   Patients are febrile, diarhopetic, flushed. may have tinnitus, vomiting, headache

Question 7

lab findings in salicylate poisoning

Answer 7

resp alkalosis with anion gap acidosis; hyperglycemia; hypokalemia

Question 8

treatment of salicylate poisoning

Answer 8

1. gastic lavage (salicylates delay gastic emptying)
2. charcoal q4 hrs
3. serum salicylate 6 hrs after ingestion.
4. alkalinization of urine with sodium bicarb to urine >pH 7
5. Dialyze

Question 9

Iron toxicity

Answer 9

consider for child overingestion of prenatal vitamins
can cause damage to GI tract/hemorrhage, hepatic injury/necrosis, third spacing, interefence with oxidative phosphorylation. can be life-threatening

Question 10

Treatment of iron toxicity

Answer 10

1. gastic lavage
2. treat blood loss/hypovolemia
3. consider whole bowel irrigation
4. obtain iron level 2-4 hrs after ingestion
5. IV deferoxamine if >100 mg/kg ingested, severe symptoms, levels >500. May also be given before levels are known.

Question 11

treatment of lead toxicity

Answer 11

dimercaprol, EDTA

Question 12

Features/complications of caustic ingestions; treatment

Answer 12

burning pain, obstructive airway edema (esp. with acids), gastric perforation with acids, esophageal perforation (esp. with alkali).
tx: these patients need endoscopy

Question 13

How do you manage dog bites?

Answer 13

1. wound irrigation
2. suture wounds on face, large wounds, and wounds <24 hrs
3. abx (amoxicillin-clavulanic acid (aka augmentin)
4. tetanus prophylaxis