Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Anaesthetics, ED and Plastics > ED - Toxicology > Flashcards

ED - Toxicology Flashcards

1
Q

What do you want to know in the history of overdose

A 
How much? 
What they took? More than one drug? 
Accurate timing? 
Staggered or all together? 
With alcohol or water? - alcohol worsens
Do bloods and blood gas
TRAKCARE for drug Hx 
Collateral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do you assess

A 
ABCDE
Check BM as reversible cause of low GCS before intubate
ECG 
Check vitals, temp, pupil size, 
IV access
Bloods
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What else should you do

A

Risk assess
Do they have capacity
Do they need psychiatry / police

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is good source of information

A

TOXBASE
Look up drugs to see what they cause and form management
Always suspect possibly overdose if patient with abdominal pain / vomit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a toxidrome

A

Signs and symptoms that suggest a specific type of poisoning as patient may not be able to tell you

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do you examine

A 
ABCDE
A+B = RR and HR 
C = pulse and BP 
D = GCS, pupils, reflex, any seizures
E = temp, skin, mucous membrane
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What drugs cause sympathomimetic / adrenergic toxidrome

A 
Cocaine
Amphetamine
Theophylline 
Decongestants
Legal highs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What drugs cause sedative / hypnotic toxidrome

A

Benzodiazepine
Zopiclone
Barbiturates - phenobarbital (CNS depressant)
Alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What drugs cause opioid toxidrome

A

Heroin
Methadone
Codeine
MST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What drugs cause anti-cholinergic toxidrome

A

TCA
Anti-histamine
Anti-psychotics
Oxybutin / tolterodine - incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What do sympathomimetic drugs do

A

Stimulate A and B adrenergic receptors
Prevent uptake of Noradrenaline, dopamine and serotonin
Release Na

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do they present

A 
Chest pain - MI can develop
Aortic dissection 
Arrythmia- QT prolonged 
High HR
High BP - can cause bleed 
High RR
Sweating
Fever
Dilated pupils 
Brisk reflexes
HYpertonia 
Seizure
Metabolic acidosis
Rhabdomyolysis 
Excessive speech and motor 
Restless
Agitated
Insomnia
Hallucination
Ischaemic colitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do you treat

A 
IV fluid + cooling
ECG to look for arrhythmia 
Control agitation - diazepam / benzo 
Check CK 
Control BP - GTN infusion (Na nitroprusside) 
If chest pain = GTN and PCI if MI develops 
- Treat as MI 
Anti-pyretic to lower temp
Treat arrythmia
Treat metabolic acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you treat acidosis / raised CK

A

IV fluid and sodium bicarb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What do you NOT give

A

BB

leads to unopposed alpha antagonism and HTN crisis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How do sedative drug overdose present

A 
Braydcardia
Respiratory depression
Hypotension
Slurred speech
Ataxia
Reduced reflex
Normal skin / membrane
Pupil size normal 
May have blurring / diplopia / nystagmus 
Hallucination
Delerium
Coma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do you manage sedative overdose

A

Protect airway
Support ventilation if reduced GCS
Correct hypo - may need vasopressor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What drug can be used to manage Benzo OD

A

Flumazenil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When do you use

A 
If 100% confident isolated Benzo OD 
Iatrogenic 
Severe or would otherwise require ventilation 
HIGH RISK OF SEIZURE 
Not dependent as risk of withdrawal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When do you consider opioid overdose

A

If person on opioids regularly on drug chart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What does opioid toxidrome look like

A 
Resp depression
Bradycardia
Hypotension
Pin point pupil - miosis
Reduced GCS
Hypothermia
Seizure
Normal skin and mucous
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How do you treat

A

Nalaxone (competitive antagonist) up to 2mg
Start with 400 microgram
IM or IV
Lasts 45 minutes so may have to keep doing it as opiate will have longer half life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What suggests anti-cholinergic overdose

A

Hot as hare
Dry as bone
Mad as hatter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are ECG changes

A 
Sinus tachycardia 
Widen QRS
Long PR
Long QT 
Arrythmia
25
Q

What is toxidrome of anti-cholinergic overdose

A 
Hypertension
Tachycardia
Dilated pupil
Brisk reflexes then absent - myoclonus
Pyrexia
Flushed dry skin / dry mouth 
Urinary retention 
Restless 
Arrythmia 
Metabolic acidosis
Seizure 
Confused
Later drowsy then coma
26
Q

How do you manage

A

Repeated doses of charcoal if within 1 hour
Check CK
Correct acidosis
IV bicarb = 1st line to reduce risk of seizure
Glucagon if severe hypo / HF or cariogenic shock
Many anti-arrythmics CI as prolong QT

27
Q

What do you do if CK raised

A

Fluid

28
Q

When do you give sodium bicarb

A

Metabolic acidosis
QRS prolonegd
Arrythmia
Hypo not responding

29
Q

How does paracetamol overdose present

A 
N+V
Coma
Severe metabolic acidosis 
Abdo pain = late sign 
After 2-3 days hepatic necrosis = RUQ pain, jaundice, renal failure, coma
30
Q

Where is paracetamol conjugated and broken down

What puts you at increased risk of hepatotoxicy

A

Liver by p450 enzyme

Patients taking p450 inducers
Malnourished patient as enzyme to break down depleted
Acute alcohol therefore may be protective as p450 inhibitor

31
Q

How do you investigate paracetamol overdose

A

Do levels 4 hours after overdose
LFT as well + clotting (PT bad)
Bloods - FBC, U+E, LFT, clotting, INR
Do VBG for acid base balance / pH - gives instant result
- Abnormal LFT, acidosis, hypoglycaemia, coag abnormalities
Get paracetamol level after 4 hours to see if need NAC
If present >8 hours take straight away and give NAC immediate
This allows you to decide if patient needs NAC
Mental health referral

32
Q

How do you treat

A

Activated charcoal if <1 hour
N-acetylcysteine (NAC)- Allows safe metabolism of toxin
Liver transplant

33
Q

When should NAC be commenced

A

Within 8 hours to be fully effective

21 hour infusion

34
Q

What do you do if staggered overdose (not all taken within 1 hour)

A

Level in blood not helpful

Just work out if toxic overdose >150ml/kg and give nAC

35
Q

What is liver transplant indicated / referral to liver unit

A

King’s College Criteria
- pH <7.3 24 hours later OR

All 3 of

  • PT >100 or INR >6.5
  • Creatinine >300
  • Grade 3 -4 encephalopathy
36
Q

How does CO poisoning present

A 
Headache = 90%
N+V
Malaise 
FAtigue 
Flu like symptoms 
Chest pain
Confusion
Vertigo 
Weakness 
Diarrhoea
Drowsy

Severe
Bizarre neuro / extra-pyramidal if severe
Pink mucosa
Arrhythmia

37
Q

How do you Dx

A

ABG or VBG showing elevated HbCO

Pulse oximetry can read high as similar to HbO

38
Q

What else should you do

A

ECG + cardiac biomarkers to look for ischaemia

39
Q

What other tests

A 
CK / urine myoglobullin - rhabdo in severe cases
FBC
U+E - hypokalaemia 
LFT
Glucose - hyperglycaemia 
Blood lactate - severity 
Toxicology - if suspect suicide 
Urinanalysis - +ve albumin / glucose in chronic
40
Q

How do you Rx

A

100% O2 non rebreather mask
Continue till symptoms resolved but minimum 6 hours
Intubate if coma
Cardiac monitoring + pulse oximetry

41
Q

Pathophysiology behind

A

CO has high affinity for oygen

Shifts oxo-haemoglobin curve to the left resulting in hypoxia

42
Q

Indications for Hyperbarci oxygen

A

LOC
Neuro signs
Arrhythmia
Pregnancy

43
Q

How do you manage BB overdose

A

Atropine if Brady

Glucagon if resistant

44
Q

How do manage heparin overdose

A

Protamine sulphate

45
Q

What are features of Salicylate overdose (Aspirin)

A 
Tinnitus
Lethargy
Sweating
Pyrexia
N+V
Hyper or hypoglycaemia
More severe = hyperventilation and resp alkalosis 
AKI 
Confusion 
Seizure
Coma
46
Q

What acid base

A

Respiratory alkalosis due to early stimulation of resp = late
Metabolic acidosis due to AKI / direct effect = early

47
Q

How do you Rx

A

ABC
Charcoal if acute
Urinary alkalisation with sodium bicarbonate
Haemodialysis

48
Q

What are indications for dialysis

A 
High concentration
Resistant acidosis
AKI
PUlmonary oedema
Siezure
Coma
49
Q

How does ecstasy poisoning present

A 
Neuro - agitation, confusion, ataxia
CVS - tachy + HTN
Hyponatraemia
Hyperthermi
Rhabdomyolysis
50
Q

How do you Rx

A

Supportive

Dantrolene for hyperthermia if fails

51
Q

What is activated charcoal used for

A

Reduce absorption and accelerate excretion following overdose
Give 50g within 1 hour of overdose
Binds free drug
Can cause vomiting

52
Q

Lithium toxicity

A

IV saline

Dialysis if severe

53
Q

Theophylline toxiciity

A

Activated charcoal

Dialysis

54
Q

Antitode to opiate

A

Nalaxone

55
Q

Antitotde to BB

A

Glucagon

56
Q

Antitode to Iron

A

Desferroxamine

57
Q

Antitode to CO

A

Hyperbaric O2

58
Q

Antitode to digoxn

A

Digiband

Anaesthetics, ED and Plastics (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions