EM poisoning Flashcards
In kerosene oil ingestion there may be aspiration of small amount of oil into the lungs directly or a vomit can be aspirated. Clinical symptoms of cough, tachypnea, grunting, and chest retractions may appear within half an hour after aspiration. Chest X-ray may be normal initially and may show changes after 8-12 hours after ingestion with a peak at 48-72 hours. Pneumatoceles or pleural effusions may occur.
The best line of management is supportive with oxygen and intravenous fluids. The most dangerous consequence of kerosene oil ingestion is usually aspiration resulting in chemical pneumonitis.
The child should be hospitalized and observed for respiratory failure which can be managed by assisted ventilation.
In kerosene poisoning what is contraindicated
Inducing emesis is always contraindicated because the danger of aspiration is greater than systemic toxicity.
Gastric lavage is also contraindicated for the same reason of risk of aspiration.
Measurement of _______ is useful in providing clues about the duration of exposure and the degree of lead accumulation.
heme precursor, protoporphyrin
Which of the following would be the best initial management of ethanol intoxication
Correction of hypoglycemia
3-year-old boy presents with “hallucinations”. On exam, the child is found to be hypertensive and tachycardic. The mother reveals to you that the child has had severe nasal congestion for 1 month; symptoms include excessive sneezing, watery eyes, and an itchy nose. She admits to giving the child a medication that she received at an “alternative therapy” clinic.
Ephedra, also known as ma huang, has the active ingredient ephedrine. It is used for nasal congestion, asthma, appetite suppression, and as a ‘natural high’. The side effects include hypertension, tachycardia, anxiety, palpitations, restlessness, headache, insomnia, and dizziness.
Acetaminophen crosses the placenta and may cause fetal hepatic necrosis. A delay in treating pregnant patients may result in fetal demise. This 15-year-old female patient is of child-bearing age.
test pregnancy in teenage acetaminophen toxicity
Screening immunoassay tests often do not detect methadone. More comprehensive though expensive screens like ___ should be used in situation, when there is a high suspicion of possible intentional administration of methadone.
gas chromatography/mass spectrophotometry (GC/MS) or high-performance liquid chromatography
A car running in a small covered garage will produce dangerous levels of ____ in a short period of time. ______ has a much higher affinity for hemoglobin than oxygen (200-300 times). This leads to cellular hypoxia.
The child had inhaled carbon monoxide from the exhaust fumes of the car.
The cherry red color is secondary to the
carboxyhemoglobin.
What clinical presentation would most likely be seen in children (but not in adults) exposed to a nerve agent?
Significant weakness and hypotonia have been observed in 70 to 100% of pediatric victims with moderate to severe exposure. Nerve agents (NA) are organophosphorus anticholinesterase compounds, or insecticides, that are more toxic by orders of magnitude. They primarily act by inhibiting esterase enzymes, the most pathophysiologic being acetylcholinesterase (AChE).
A blood lead level of 10-14 mcg/dL is considered moderate risk II and warrants, in addition to reporting to the local health department…. next step
repeating all capillary samples and confirming with a venous sample within 1 month for new cases and 1-3 months for known cases.
In known cases of lead levels between 10-14 mcg/dL, a confirmatory venous sample can be done within 1-3 months;
however, as this is a new case, testing should be done within 1 month.
Ingestion of _____ , found in sweet tasting antifreeze used in car radiators, causes severe metabolic acidosis, hypocalcemia, and nephrotoxicity.
ethylene glycol
Ricin is a plant-derived, heat-stable toxin extract of the castor bean that enters cells through endocytosis, is transported to the Golgi apparatus and endoplasmic reticulum, and acts as a protease-resistant, enzymatically active structure that interacts with the sarcin-ricin domain of the large ribosome subunit RNA. This causes a disturbance of translation by preventing the binding of elongation factors to the ribosome and it also inactivates nonribosomal nucleic acid substrates. Rapidly dividing tissues, particularly the gastrointestinal epithelium, are most susceptible such that when ingested it can produce a syndrome of severe gastrointestinal upset, vomiting, hemorrhagic gastroenteritis, shock, and cardiovascular collapse.
Ricin may be ingested, inhaled, or injected. Ricin has been associated with terrorist activity in the United States when ricin-containing letters where found the US postal system in 2003 and again the following year in the mail sorter of a congressional post office. Multiple confiscations have also occurred in the US and abroad over the last 5 years. Treatment is supportive and a vaccine is currently under development.
When a patient ingests ______ s/he often presents with the combination of altered mental status, seizures, and cardiac toxicities (tachycardia, hypotension, and dysrythmias such as prolonged QT and QRS intervals that may degenerate into ventricular tachycardia)
tricyclic antidepressants,
