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Clin Med IV: Emergency Medicine > EM Toxicology > Flashcards

EM Toxicology Flashcards

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1
Q

what are methods to protect airway

A

positioning (head tilt, jaw thrust)
Removal of any secretions
nasal or oral airway
administration of reversal agent

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2
Q

what drugs generally cause respiratory depression

A

barbituates
opioids
sedative-hypnotics
ETOH

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3
Q

what drugs can cause hypoxia from aspiration pneumonia or pulmonary edema

A

cocaine, opioids, sedative-hypnotics, antipsychotics, TCA

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4
Q

what drugs can cause bradycardia or AV block

A

opioids
clonidine
BB
TCAs

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5
Q

what drugs cause QRS prolongation

A

cocaine
BB
TCAs

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6
Q

what drugs can cause tachycardia

A

cocaine
PCP

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7
Q

what drugs can cause v-tach/V-fib

A

amphetamines
cocaine
TCAs
CCB

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8
Q

what drug can cause QT prolongation

A

Methadone

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9
Q

what drugs cause hypotension

A

opioid
sedative-hypnotics

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10
Q

what drugs can cause hypertension

A

amphetamines
cocaine
marijuana

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11
Q

if patient has low respiratory drive, what is the first treatment of choice

A

Narcan

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12
Q

what is hyperthermia associated with

A

several toxidromes (sympathomimetics, serotonin, neuomuscular malignancy)

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13
Q

how quickly should activated charcoal be administered

A

within 1 hour while toxin is within the stomach

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14
Q

what are contraindications to charcoal

A

altered LOC to prevent aspiration

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15
Q

what are SE of charcoal

A

constipation, impaction, stomach cramps, abd distention, vomiting -> aspiration

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16
Q

What is the toxidrome for cholinergics

A

SLUDGEM
Salivation
Lacrimation
Urination
Defecation
Gastroenteritis
Emesis
Miosis

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17
Q

what drug class casues “red as a beet, dry as a bone, blind as a bat, mad as a hatter”

A

anticholinergics

ex. scopolamine

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18
Q

what is the use of physostigmine

A

for life-threatening anticholinergic toxicity
Increases acetylcholine

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19
Q

what are the symtpoms of cyanide

A

HA
Nausea
Dyspnea
syncope
seizure
coma
agonal respirations
lactic acidosis

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20
Q

what is the toxic level of acetaminophen

A

150mg/kg

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21
Q

how is cyanide poisoning treated

A

cyano-kit

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22
Q

What is the Rumack-Matthrew Nomogram used for

A

acetaminophen toxicity
(probably toxicity, treat vs likely safe)

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23
Q

what is the treatment for Acetamenophen toxicity

A

NAC (N-acetylcystine)

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24
Q

what is used to reverse opioid over dose

A

Naloxone
Narcan

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25
Q

what is Naloxone

A

competitive opioid antagonist
can be given IM, IV, IO, IN
onset: <2min if IV
lasts: 20-60min

26
Q

what is the initial dose of Narcan

A

0.2 - 0.4mg
repeat every 2-3 minutes, increasing dose

27
Q

what is the max dose of Narcan

A

10-20mg (relative)

28
Q

what occurs with salicylate OD

A

stimulates respiratory drive -> hypervent -> resp alkalosis -> dehydration -> compensatory metabolic acidosis

29
Q

what is the treatment of salicylates OD

A

sodium bicarb for metabolic acidosis
fluid resuscitation
glucose
amenable charcoal
whole bowel irrigation

30
Q

What are symptoms of salicylate OD

A

tinnitus, lethargy, seizures, hypoglycemia, hyperthermia, hypokalemia

31
Q

what are s/s of non-TCA antidepressant overdose

A

CNS depression - ataxia, sedation, coma, resp depress
seizures
sinus tach and HTN
sinus brady or hypotension
QRS/QT prolongation

32
Q

what occurs with serotonin syndrome

A

Triad: autonomic instability, AMS, neuro abnormality (hyperreflex/clonus)
tachy
HTN
diaphoresis
hyperthermia
mydriasis
tremor

33
Q

what is the treatment of serotonin syndrome

A

Benzos
Cyproheptadine

34
Q

what is the toxic dose of TCAs

A

<10x therapeutic dose
10-20mg/kg life threatening
onset: 30-60 min after ingestion

35
Q

how does TCA manifest

A

anticholinergic effects, alpha blockade and electrical derangements
prolonged PR, QRS, QT
seizures
acidosis
hypotension

36
Q

what is the treatment for carbdon monoxide poisoning

A

100% O2 until CO < 5%

37
Q

what are symptoms of CO overdose

A

HA
drowsiness
Nausea
MI/angina
change in cognition
syncope
seizure
coma
hypotension
cardaic arrest

38
Q

what is mild intoxication with antipsychotics

A

sedation
small pupils
orthostatic hypotension
dry mouth
abscence of sweating
tachy

39
Q

what are severe signs of antipsychotic intoxication

A

coma
seizures
respiratory arrest
QT/QRS prologation
poikilocytosis

40
Q

what is neuroleptic malignant syndrome

A

can see with antipsychotic intoxication
muscle rididity
bradykinesia
sweating
AMS
volatile vital signs
lactic acidosis
rhabdomylosis

41
Q

what is the treatment of antipsychotic intoxication

A

benadry or benztropine for drug-induced extrapyramidal d/o
sodium bicard for CNS effects
Vasopressors for hyptension
amenable to charcoal

42
Q

what are symptoms of benzodiazepine intoxication

A

hypothermia
bradycardia
bradypenia
hypotension
CNS depressioin
hyporeflexia
dry mouth
no pupillary changes

43
Q

What is the treatment of benzo intoxication

A

drug specific antidote: Flumazenil

44
Q

how quickly do alcohol levels drop

A

15-30mg/dL/hr

45
Q

what are common presentations of alcohol abuse/intoxication

A

coma
respiratory depression
aspiration
hypothermia
hypotension
brady

46
Q

what is the treatment for alcohol intoxication

A

first line: Naltrexone (oral or depor injection)
Antabuse
Topiramate (off label)

47
Q

what is Wernickes

A

acute/subacute
AMC, CN6 palsy, gait disturbance
give thiamine

48
Q

what is Korsakoff

A

Irreversible confabulation associated with chronic alcohol abuse and low thiamine
Amnesia
Apathy

49
Q

how do we treat anticholinergic OD

A

supportive care
Benzos
IV hydration
cooling measures if hyperthremic
Physostimgine
Bicarb if wide QRS

50
Q

what is the treatment of amphetamine OD

A

activated charcoal if large single ingestion
can tx agitation with benzos/antipsych
BB for tachy
may need cooling

51
Q

what causes mortality with amphetamine use

A

ventricular arrhythmias
status epilepticus
intracranial hemorrhage
hyperthermia

52
Q

what causes mortality wiht cocaine use

A

arrhythmias
status epilepticus
intracranial hemorrhage
hyperthermia

53
Q

what is the treatment of cocaine OD

A

supportive care, tx complications:
ASA, nitrates, CCB for angina
Benzo - HTN/tachy/agitation

54
Q

what is the #1 cause of drug-induced shock

A

Beta-blockers
higher risk if combo with CCB/TCAs

55
Q

what are symptoms of BB OD

A

classic triad: hypotension, bradycardia, hypoglycemia
AMS
seizure and come
AV block, QT prolongation, vasodilation
HTN
Hypokalemia
bronchospasm
respiratory arrest

56
Q

what is the treatment of BB abuse

A

follow ACLS algorithm (atropine for brady)
glucagon if resistant brady/hypotension
amenable to charcoal

57
Q

what is the primary presentation of CCB abuse

A

bradycardia with hypotension
- no QRS prolongation initially + hyperglycemia

58
Q

what is treatment of CCB abuse

A

ACLS alorithsm
calcium chloride or gluconate to counter redcued contractility
insulin and glucose
vasopressors for sock
amenable to CCB

59
Q

what are withdrawal symptoms of Marjuana

A

irritability, difficulty sleeping, decreased appetite, anxiety

60
Q

what are withdrawal symptoms from opioids

A

restlessness, pain, insomnia, d/v, cold flashes, leg movements

Clin Med IV: Emergency Medicine (18 decks)

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