EM/Toxicology Flashcards
When a patient presents with AMS of unknown etiology what three items are given?
Naloxone (narcan), thiamine, dextrose
When is gastric emptying useful for managing a pill overdose?
Only in the first hr after ingestion, otherwise it is not very helpful
Does charcoal have utility in overdose cases?
Yes it does. It won’t harm anyone so you can give it
If a patient ODs on benzodiazepines should you give flumazenil?
No, it may precipitate a seizure
Antidote for digoxin
Digoxin-binding Abs
Antidote for ethylene glycol or methanol
Fomepizole or methanol
Antidote methemoglobinemia
Methylene blue
Antidote neuroleptic malignant syndrome
Bromocriptine, Dantrolene
Antidote for organophosphates
Atropine, pralidoxime
Antidote for TCAs
Bicarbonate (protects the heart)
How does acetaminophen toxicity present in the first day? Days 2 - 3?
Day 1: nausea and vomiting
Days 2-3: liver failure
During what time period is N-acetylcysteine beneficial in preventing liver toxicity after acetaminophen overdose?
First 24 hours
What affect does aspirin have on the brainstem? What effect on the lungs?
Brainstem: causes hyperventilation (respiratory alkalosis)
Lungs: ARDS
What are acid/base disturbances in aspirin OD and in which order do they present?
Respiratory alkalosis from brainstem evoked hyperventilation occurs first
Metabolic acidosis occurs second
Treatment of aspirin overdose
Bicarbonate to alkalinize the urine
Charcoal to block absorption
Dialysis if necessary
All patients that come in with some sort of overdose should have what drug levels checked too as possible co-ingestions?
Acetaminophen
Aspirin
Ethanol
How should you handle a benzodiazepine overdose?
Don’t give flumazenil. Let the patient sleep and it will pass
How does digoxin toxicity often present?
What effect does digoxin have on potassium?
GI disturbance most commonly; other symptoms are yellow halos in visual field, confusion, arrhythmia
Digoxin causes hyperkalemia; Digoxin overdose can be made worse by hypokalemia
Hypocalcemia and oxalic acid crystals in urine are signs of what toxicity?
Ethylene glycol
What types of drugs may precipitate methemoglobinemia?
Oxidizing drugs. Any -caine, nitrates, anestheticsm dapsone.
How will methemoglobinemia appear on ABG?
What can make dx?
Normal PO2
Methemoglobin level
What are the most dangerous complications of TCA overdose? What other presenting symptoms may they have?
Arrhythmia, Cardiotoxicity
Other Sx: dilated pupils, dry mouth, constipation, urinary retention (all related to anticholinergic effects)
Abdominal pain, rigidity, and hypocalcemia in a patient without abdominal tenderness is suggestive of what exposure? Tx?
Black widow spider bite
Antivenim
How do brown recluse spider bites present?
Mgmt?
Local bruising, bullae, and dark lesions
Debride the wound
What is the best initial therapy for acute angle closure glaucoma? What are other drugs which may be provided?
Initial: Pilocarpine (causes miosis)
Others: acetazolamide, mannitol, latanoprost, timolol, apraclonidine
What presents with visual problems described as “a curtain coming down”?
Retinal detachment
How is uveitis diagnosed and what is tx?
Diagnosed with slit lamp exam
Tx: steroids
Are there any specific therapies for corneal abrasion? What can make dx?
No
Fluorescein stain
