EM- toxicology/OD Flashcards
do you need to identify the poison before treating someone?
NO! Attempts to identify the poison should NOT delay care!
if someone has an altered mental status or depressed GCS, what three things can we give them?
the “coma cocktail” - DTN
D50 (for possible hypoglycemia)
thaimine (for possible alc. caused wernickes enceph.)
narcan aka naloxone (for possible opiod OD)
4 part general management for suspected overdose
- Ensure adequate airway: oral, nasal, intubate if necessary
- Ensure adequate oxygenation: high-flow O2, treat bronchospasm
- IV access: two large-bore lines
- Cardiac, VS & SpO2 monitor
what things can cause an altered mental status?
“AEIOU TIPS”
Alcohol, Endocrine, Epilepsy, Intoxication, Oxygen (hypoOx) , Uremia
Trauma, Tumor, Infection, Psychological, Shock, Stroke
Dx workup for suspected OD/tox?
labs: urine drug screen, CMP
imaging: Abdominal Xray
EKG: for conduction delays or ischemia
what is a toxidrome?
A collection of symptoms and signs that consistently occur after ingestion of a particular toxin or drug class or agent
how is a toxidrome Dx?
history and PE
5 classic toxidromes
Sympathomimetic (cocaine, decongestants, MDMA, etc) Opiate Anticholinergic Cholinergic Sedative-Hypnotic
what are the various mechanisms of sympathomimetic toxidromes?
- direct alpha & beta receptor agonists
- indirectly release catecholamines
- prevent metabolism & reuptake of catecholamines
what are the effects of a sympathomimetic toxidrome?
Increased temp, diaphoresis
Tachycardia & hypertension, Palpitations, chest pain
Mydriasis
CNS excitation, Hyperactivity, seizures
3 part txt for sypathomimetic toxidrome?
ABC
supportive care: lots of BENZOS!, temp control
consider GI decontamination
*txt HTN unresponsive to benzos
what are the 3 CNS receptors that opiods bind to? what are the effects of each?
Mu – analgesia, resp depression, euphoria
Kappa – sedation, analgesia, mioisis
Sigma – dysphoria, hallucinations
what are the effects of an opiate toxidrome?
CNS depression & Respiratory depression Bradycardia, Hypotension Miosis Hypothermia Nausea/vomiting Flaccidity
opiate toxidrome txt?
ABCs, supportive care, narcan!
what is the half life of narcan?
60-90 min in adults (shorter than opiod drugs)
what are the effects of an anti-cholinergic toxidrome?
“RED as a beet, DRY as a bone, BLIND as a bat, HOT as a hare, MAD as a hatter, FULL as a flask”
what is the antidote for anti-cholinergic toxidrome? when would you use it? why is this?
Physostigmine: ONLY if Severe agitation or psychosis unresponsive to other therapy
-NO history of seizures
-w/ normal EKG
-not on TCAs (b/c chol. syndrome)
why? Can cause cholinergic syndrome (if you go too far with txt)
these are all examples of what kind of toxidrome?
organophosphate & carbamate pesticides, nerve agents, edrophonium, pilocarpine, pyridostigmine
some ‘shrooms -muscarine containing
cholinergics
what are the effects of cholinergic toxidrome?
D - diaphoresis, diarrhea, decr BP U - urination M - miosis B - bronchorrhea, bronchospasm, brady E - emesis, excitation of skeletal muscle L - lacrimation S - salivation, seizures
what is the pathophys of the cholinergic toxidromes?
Inhibition of acetylcholinesterase: leads to increased acetylcholine
Muscarinic activation
bradycardia, incr secretions, bronchospasm
Nicotinic
fasciculations, HTN, weakness
what antidote can you give for cholinergic toxidrome?
atropine (antichol)
these are all what type of toxidrome? ETHANOL!! anticonvulsants barbiturates benzodiazepines GHB Ambien
sedative=hypnotics
what are the effects of sedative-hypnotic toxidrome?
ataxia, decr reflexes, slurred speech, APNEA! confusion, sedation, coma delirium, hallucinations blurred vision/diplopia dysesthesias/paresthesias
pathophys of sedative-hypnotic toxidromes
direct & indirect GABA agonists resulting in CNS inhibition
