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Medical Finals (High Yield) > [EMed] Overdose > Flashcards

[EMed] Overdose Flashcards

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USMLE® Step 1 flashcards
1
Q

what are the features of tricyclic antidepressant (TCA) overdose: anticholinergic?

A
  • dry mouth
  • blurred vision
  • dilated pupils (mydriasis)
  • hyperthermia
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2
Q

what are the features of tricyclic antidepressant (TCA) overdose: cardiac?

A
  • sinus tachycardia
  • arrhythmias
  • vasodilation
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3
Q

what are the features of tricyclic antidepressant (TCA) overdose: CNS?

A
  • reduced GCS
  • seizures
  • delirium
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4
Q

what is the mx for TCA overdose: Airway?

A

airway protection

GCS <8 = intubate

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5
Q

what is the mx for TCA overdose: Breathing?

A

high-flow O2

ABG analysis

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6
Q

what is the mx for TCA overdose: Circulation?

A

treat hypotension with fluid bolus +/- vasopressors

ECG

sodium bicarbonate 8.4% for arrhythmias and low BP

glucagon / MgSO4 for refractory anaemia

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7
Q

what does an ECG show for TCA overdose?

A

QRS prolongation >100ms

QTc prolongation >430ms

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8
Q

what is the mx for TCA overdose: Disability?

A

benzodiazepines for seizure control or agitation

avoid phenytoin

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9
Q

for TCA overdose, what do you do if pt is asx with no ECG or blood gas abnormalities >6 hours after ingestion?

A

discharge

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10
Q

what are the features of paracetamol overdose?

A
  • nausea/vomiting, features of metabolic acidosis if levels ++
  • abdominal pain/RUQ pain → overt hepatic failure with coagulopathy, deranged LFTs, hypoglycaemia, jaundice, acute renal failure
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11
Q

how do you manage paracetamol OD if ingestion <1 hour?

A

activated charcoal gastric lavage

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12
Q

what would you send off bloods for in paracetamol OD?

A
  • paracetamol levels
  • U+Es
  • LFTs
  • VBGs
  • coags
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13
Q

how do you manage paracetamol OD if >8 hours from ingestion and >75mg/kg ingested?

A

start N-acetylcysteine (NAC)

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14
Q

how do you manage paracetamol OD if <8 hours from ingestion?

A

wait for paracetamol levels and treat as per normogram

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15
Q

when should a 4th bag of NAC be given?

A

if after full Rx: Cr above baseline, ALT 2x baseline or INR >1.3

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16
Q

what do you do if there are severe derangements in ALT/INR?

A

discuss with regional hepatology centre

17
Q

what are features of opiate overdose?

A
  • reduced conscious level
  • reduced RR (<12 breaths/min)
  • constricted pupils (miotic)
18
Q

what is the mx for opiate OD?

A

A: airway protection, manoeuvres/adjuncts if needed

B: O2, may require bag-valve mask ventilation if apneoic or very low RR

19
Q

what is the reversal agent for opiate OD?

A

naloxone

  • initial dose 400mcg IV bolus
  • bolus dosing can be uptitrated at 1-2 min intervals if no response
  • aim: adequate ventilation
20
Q

if pt responds to rx for opiate OD, what will they likely need and why?

A

ongoing infusion as T1/2 of opioids is&raquo_space; naloxone (especially if ingested)

21
Q

what is the antidote for: beta blocker?

A

glucagon

22
Q

what is the antidote for: benzodiazepines?

A

flumazenil

23
Q

what is the antidote for: cyanide?

A

dicobalt edetate / methylene blue

24
Q

what is the antidote for: digoxin?

A

DigiFab / Digibind

25
Q

what is the antidote for: iron?

A

desferrioxamine

26
Q

what is the antidote for: local anaesthetic?

A

intralipid 20%

27
Q

what is the antidote for: paracetamol?

A

NAC

28
Q

what is the antidote for: opiates?

A

naloxone

29
Q

what is the antidote for: warfarin?

A

vitamin K

30
Q

flushed, dry, tachycardia, dilated pupils. dx?

A

anticholinergic sx

31
Q

reduced GCS, pupillary changes and cardiorespiratory depression. dx?

A

sedative syndrome - opiates, baclofen, benzos, barbiturates

32
Q

confusion, autonomic instability and neuromuscular hyperactivity. dx?

A

serotonin syndrome

33
Q

what is the 1st line ix for overdoses?

A

blood gas and ECG

Medical Finals (High Yield) (57 decks)

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