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TDM > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

Overdose Treatment & Antidote & Monitoring

Acetominophen

A

ABC

Decontaminate - Activated charcoal

N-Acetylcysteine

M: 
Drug levels 4h post ingestions
Liver enzymes
INR
PTT
Creatinine, BUN
Glucose
Blood gas (metabolic acidosis)
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2
Q

Overdose Treatment & Antidote

Acute Dystonic Reaction

A

Benztropine 2mg IMI then 2mg PO x 3days

Diphenhydramine 2mg/kg IVI then 25mg PO QID x 3days

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3
Q

Overdose Treatment & Antidote & Monitoring

ASA

A

ABC

Decontaminate - Activated charcoal

Alkalinize urine - pH >7,5

  • After fluid resuscitating patient give 3 amps of NAHCO3 per litre of 5% Dextrose water at 1.5 x maintenance
  • Add 20 mEq/L of KCl if patient can urinate

Hemodialysis if:

  • Refractory metabolic acidosis
  • Very high levels
  • End organ damage
  • Unable to diurese

M:
Serum drug levels
Serum pH
K+ levels

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4
Q

Overdose Treatment & Antidote & Monitoring

Benzodiazepines

A

ABC

Decontaminate - Activated Charcoal

Vitals Stable: Supportive Care

Vitals Unstable: Flumazenil

M:
GCS
Vitals

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5
Q

Overdose Treatment & Antidote & Monitoring

Beta Blockers

A

ABC

Decontaminate - Activated Charcoal

High dose insulin euglycemic therapy

Dialysis

Intralipid

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6
Q

Overdose Treatment & Antidote & Monitoring

Calcium channels blockers

A

ABC

Decontaminate - Activated charcoal

Hypotensive = CaCl 2g Of 10% solution IVI

High dose insulin euglycemic therapy

Intalipids

M:
ECG
Electrolytes
CMP

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7
Q

Overdose Treatment & Antidote & Monitoring

Cocaine

A

ABC (Rocuronium for intubation)

Decontaminate - Activated charcoal if Oral

Agitation:
1. Diazepam 5mg IVI every 5min

Hypertension:
1. Diazepam 5mg IVI
2. Phentolamine 5mg IVI
!! NOT BETA BLOCKERS!! CONTRAINDICATED!!

Myocardial Ischemia:
1. Diazepam 5mg IVI 
2. Aspirin 325mg PO
3. Nitroglycerin 0,4mg SL
4. Phentolamine 5mg IVI 
!! NOT BETA BLOCKERS!! CONTRAINDICATED!!

QRS widening:
1. Sodium Bicarbonate 2 mEq/kg IVI

M: 
ECG 
Glucose
Acetominophen and salicylate levels 
Urine pregnancy test 
\+/- Cardiac biomarkers 
\+/- CT
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8
Q

Overdose Treatment & Antidote & Monitoring

CO poisoning

A

ABC

100% Oxygen

Supportive Care

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9
Q

Overdose Treatment & Antidote

Cyanide

A

ABC

Hydroxycobalamin

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10
Q

Overdose Treatment & Antidote & Monitoring

Digoxin

A

ABC

Decontaminate - Activated charcoal

Digoxin specific Ab Fragments 
15 vials if acute 
5 vials if chronic 
Do not treat hyperkalemia because DSAbF shifts K+ intracellular 
Indications: 
*Dysrhythmias [VFib, VTach, Conduction Blocks]
* 6h serum Digoxin levels >12
* K+ >5
* Ingested more than 10mg (adult)
* more than 4mg (child)

M:
ECG
Digoxin levels

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11
Q

Overdose Treatment & Antidote & Monitoring

Ethanol

A

ABC

Thiamine 100mg IVI/IMI
Glucose

M:
Glucose levels
Serum Etoh levels

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12
Q

Overdose Treatment & Antidote & Monitoring

Ethylene Glycol / Methanol

A

ABC

Fomepizole
Load: 15mg/kg over 30min
Then: 10mg/kg q12h

Hemodialysis

M: 
Full blood count 
electrolytes 
Glucose 
Ethanol levels
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13
Q

Overdose Treatment & Antidote

Unfractionated heparin

A

ABC

Protamine Sulfate 25mg IVI

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14
Q

Overdose Treatment & Antidote & Monitoring

MDMA

A

ABC

Decontaminate - Activated Charcoal

Supportive care 
Fluids (rhabdomyolysis) 
External cooling (hyperthermia)

M:
CK - Rhabdomyolysis

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15
Q

Overdose Treatment & Antidote & Monitoring

Opioids

A

ABC

Decontaminate - Activated charcoal

ADULT:
Naloxone 0,4mg
then 0,6mg
then 1mg

then maintain with ⅔ of above as hourly infusion

CHILD:
0,01mg/kg IVI
then 0,1mg/kg upto 10mg

M:
RR

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16
Q

Overdose Treatment & Antidote & Monitoring

TCA

A

ABC

Decontaminate - Activated charcoal

Wide QRS or Seizures:
NaHCO3 bolus

Supportive care

TCA + Benzo OD - Flumazenil CONTRAINDICATED!!!

TDM (7 decks)

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