Emergency Medicine & Toxicology Flashcards
When to use IV Deferoxamine?
Iron level > 500 ug/dL
Moderate symptoms
Anticholinergic toxidrome symptoms
Dry flushed skin
Hyperthermia
Mydriasis
Urinary retention
Tachycardia, hypertension.
Anticholinergic toxidrome meds
Atropine
Antihistamine
TCA
Oxybutynin
Cholinergic toxidrome symptoms
DUMBELS:
Diarrhea
Urination
Miosis
Bradycardia
Lacrimation
Salivation.
Cholinergic toxidrome meds
Organophosphates
Nicotine
Opioid toxidrome symptoms
CNS depression
Miosis
Resp depression
Hypotension
Sympathomimetic toxidrome symptoms
Hallucination seizure, tachycardia, hypertension, rhabdomyolysis
Sympathomimetic toxidrome meds
Cocaine
Amphetamine
Pseudoephedrine
Radioopaque substances in x-ray
Chloral hydrate
Calcium.
Heavy metals.
Iron.
Salicylate
Phenothiazines
Sustained release tablets
Prolonged QRS is seen in
TCA poisoning
Elevated serum osmolal gap
Methanol
Ethylene glycol
Isopropyl alcohol
High anion gap
Mudpiles
Methanol, uremia, DKA, propylene glycol, iron, INH, lactate, ethanol, salicylate, cyanide and CO
Activated charcoal contraindications
Risk of aspiration
G.I. obstruction.
Hydrocarbon & caustic ingestion.
Iron, metals & cyanide ingestion.
Alcohol ingestion.
What is the toxic metabolite of acetaminophen?
N acetyl p benzoquinone imine
(NAPQI)
What is the minimal toxic dose of acetaminophen in children?
150mg/kg
Stages of acetaminophen toxicity
S1 (24hrs): N&V
S2 (72hrs): RUQ pain, labs affected
S3 (96hrs): fulminant hepatic failure, and coagulopathy
S4 (4-14d): Recovery or death
What to do if patient presented with acetaminophen ingestion
1- activated charcoal during the first hour
2- acetaminophen livers four hours after ingestion
Name of graph used in acetaminophen toxicity
Rumack Matthew Nomogram
Name of graph used in acetaminophen toxicity
Rumack Matthew Nomogram
Appropriate for SINGLE overdose
What is the level of significant salicylate toxicity?
300mg/kg
Most specific finding of salicylate toxicity
Tinnitus
How & when to alkalinize urine after salicylate indigestion?
NaHCO
If level is > 39mg/dL
Ferric chloride turns urine _____ if salicylates are present
Brown or purple
Ibuprofen toxic dose
> 400mg/kg
Triad of opioid poisoning
Coma
Respiratory depression.
Pinpoint pupils
Opioid antidote
Naloxone
Which beta blocker cause in his symptoms and why?
Propranolol
Highly lipids soluble
Which beta blocker causes torsade de pointes?
Sotalol
Beta blocker ingestion symptoms
Hypoglycemia
Ventricular dysarrhythmia
CCB & BB
Effect on glucose
CCB: hyperglycemia
BB: hypoglycemia
Clonidine toxic dose
1 pill can kill!!!
Clonidine antidote
Naloxone
Atropine/dopamine helps with bradycardia
TCA antidote
Physostigmine
Not used for treatment
Specific findings of serotonin syndrome
Myoclonus
Neuroleptic malignant syndrome is a drug reaction to which type of medication?
Antipsychotics
Treatment for acute dystonic reaction
Anticholinergic agent (diphenhydramine)
Glipizide toxic dose
One pill can kill!!!
Tx of methemoglobinemia
Methylene blue and O2
Burton lines are seen with which type of poisoning
Lead
Basophilic tippling is seen in smear of:
Lead poisoning
Lead poisoning treatment
Calcium disodium edetate
Dimercaprol
Carbon monoxide treatment
High flow oxygen
Cyanide treatment
Oxygen and hydroxycobalamine
Alkaline agents cause _____ necrosis
Liquefication
Acidic agents cause _____ necrosis
Coagulation
Hydrocarbon inhalation cause death by
Ventricular arrhythmia
Benzene is associated with which type of anemia
Aplastic anemia
Toluene causes ____
RTA
Hydrocarbon treatment
Oxygen and inhaled beta agonist
Methanol ingestion causes
Blindness
Visual complaint.
Abdominal pain.
Metabolic acidosis with high an iron gap, but no lactic acidosis.
Is a triad of what?
Methanol ingestion
Methanol antidote is
Fomepizole
+ folic acid to enhance metabolism of toxic metabolites
Which organ is affected the most by ethylene glycol ingestion
Kidneys
Treatment of ethylene glycol ingestion
IV fomepizole
NaHCO
Treatment of organophosphate poisoning
Atropine and pralidoxime
Object in esophagus, child is asymptomatic
Wait for 24 hours to see if it will pass into stomach
Object in stomach, child is asymptomatic
Follow up in four weeks unless symptomatic
Is Sofi button batteries cause which type of necrosis?
Liquefication necrosis
Button battery in esophagus, child is asymptomatic
Remove immediately
Button battery and stomach, patient is symptomatic, complication?
Perforation or aortoenteric fistula
Most common organism in cat bite
pasteurella multocida
Staph A
Bite prophylaxis duratuon is _____
If wound is infected, Duration is ____
5 days
7-10 days
Indication of antibiotic, prophylaxis in human bites
Wound undergoing closure
Wound close to joints
Wounds with poor circulation
Crush injuries.
Immunocompromised patients
Which burn is painless
Full thickness burns
What’s the most common cause of death in submersion injury?
Cerebral edema resulting from hypoxia
What to do if a patient has cardiac tamponade causing vascular compromise
Pericardiocentesis
What to do if a patient has pneumothorax, causing respiratory compromise
Needle thoracostomy
White mediastinum indicates which injury
Aortic injury
