Emergency Medicine - Toxicology

Question 1

5 toxidrome features

Answer 1

Sympathomimetic - SNS activation. Fast HR, pupils dilated, hot. normal skin.
Anti-cholinergic - blocks PNS, same as above, but dry skin and secretions. red and flushed.
Cholinergic - stimulates PNS - sweaty, increased secretions (inc urine, defecation), slow HR.
Sedative - sedative, may lose airway protective reflexes, resp depression
Opiod - sedation, resp depression, miosis

Question 2

Treatments toxidromes

Answer 2

Always figure out substance

Anti-cholinergic - Sedate patient if aggitated, IV fluids, physostigmine (ach inhibitor)

Cholinergic - Remove toxic exposure, intubate, atropine
Opiod - oxygen + bag mask, naloxone

High toxicity ingestion (multiple) - Local poison center or toxicologist

• GI decontamination (NG lavage, activated charcol, bowel irrigation)
• supportive care
• antidote

Question 3

Paracetamol overdose

Answer 3

N-acetyl-cystine (given within 8hrs of ingestion)
-liver failure

Normogram

• check 4hrs
• High risk - treat

Question 4

Burn depth categorization

Answer 4

Superficial (first degree)

• sunburn. Red, no blister
• Sensitive ++

Superficial partial degree (2nd)

• red, blister
• sensitive ++

Deep partial (2nd)

• white, non-blister
• tense tissue
• skin graft

Full thickness (3rd)

• yellow, thick, leather, charred, leather
• Cannot feel (nerve endings burnt)
• excision, graft

Question 5

Management - Airway Burns

Answer 5

Assess - Stridor, swelling, resp distress

• -> Intubate
• Also assess for future airway compromise - facial, oral burns, singed nasal hair ect.

B - oxygen >92% (humidified)
-bronchodilators
-Intubation, mechanical ventilation 
Carbon monoxide poisoning 
measure carboxyhemoglobin (CO-Hgb)
-cannot rely on o2 sats - because it is false 
-high flow 02

Question 6

Burns fluid formula

Answer 6

fluid given in 24hrs

• TBSA% x BW x4mls
• Rule of 9’s

-first 50% given in 8 hours, rest given over 16 hours

Question 7

Other burn management

Answer 7

-ABCs, Fluids

• remove jewelry, and clothing of affected areas
• clean wounds
• aspirate tense blisters, gently remove nectrotic tissue
• wound dressing- sterile/protective, many options
• Pain control
• tetanus prophylaxis
• classify severity
• measure CO-HGb and treat w oxygen, rule out airway burn

Question 8

Anaphylaxis

Answer 8

Triggers - foods, drugs, insects, latex, radio contrast agents

Type 1 hypersensitivity. Exposure to antigen, body produces antibodies. 2nd time exposure - causes release of inflammatory response (mast cells, histamine) (igE)

-allergic symptoms + compromise of breathing or circulation
Skin, pulmonary, cardio, gastro involvement

Management 
ABCs 
-Airway
-IV access 
-0.5ml - 0.5mg of 1:1000 epinephrine IM
0.01mg/kg for pediatrics 
-repeat every 5-10mins 

• antihistamines
• corticosteroids

D/C - 4-8hrs after

• Airway involvement, hypo tension -keep in hospital
• more than 2 doses of epinephrine

Identify trigger - epi-pen