Emergency Medicine - Toxicology Flashcards

1
Q

5 toxidrome features

A

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

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2
Q

Treatments toxidromes

A

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
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3
Q

Paracetamol overdose

A

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

Normogram

  • check 4hrs
  • High risk - treat
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4
Q

Burn depth categorization

A

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
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5
Q

Management - Airway Burns

A

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
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6
Q

Burns fluid formula

A

fluid given in 24hrs

  • TBSA% x BW x4mls
  • Rule of 9’s

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

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7
Q

Other burn management

A

-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
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8
Q

Anaphylaxis

A

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

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