Emergency Medicine - Toxicology Flashcards
5 toxidrome features
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
Treatments toxidromes
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
Paracetamol overdose
N-acetyl-cystine (given within 8hrs of ingestion)
-liver failure
Normogram
- check 4hrs
- High risk - treat
Burn depth categorization
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
Management - Airway Burns
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
Burns fluid formula
fluid given in 24hrs
- TBSA% x BW x4mls
- Rule of 9’s
-first 50% given in 8 hours, rest given over 16 hours
Other burn management
-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
Anaphylaxis
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