Emergency Toxicology Flashcards
UDS for diagnosis of narcotics
positive for 36-48 hours (won’t guide initial tx though)
diagnostics for Narcotics
UDS, CBC, CMP, ASA, acetaminophen, ABG, CXR to check fo raspiration, and EKG
management of narcotic overdose
pre-hospital- airway, resuscitation. ED management- narcan 0.4-2 mg every 2-3 mins (max of 10 mg), activated charcoal within 2 hours of ingestion, orogastric lavage
half life of narcan
30 minutes
narcotics MOA
opiates bind the mu opioid receptor to cause pain relief, decreased GI motility (constipation), respiratory depression, mood alteration, cough suppression, ACTH suppression, miosis, N/V, pruritus
effect of benzos on NT
increase circulating GABA
effect of benzo overdose
can cause CNS depression, coma, respiratory failure
most prescribed benzo in U.S.
alprazolam (xanax)
most toxic benzo
xanax (alproazolam)
alprazolam brand name and half life
xanax- 11 hours
lorazepam brand name and half life
ativan - 12 hours
midazolam brand name and half life
versed- 1-12 hours
diazepam brand name and half life
valium- 20-70 hours (stays in body for long time!)
ED tx for benzo overdose
airway management. charcoal only if co-ingestion (must be given within 2 hours), lavage not recommended unless co-ingestion is severe- do within first hour.
half life of acetaminophen
1-4 hours
acetominophen toxicity risk is increased by…
ETOH co- ingestion
acetaminophen MOA
cox 2 inhibition without anti inflam effects of NSAIDS
acetaminophen metabolized via
liver
toxic dose acetaminophen
7.5-10 g over 24 hours. 150 mg/kg single toxid dose.
recommended doses acetaminophen
kids- 15 mg/kg. adults - not more than 4 g/day
tx acetaminophen toxicity
NAC (N acetyl cysteine) which inactivates NAPQI. IV load preferred 150 mg/kg over 1 hour. PO load is 70 mg/kg. max benefit within first 8 hours. Activated charcoal, transplant if too late in stage
when do transaminase levels rise post acetaminophen toxic ingestion?
12 hours post-ingestion
Phase 1 acetaminophen toxicity
rise in transaminase levels after 12 hours, pallor and diaphoresis
phase 2 acetaminophen toxicity
RUQ pain, anorexia, N/V, continued rise in transaminase levels
Phase 3 acetaminophen toxicity
centrilobular hepatic necrosis, tender hepatic edge, jaundice, coagulopathy. Death from multiorgan failure may occur in this stage
negative prognostic factors in acetaminophen toxicity
pH less than 7.3 after adquate resuscitation, INR greater than 3, Creat greater than 2.6, Hepatic encephalopahty grades III or IV, hypoglycemia, thrombocytopenia
diagnostics in stimulant overdose
EKG, Troponin, UDS, CMP, preg
long term abuse of stimulants can cause
lasting psychosis
tx of stimulant toxicity
sometiems none. sedation, monitoring, BB - CI in chest pain with cocaine abuse
antidote for anticholinergic poisoning
physostigmine
cholinergic and anticholingergic syndrome diagnostics
EKG, ABG, chemistry, UDS, CBC
cholinergic syndrome symptoms
SLUDGE (salivation,lacrimation, Urination, defecation, GI distress, emesis
tx of cholinergic syndrome
airway, decontamination, atropine 1-2 mg IV
jimson weed causes
anticholinergic syndrome
“red as a beet, dry as a bone, blind as a bat, mad as a hatter, hot as a hare”
anticholinergic syndrome
anticholingergic tx
IV, airway, rapid transport. physostigmine, sodium bicarbonate if QRS prolonged, charcoal
anion gap acidosis
MUDPILES- methanol (10-20 mL), uremia, Diabetic ketoacidosis, propylene glycol, idiopathic/isoniazid, lactic acidosis, ethylene glycol (antifreeze), salicylates
AGMA presentation
dehydration, fruity breath, kussmaul breathing
ED management of AGMA
correct underlying condition, fluids, sodium bicarb rarely, hemodialysis
carbon monoxide risks
cold season, factory/smelting occupation
everyone if house with headache. Winter began 2 weeks ago. N/V, weakness, dizziness. PE shows cherry red uvula and retinal hemorrhages. automatically think…
carbon monoxide poisoning
carbon monoxide diagnostics
ABG
ED tx carbon monoxide
oxygen via non-rebreather takes 80 minutes compared to 320 minutes (carboxyhemoglobin back to hemoglobin)
alcohol blood level over 400 mg/dL
respiratory failure, coma, death
legal alcohol driving limit
over 80 is illegal
synthetic cannibinoid receptor agonist similar to THC
K2
cathinones produce significant stimulatn, amphetamine effect
bath salts
varieties of K2
spice, genie, yucatan fire
case reports of death from K2 most often related to
CNS, CV, or psychiatric complications
K2 and bath salts consequences
hypertensive emergency, tachycardia, severe hallucinations, seizues, scleral injection, prolonged hangover period, N/V
