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Surgery/ER Fall 2013 > Emergency Toxicology > Flashcards

Emergency Toxicology Flashcards

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1
Q

UDS for diagnosis of narcotics

A

positive for 36-48 hours (won’t guide initial tx though)

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2
Q

diagnostics for Narcotics

A

UDS, CBC, CMP, ASA, acetaminophen, ABG, CXR to check fo raspiration, and EKG

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3
Q

management of narcotic overdose

A

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

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4
Q

half life of narcan

A

30 minutes

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5
Q

narcotics MOA

A

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

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6
Q

effect of benzos on NT

A

increase circulating GABA

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7
Q

effect of benzo overdose

A

can cause CNS depression, coma, respiratory failure

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8
Q

most prescribed benzo in U.S.

A

alprazolam (xanax)

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9
Q

most toxic benzo

A

xanax (alproazolam)

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10
Q

alprazolam brand name and half life

A

xanax- 11 hours

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11
Q

lorazepam brand name and half life

A

ativan - 12 hours

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12
Q

midazolam brand name and half life

A

versed- 1-12 hours

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13
Q

diazepam brand name and half life

A

valium- 20-70 hours (stays in body for long time!)

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14
Q

ED tx for benzo overdose

A

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.

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15
Q

half life of acetaminophen

A

1-4 hours

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16
Q

acetominophen toxicity risk is increased by…

A

ETOH co- ingestion

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17
Q

acetaminophen MOA

A

cox 2 inhibition without anti inflam effects of NSAIDS

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18
Q

acetaminophen metabolized via

A

liver

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19
Q

toxic dose acetaminophen

A

7.5-10 g over 24 hours. 150 mg/kg single toxid dose.

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20
Q

recommended doses acetaminophen

A

kids- 15 mg/kg. adults - not more than 4 g/day

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21
Q

tx acetaminophen toxicity

A

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

22
Q

when do transaminase levels rise post acetaminophen toxic ingestion?

A

12 hours post-ingestion

23
Q

Phase 1 acetaminophen toxicity

A

rise in transaminase levels after 12 hours, pallor and diaphoresis

24
Q

phase 2 acetaminophen toxicity

A

RUQ pain, anorexia, N/V, continued rise in transaminase levels

25
Q

Phase 3 acetaminophen toxicity

A

centrilobular hepatic necrosis, tender hepatic edge, jaundice, coagulopathy. Death from multiorgan failure may occur in this stage

26
Q

negative prognostic factors in acetaminophen toxicity

A

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

27
Q

diagnostics in stimulant overdose

A

EKG, Troponin, UDS, CMP, preg

28
Q

long term abuse of stimulants can cause

A

lasting psychosis

29
Q

tx of stimulant toxicity

A

sometiems none. sedation, monitoring, BB - CI in chest pain with cocaine abuse

30
Q

antidote for anticholinergic poisoning

A

physostigmine

31
Q

cholinergic and anticholingergic syndrome diagnostics

A

EKG, ABG, chemistry, UDS, CBC

32
Q

cholinergic syndrome symptoms

A

SLUDGE (salivation,lacrimation, Urination, defecation, GI distress, emesis

33
Q

tx of cholinergic syndrome

A

airway, decontamination, atropine 1-2 mg IV

34
Q

jimson weed causes

A

anticholinergic syndrome

35
Q

“red as a beet, dry as a bone, blind as a bat, mad as a hatter, hot as a hare”

A

anticholinergic syndrome

36
Q

anticholingergic tx

A

IV, airway, rapid transport. physostigmine, sodium bicarbonate if QRS prolonged, charcoal

37
Q

anion gap acidosis

A

MUDPILES- methanol (10-20 mL), uremia, Diabetic ketoacidosis, propylene glycol, idiopathic/isoniazid, lactic acidosis, ethylene glycol (antifreeze), salicylates

38
Q

AGMA presentation

A

dehydration, fruity breath, kussmaul breathing

39
Q

ED management of AGMA

A

correct underlying condition, fluids, sodium bicarb rarely, hemodialysis

40
Q

carbon monoxide risks

A

cold season, factory/smelting occupation

41
Q

everyone if house with headache. Winter began 2 weeks ago. N/V, weakness, dizziness. PE shows cherry red uvula and retinal hemorrhages. automatically think…

A

carbon monoxide poisoning

42
Q

carbon monoxide diagnostics

A

ABG

43
Q

ED tx carbon monoxide

A

oxygen via non-rebreather takes 80 minutes compared to 320 minutes (carboxyhemoglobin back to hemoglobin)

44
Q

alcohol blood level over 400 mg/dL

A

respiratory failure, coma, death

45
Q

legal alcohol driving limit

A

over 80 is illegal

46
Q

synthetic cannibinoid receptor agonist similar to THC

A

K2

47
Q

cathinones produce significant stimulatn, amphetamine effect

A

bath salts

48
Q

varieties of K2

A

spice, genie, yucatan fire

49
Q

case reports of death from K2 most often related to

A

CNS, CV, or psychiatric complications

50
Q

K2 and bath salts consequences

A

hypertensive emergency, tachycardia, severe hallucinations, seizues, scleral injection, prolonged hangover period, N/V

Surgery/ER Fall 2013 (11 decks)

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