Emergency/Toxicology Flashcards
What is miosis?
Small pupils
What drugs can cause miosis?
"CCOOPPS looks for small pupils." Clonidine Cholinergics Opioids Organophosphates Pilocarpine Phencyclidine Sedatives
What is mydriasis?
Large pupils
What drugs can cause mydriasis?
“Think of how big your eyes got when you realized the benefit of AAA Savings.”
Antihistamines
Antidepressants
Anticholinergics (Atropine)
Sympathicomimetics (amphetamine, cocaine, phencyclidine)
What drugs can cause diaphoresis?
"Sweaty skin needs SOAP." Sympathicomimetics Organophosphates Aspirin Phencyclidine (PCP)
What drugs cause nystagmus?
"Your PAAL should not give you nystagmus, but she does." PCP Alcohol Anticonvulsants Lithium
Which ingestions can charcoal be used for?
"Charcoal uses TAATA trucks to ship out the toxins from the body." Tricyclic antidepressants Aspirin Acetaminophen Theophylline Anticholingergics
What are the symptoms of amphetamine use?
HYPERTENSION EUPHORIA Agitation Arrhythmias Psychosis Seizures
What are the symptoms of cocaine use?
AGGRESSION VIOLENCE EUPHORIA Overconfidence Hypertension (tx w/ nitoprusside)
May give diazepam
What are the symptoms of Phencyclidine (PCP) use?
Vertical or horizontal nystagmus Ataxia Muscle rigidity Rhabdomyolysis Paranoia Agitation Hypertension Violence Hallucinations (auditory or visual) Pupils may be big or small
Tx: cooling blanket, haloperidol
What are the symptoms of opioid use?
Respiratory depression Miosis Euphoria Indifference to pain Hypotension Hypothermia Urinary/stool retention Pulmonary edema
Is binge drinking a predictor for future alcoholism?
No
Which alcohol does not cause a positive anion gap?
Isopropyl alcohol
What is the most common substance of abuse among adolescents?
Alcohol
What is the most common illicit substance of abuse in adolescents?
Marijuana
What are the symptoms of Ethylene glycol ingestion?
- Antifreeze
- Tachycardia
- Hypertension
- Cardiorespiratory failure from acidosis and hypocalcemia (calcium oxalate crystals in the urine)
- Tx: ethanol, fomepizole, HD
What are the symptoms of methanol ingestion?
- Windshield washer fluid
- Visual complaints (snowstorm appearance)
- Abdominal pain
- Tx: ethanol, fomepizole, HD
Which alcohol result in a positive ethanol reading on toxicology screens?
Isopropyl alcohol
What are the findings of isopropyl alcohol ingestion?
- Found in mouthwash and rubbing alcohol
- CNS depressant
- Fruity odor from breath
- Ketones present
How long is drug testing positive for marijuana use?
- One time use: 1 week
- Frequent use: 2 weeks
- Daily use: 1 month
When do you obtain and acetaminophen level after ingestion?
4 hours post ingestion
At what dose do you give NAC without waiting for an acetaminophen level?
140 mg/kg
What is the time cut off for giving NAC after acetaminophen ingestion?
8 hours
Name the cholinergic drugs.
Bethanochol
Organophosphates (pilocarpine)
Neostigmine
What are the effects of cholinergic drugs?
DUMBELLS Diarrhea Urination Miosis Bronchospasm, bradycardia Emesis Lacrimation Lethargy Salivation
- Includes organophosphates = ⬆️ organ activity (except for ❤️ - bradycardia)
What is the treatment for cholinergics?
Atropine
Pralidoxime
What medications have anti-cholinergic effects?
Diphenhydramine Atropine Pralidoxime Tricyclic acids Jimson weed
What are the symptoms of anti-cholinergics?
“Hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a Hatter while the bowel and bladder lose their tone, and the heart runs alone.”
Fever Blurred vision Dry mouth/eyes Hyperthermia Psychosis Decreased bowel sounds Urinary retention Tachycardia
What are the symptoms of TCA toxicity?
- Anticholinergic symptoms
- Anion gap acidosis
- Wide QRS complex
- QT prolongation
- Tx: sodium bicarbonate
- Meds end with: -pine, -mine, -line (except doxepin)
What are the symptoms of salicylate toxicity?
- Drugs: aspirin, oil of wintergreen
- Primary anion gap metabolic acidosis
- Cerebral edema, pulmonary edema, electrolyte disturbances, cardiovascular collapse
- Decreases gastric motility
- Tx: gastric lavage, charcoal, hydration, bicarbonate, hemodialysis
How is iron overdose managed?
- Sxs: capillary leak, hypertension, anion gap acidosis, hematemesis, scarring of pylorus
- Tx: chelation with deferoxamine
- Give if level is >500 mg/dL
- Makes urine pink
- Continue until urine is not pink
What are the stages of iron overdose?
IR❤️N
I = indigestion (GI): nausea, vomiting, abdominal pain, hematemesis R = recovery (latent) ❤️ = cardiovascular collapse, liver damage N = (delayed) narrowing of pylorus or other parts of GI track, obstruction from strictures
When is chelation therapy for lead poisoning indicated?
- Level > 45
- EDTA, dimercaptol, d-penicillamine
What medications can cause dystonic reactions?
Clonidine
Phenothiazine
Metoclopramide
Promethazine
Tx with diphenhydramine
What are the symptoms of and treatment for digoxin toxicity?
- GI symptoms, weakness, arrhythmias
- There is an increased chance of toxicity with low K+, low Mg, poor renal fxn, hypoxia
- Tx: charcoal, digibind, correct K+ and Mg
What are the symptoms of and treatment for theophylline toxicity?
- Levels > 20: N/V, ⬇️BP, ⬆️Ca, ⬇️K+, metabolic acidosis, seizures
- Tx: charcoal, beta-blockers for arrhythmias (if BP ok), benzos for seizures
- Decreases GI motility
When do you treat carbon monoxide poisoning with 100% oxygen?
- Carboxyhemoglobin level > 25%
- Pt has GI sxs
- Pt has neurological sxs
How do you treat cyanide poisoning?
Sodium thiosulfate
Nitrate
What is the clinical presentation of and treatment for methemoglobinemia?
- Due to an enzyme deficiency
- Reduced O2 carrying capacity
- Blue/cyanotic skin
- Chocolate colored blood
- Tx: methylene blue, oxygen, remove offending agent
What animals transmit the rabies virus?
BCDFRSW
Bats Cats Dogs Foxes Raccoons Skunks Woodchucks
What is the management for possible rabies exposure?
Wound care + HRIG + 4 vaccine doses
What is the BSA for burn estimation?
Arms: 9%
Legs: 18%
Front trunk: 18%
Back trunk: 18%
Head:
Adult: 9%
Baby: 18%What is the treatment for 1st° burns?
- Red, painful skin
- Soap, cool water, analgesics
What is the treatment for second-degree burns?
- Partial thickness
- Blisters, erythematous skin that blanches with pressure
- Painful
- Do not rupture blisters
- Once blisters rupture, treat with debridement, topical anabiotics, non-adherent dressing
What is the treatment for third-degree burns?
- Full thickness
- White, dry, leathery skin
- Painless
- Burn center referral
What is the Parkland formula and when is it used?
- To replace fluids for burns on > 15% of body
(4ml/kg) x (% body burned) + maintenance
Give half over first 8 hours after burn
What indicates a good prognosis after a near drowning?
Good pulse on EMS arrival
OR
Required <10 minutes CPR
What criteria are needed for a patient to be discharge from the ED after a near drowning?
Does not need hospitalization if:
- In water for <60 seconds
- No LOC
- No CPR required
What indicates a poor prognosis after a near drowning?
- Cold on EMS arrival (< 90°F)
- CPR needed for >10 minutes
- > 25 minutes under water
- Apnea
- Coma
- pH < 7.1
How do you determine the appropriate ET tube size?
Uncuffed: (Age/4) + 4 in.
Cuffed: (Age/4) + 3 in.
Babies:
<1.5 kg: 2.5 mm
<2.5 kg: 3.0 mm
> 2.5 kg: 3.5 mm
What medications can be given via ETT?
NAVEL Naloxone Atropine Valium Epinephrine Lidocaine
