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PRE REG > Emergency TX of poisoning > Flashcards

Emergency TX of poisoning Flashcards

1
Q

Which websites should be consulted when managing a patient with toxicity?

A

Toxbase or the UK national poisons information service

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2
Q

What should happen if a patient has features of poisoning?

A

Should generally be admitted to hospital, even poisons with delayed action

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3
Q

Which poisons have delayed action?

A

aspirin, iron, paracetamol, TCAs, co-phenotrope

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4
Q

How should specialist antidotes be stored?

A

Separate area, and clearly labelled as specialist antidotes

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5
Q

What is common in severe poisoning with cns depressants?

A

Hypotension. Systolic bp of less than 70mmHg may lead to irreversible brain damage. Correct by raising the foot of the bed and administer sodium chloride or colloid. Fluid depletion after hypotension is common

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6
Q

What is common after aspirin poisoning?

A

Fluid depletion due to vomitting, sweating and hyperpnoea

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7
Q

What is associated with poisoning due to sympathomimetic drugs?

A

Hypertension

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8
Q

What can occur in acute poisoning with tcas, antipsychotics and antihistamines

A

Cardiac conduction defects and arrythmias

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9
Q

What is associated with overdose with barbituates or phenothiazines

A

Hypothermia

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10
Q

How are convulsions during poisoning treated

A

Short lived convulsions lasting less than 5 minutes do not require treatment. If the convulsions are protracted or recur frequently, lorazepam or diazepam should be given by slow iv injection into a large vein. Midazolam can be given buccally

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11
Q

Discuss the use of charcoal for poisoning

A

Activated charcoal can bind many poisons in the GI system and reduce their absorption. The sooner it is given, the more effective it is, but it may still be effective up to one hour after ingestion of the poison. Particularly useful with antidepressants

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12
Q

When is repeated doses of activated charcoal given in poisoning?

A

After overdosage with:
carbamazapine
dapsone
phenobarbital
quinine
theophylline

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13
Q

What are the symptoms of acute intoxication with alcohol?

A

Ataxia, dysarthria, nystagmus, drowsiness, hypotension and acidosis, hypogylcaemia can occur.

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14
Q

How is alcohol intoxication treated?

A

Manage patients supportively and maintain clear airway. Blood glucose measured and give glucose if indicated

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15
Q

What are the main symptoms of salicylate poisoning?

A

Hyperventilation, tinnitus, deafness, vasodilation, sweating.

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16
Q

How is aspirin poisoning treated?

A

In hospital, where plasma salicylate, pH and electrolytes can be measured, aspirin absorption may be slow and the plasma conc may continue to rise for several hours. Can give activated charcoal, haemodialysis is the tx of choice if severe

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17
Q

What are the symptoms of opioid poisoning?

A

Coma, respiratory depression, pinpoint pupils

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18
Q

How is opioid poisoning treated?

A

Naloxone, if there is coma or bradypnoea. Has a shorter duration of action, so close monitoring and repeated injections may be necessary according to the respiratory rate.

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19
Q

What are the symptoms of paracetamol poisoning?

A

Nausea and vomitting are the early features, and usually settle within 24 hours. The recurrence of nausea and vomitting after 2-3 days and onset of pain indicates hepatic necrosis.

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20
Q

Discuss the use of acetylcysteine following paracetamol overdose

A

It prevents or reduces the severity of liver damage if given up to and beyond 24 hours after ingesting paracetamol. Most effective if given within 8 hours of ingestion

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21
Q

When should patients be referred to hospital in acute paracetamol od?

A
  • ingested with the purpose of self-harm
  • symptomatic
    -75mg/kg or more in one hour or less
  • 75mg/kg or more
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22
Q

When should children be referred to hospital in acute paracetamol overdose?

A
  • symptomatic
  • ingested 150mg/kg or more
  • uncertainty about the dose ingested/circumstances
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23
Q

What are the two IV regimes for acetylcysteine?

A

The standard 21 hour regimen and the modified 12 hour regimen. For the 21 hour, the dose is given in a total dose divided into 3 consecutive iv infusions over a total of 21 hours.

24
Q

What are the symptoms of overdose with TCAs?

A

Dry mouth, coma, hypotension, hypothermia, hyperreflexia, extensor plantar responses, convulsions, respiratory failure, cardiac conduction defects and arrythmia, dilated pupils, urinary retention

25
Q

What is the treatment of overdose with TCAs

A

Assessment in hospital strongly advised, clear the airway, IV lorazepam and diazepam for convulsions, activared charcoal within 1 hour of od.

26
Q

What are the symptoms of overdose with SSRIs

A

Nausea, vomitting, agitation, tremor, nystagmus, drowsiness, sinus tachycardia, convulsions. Severe poisoning results in serotnin syndrome

27
Q

What is the tx of ssri poisoning

A

Supportive, activated charcoal within 1 hour of overdose and treat convulsions with benzos

28
Q

What can occur with od of antimalarials

A

Overdosage is extremely hazardous and difficult to treat. lIFE THREATENING FEATURES SUCH AS ARRYTHMIAS AND CONVULSION

29
Q

What are the symptoms of phenothiazine poisoning?

A

Hypotension, hypothermia, tachycardia and arrythmias. Dystonic reactions and convulsions may occur

30
Q

What are the symptoms of overdose in second generation antipsychotics

A

Drowsiness, convulsions, eps, hypotension, ecg abnormalities inckuding prolongation of QT interval. Activated charcoal within one hour

31
Q

What are the symptoms of benzodiazepene od

A

Drowsiness, ataxia, dysarthria, nystagmus and resp depression/coma.

32
Q

What is the tx of benzo od

A

Charcoal within one hour, flumenazil

33
Q

What are the features of beta-blockers poisoning

A

Cardiac effects such as bradycardia, hypotension, syncope, conudction abnormalities and HF.

34
Q

What can sotalol cause in od

A

Ventricular tachyarrythmias secondary to prolongation of the QT interval eg sotalol

35
Q

What can propranolol cause in od

A

Prolongation of the QRS interval. Coma and convulsions

36
Q

What are the features of ccb poisoning

A

Nausea, vomitting, dizziness, agitation, confusin and coma in severe poisoning. Metabolic acidosis and hyperglycaemia can ocur

37
Q

What can verapamil and diltiazem cause in overdose

A

Profound cardiac depressant effect causing hypotension and arrythmias

38
Q

How is ccb od treated

A

Charcoal, repeated if mr prep involved. Calc chloride or gluconate can be given if severe and atropine for symptomatic bradycardia

39
Q

What are the symptoms of iron poisoining

A

Nausea, vomitting, abdo pain, diarrhoea, haematemesis, rectal bleeding. Coma, shock and metabolic acidosis indicate severe poisoning. Desferrioxamine chelates iron

40
Q

What can cause lithium intoxication?

A

Reduced excretion of the drug due to dehydration, deteriorated renal function, infections, diuretics, NSAIDs.

41
Q

What are the clinical features of lithium toxicity

A

Early clinical features are non-specific and may include apathy, vomitting, diarrhea, ataxia, weakness, dysarthria, muscle twitiching, tremor. Severe poisoning is associated with convulsions, coma, renal failure, electrolyte imbalance, dehydration and hypotension

42
Q

What is the therapeutic serum lithium conc

A

0.4-1mmol/litre

43
Q

What conc of lithium indicates toxicity?

A

In the excess of 2mmol/l

44
Q

What are the symtpoms of stimulant drug poisoning and how is it treated?

A

Wakefulness, excessive activity, paranoia, hallucinations, hypertension followed by exhaustion, convulsions, hyperthermia and coma. Can control with diazepam/lorazepam

45
Q

What are the symptoms of cocaine overdose?

A

agitation, dilated pupils, tachycardia, hypertension, hallucinations, hyperthermia, hypertonia, hyperreflexia, chest pain, MI, arrythmias

46
Q

What is the initial tx of cocaine poisoning?

A

iv diazepam, cooling measures for hyperthermia

47
Q

What are the most serious side effects associated with mdma

A

delirium, coma, convulsions, ventricular arrythmias, hyperthermia, rhabdomylosis, renal failure, hepatitis, intravascular coagulation, hypotension, haemorrhage, hyponatraemia

48
Q

What are the symptoms of theophylline poisoning?

A

Vomitting, agitation, restlesness, dilated pupils, sinus tachycardia and hyperglycaemia. Haematemesis, severe hypokalaemia may develop rapidly

49
Q

What is the tx of theophylline poisoning

A

Repeated doses of activated charcoal if more than an hour has elapsed or taken mr prep. Odansertrin anti emetic and correct hypokalaemia with pot chloride

50
Q

What is the tx of cyanide poisoning

A

Oxygen administered, dicobalt if not severe.

51
Q

Discuss dicobalt

A

Toxic and associated with anaphylactoid reactions, potentially fatal if administered in the absence of cyanide posoning

52
Q

What can be given for victims of cyanide smoke inhlation showing signs of significant poisoning?

A

Hydroxocobalamin - cyanokit

53
Q

What is the tx for ethylene glycol and methanol poisoning?

A

Fomepizole, or ethanol

54
Q

What is the tx of carbon monoxide poisoning?

A

move to fresh air, clear air way and give high flow oxygen.

55
Q

What are the symptoms of organophosphorous poisoning

A

Anxiety, restlesness, dizziness, headache, miosis, nausea, hypersalivation, vomitting, colic, diarrhoea, bradycardia and sweating

56
Q

What is the tx of cardiac glycoside poisoning

A

Digoxin specific antibody fragments

57
Q

What is the toxic range for digoxin?

A

1.5-3 micrograms/litre

PRE REG (24 decks)

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