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CEN > Environment and Toxicology Emergencies > Flashcards

Environment and Toxicology Emergencies Flashcards

1. Explain the concepts related to care of an emergency department patient experiencing an environment and toxicology emergency. 2. Describe the various patient presentations related to environment and toxicology emergencies. 3. List interventions necessary for a patient presenting with an environment and toxicology emergency.

1
Q

types of burns

A

chemical
electrical
radiation
thermal

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2
Q

pathophysiology of first 24 hours of burns

A

coagulation necrosis of soft tissue leading to release of vasoactive substances

capillary wall compromised, increase in permeability

vasodilation

edema peaks at 24 hours, next 18-24 hours cap permeability normalizes and third spacing resolves

fluid loss

altered tissue perfusion, airway swelling, hypovolemia leading to hypovolemic shock, decreased CO, cellular chock

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3
Q

assessing burns

A

ABCDE - trauma patients

modified for properties of causative agent and resulting injury

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4
Q

safety in burn treatment

A

decontamination
isolation
PPE

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5
Q

airway in burn tx

A

cervical spinal motion restriction

modified jaw-thrust maneuver to open airway and stabilize c-spine in neutral alignent

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6
Q

indictions for early intubation in burn patients

A 
agitation, decreased LOC
hoarseness, stridor, vocal change
progressive edema
oral, nasal erythema
can't handle secretions
extensive facial burns
carbonaceous sputum

NOT singed nasal hair alone

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7
Q

airway risks d/t burns

A

risk for obstructed airway
inhalation injury
cric or trach may be needed

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8
Q

breathing in burn tx

A

supplemental O2
CO or cyanide poisoning
circumferential burns

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9
Q

tx for circumferential burns

A

chest wall escharotomy
electrocautery
fasciotomy

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10
Q

circulation sx in burns

A

profound hypovolemia
hypovolemic shock
decreased CO
cellular shock

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11
Q

treatment of cellular shock in burns

A

IVs, careful fluids with LR
monitor I/O, cardiac output
BP cuffs and art lines may be unreliable

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12
Q

complications of cellular shock in burns

A

fluid shifting
mostly first 4-6 hours for 24+ hours

hypovolemic shock likely if >20% burned

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13
Q

disability assessment in burns

A

generally alert

if not, assess for other injurie

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14
Q

exposure assessment in burns

A

stop burning process
keep patient warm
cover with clean, dry sheet
no ice or cold fluids

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15
Q

chemical burns overview

A

powders, gases, liquids

inhalation, ingestion, skin contact

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16
Q

safety in treating chemical burns

A

PPE, isolation

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17
Q

treatment for chemical burns

A

remove clothing
brush of dry powders

irrigate with copious water for 15 min until pt reports burning has stopped

use material data safety sheets, poison control, toxicologist

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18
Q

special substance considerations with chemical burns

A

metallic lithium
sodium
K+
magnesium

react poorly with water and may potentiate injuries

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19
Q

acid burns

A

coagulation of tissue causing necrosis

generally more damaging to stomach

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20
Q

common acidic chemicals that cause burns

A

battery acid
inegar
sulfuric acid

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21
Q

alkaline burns

A

penetrate deeply into tissue and liquefy tissue

more damaging to esophagus

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22
Q

common alkaline chemicals causing burns

A

lye/drain cleaner
alkaline batteries
baking soda
ammonia

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23
Q

sx chemical ingestion burns (acidic or alkaline)

A 
oral burns
red, white, yellow
maybe bleeding
drooling, vomiting
stridor, hoarse voice
SQ emphysema
abd pain, distention
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24
Q

intervene for chemical ingestion

A

strict NPO
do not induce vomiting
toxicologist

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25
Q

characteristics of hydrofluoric acid

A

fluoride ion seeks Ca
systemic toxicity
clear, colorless liquid
corrosive, toxic

used during oil refinement and precursor to many chemicals

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26
Q

sx hydrofluoric acid exposure

A 
depends on concentration
usually affect digits
pain worsens as it penetrates
tetany
Chvostek sign
Trousseau sign
dysrhythmias
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27
Q

Chvostek sign

A

spasm or twitch of facial muscle elicited by tapping facial nerve in region of parotid gland

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28
Q

Trousseau sign

A

sign of latent tetany in which carpal spasm can be elicited by compressing the upper arm with tourniquet or blood pressure causing ischemia to distal nerves

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29
Q

assessing hydrofluoric acid exposure

A

EKG

serum Ca, sx hypocalcemia

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30
Q

intervene for hydrofluoric acid exposure

A

analgesics

2.5% calcium gluconate

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31
Q

how to use calcium gluconate for hydrofluoric acid exposure

A

combine 1 ampule Ca gluconate with 100 g water-soluble lubricating jelly

cover with plastic dressing

hold in place

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32
Q

mechanisms of thermal burns

A 
scald
flame
flash
contact
tar
steam
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33
Q

intervene for thermal burns

A

stop burning process

< 10%: moist, cool dressings

>10%: dry, sterile dressings or clean sheet
maintain body temp
protect wounds
avoid breaking blisters
no topical agents
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34
Q

tar/asphalt burns

A

adheres to skin
creates tough barrier, difficult to remove

tar may continue to burn skin

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35
Q

intervene for tar/asphalt burns

A 
stop burning
fat emollient to loosen tar
abx ointment
citrus-based products
peel off cool tar
treat underlying burns as thermal
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36
Q

Rule of 9s to estimate burn size

A

surface area of each section of body is a multiple of 9

perineum = 1%

head = 18% in children, 9% in adults

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37
Q

palm method to estimate burn size

A

better for scattered burns

patients hand = 1% TBSA

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38
Q

depths of burns

A

superficial partial thickness (1st degree)

deep partial thickness (2nd)

full thickness (3rd and 4th)

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39
Q

tissue affected by depth of burn

A

1st: epidermis (superficial)
2nd: epidermis, partial dermis
3rd: entire epidermis, dermis destroyed
4th: underlying fat, fascia, muscle and/or bone affected

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40
Q

sx of burns based on depth

A

1st: redness, hypersensitivity, pain
2nd: red, blistered, wet, weepy, whiter, edematous
3rd: whitish or charred, coagulated vessels may appear
4th: often similar to 3rd

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41
Q

healing of burns based on depth

A

1st: heals on its own in days without scarring
2nd: may heal spontaneously over 2-3 weeks, minimal scarring
3rd: scar formation, skin grafting
4th: scar contracture formation, skin grafting, surgical intervention

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42
Q

fluid resuscitation in burns overview

A

only deep partial and full thickness burns in calculations, do not include 1st degree

LR

time fluid resuscitation for first 24 hours after injury

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43
Q

Parkland formula for burn fluid resuscitation

A

4mL LR x BSA % x kg

half of volume in first 8 hours
other half in next 16 hours

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44
Q

ABLS: advanced burn life support guidelines

A

adults (thermal, chemical)
2ml LR x kg x %BSA

adults (high voltage)
4mL LR x kg x %BSA
accounts for renal damage

peds
3mL LR x kg X %BSA

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45
Q

pediatric considerations in fluid resuscitation for burns

A 
greater BSA/kg
impaired thermoregulation
limited glycogen stores
thinner skin, deeper burns
small airway, less edema for obstruction
lower to ground, inhalation
scald burns most common
consider abuse, neglect
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46
Q

characteristics of carbon monoxide

A

may be associated with burn injuries or might be separate

colorless, odorless, tasteless

byproduct of organic material combustion

hemoglobin binding affinity 200+ x greater than O2

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47
Q

sx CO poisoning: 10-20%

A 
HA
n/v
loss of coordination
flushed skin
dyspnea
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48
Q

sx CO poisoning: 20-40%

A

confusion
lethargy
visual changes
angina

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49
Q

sx CO poisoning: 40-60%

A

arrhythmias
sz
coma

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50
Q

sx CO poisoning: over 60%

A

cherry-red skin
death
Cheyne-Stokes respirations

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51
Q

carboxyhemoglobin levels in CO poisoning

A

amount of CO bound to Hg is associated with pt presentation

smoker can have baseline increased level

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52
Q

assessing CO poisoning

A

SpO2 unreliable

need carboxyhemoglobin level

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53
Q

intervene for CO poisoning

A

high-flow oxygen for at least 4 hours via nonrebreather to reduce CO half-life

severe exposures require burn center transfer and/or hyperbarics

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54
Q

define electrical burns

A

surface wounds usually small but there are severe internal injuries

caused by current flow, arc flash, or clothing ignition

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55
Q

sx low voltage electrical burns

A

delayed pain onset

fatal dysrhythmias

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56
Q

sx high voltage electrical burns

A

tissue heated immediately with tissue necrosis

arrhythmias
compartment syndrome
rhabdo
hypovolemia

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57
Q

intervene for electrical burns

A 
EKG
LR 1-2 L/hr
I/O
-adults 75-100 ml/hr
-peds: 1ml/kg/hr
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58
Q

black widow spider characteristics

A

red hourglass on abdomen

dark, secluded, damp spaces

almost always one bite

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59
Q

sx black widow spider bite

A 
pain at time of bite
halo ring
large muscle cramps
HTN, tachycardia
N/V
paresthesia, weakness
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60
Q

intervene for black widow spider bite

A 
ice, elevate
tetanus
muscle relaxants
antihistamines (sustemic edema)
antivenin with caution
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61
Q

characteristics of brown recluse spider

A

dark, violin-like spot
dark, undisturbed places
nocturnal
southern US

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62
Q

sx brown recluse spider bite

A 
painless at time of bite
bluish, irregular ring
pruritus, blisters, redness
edema
F/C, N/V
malaise, myalgia
necrotic ulcerating wound
eschar
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63
Q

intervene for brown recluse spider bite

A

ice, elevate
tetanus
wound care

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64
Q

snake pupils

A

venomous: elliptical (minus coral snakes)
nonvenomous: round

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65
Q

snake bites

A

venomous: two fangs, produce punctures
nonvenomous: several rows of small teeth, produce scratches

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66
Q

snake head shapes

A

venomous: triangular d/t venom glands
nonvenomous: rounded

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67
Q

presence of pit between eye and nostril in snakes

A

venomous: yes, in pit vipers
nonvenomous: no

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68
Q

tail in snakes

A

venomous: single row of subcaudal plates
nonvenomous: double row

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69
Q

snakes that produce hemotoxic venom

A

pit vipers
rattlesnakes
copperheads
cotton mouths

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70
Q

snakes that produce neurotoxic venom

A

coral snakes

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71
Q

local rxn to hemotoxic snake venom

A 
rapid pain
redness, swelling
ecchymosis
loss of limb fxn
severe tissue necrosis
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72
Q

systemic rxn to hemotoxic snake venom

A 
tachycardia, tachypnea, dyspnea
constricted pupils
ptsos, diplopia
muscle twitch, paresthesias
difficulty speaking
confusion
bleeding disorders
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73
Q

sx neurotoxic snake venom

A

bite less red and swollen
effects can delay up to 12 hrs

general: local paresthesais, diplopia, ptosis, difficulty swallowing
resp: resp distress, pharyngeal spasm, hypersalivation, cyanosis, trismus

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74
Q

interventions for dry snake bites

A

no venom

abx and tetanus

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75
Q

interventions for envenomation snake bites

A 
\+ venom
IV prior to tourniquet removal
immobilize, raise limb
monitor for compartment syndrome
consider antivenin
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76
Q

antivenin

A

ideally w/in 4 hours
effective up to 24 hrs
availability: Crotalid, poison center
monitor for anaphylaxis

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77
Q

tick removal

A

forceps close to skin and mouth of tic

remove, pulling straight back to counter direction entered

remove like splinter if parts remain

do not squeeze or crush

save for species identifiation

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78
Q

early sx Lyme disease

A

erythema migrans rash (in70-85%)

circular (bullseye) rash w/ flu-like sx

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79
Q

late sx Lyme disease

A 
monoarticular arthritis
multiple skin lesions
Bells palsy
memory loss
meningitis
heart block
myocarditis
painful arthritis
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80
Q

intervene for lyme disease

A

abx: oral doxy bid x 2 weeks
salicylate for pain
pacemaker for heart block

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81
Q

sx Rocky Mountain spotted fever

A

fever, chills
HA
rash
incubates 2-14 days

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82
Q

rash in Rocky Mountain spotted fever

A

maculopapular, nonpruritic spots on soles, ankles, palms, wrists, forearms

becomes nonblanching and petechial

spreads in centripetal fashion

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83
Q

complications of Rocky Mountain spotted fever

A

renal failure
thrombocytopenia
hyponatremia
impaired liver fxn

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84
Q

intervene for Rocky Mountain spotted fever

A

doxycycline

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85
Q

characteristics of rabies

A

viral disease

transmitted via bite of rabid animal via saliva

bats, raccoons, skunks, foxes

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86
Q

sx of initial stage of rabies

A

parethesia, pain, itching

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87
Q

sx of prodromal stage of rabies

A 
HA, fever
runny nose, sore throat
myalgia
GI sx
acute, progressive encephalitis
hydrophobia, aerophobia
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88
Q

intervene for rabies

A

early, aggressive wound management with soap and water

use sunlight to dry and sterilize contaminated materials

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89
Q

characteristics of stingrays

A

1+ venom-coated barbed stingers on tail for self-defense

can cause painful injuries, esp to lower extremities if entering their territory

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90
Q

sx stingray sting

A

severe pain, swelling, bleeding at site

possible systemic effects that could be life threatening

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91
Q

intervene for stingray sting

A 
hot water immersion for 2 hrs
pain management
tetanus
barb removal
wound irrigation
wound cultures, abx
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92
Q

characteristics of jellyfish

A

nematocysts are stinging darts that fire when tentacles make contact

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93
Q

sx jellyfish stings

A

local
moderate to severe pain
reddened welts

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94
Q

intervene for jellyfish stings

A 
irrigate
remove tentacles with ppe
pain management
acetic acid aka vinegar
baking soda paste

cold or heat not determined, depends on species

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95
Q

define contact dermatitis

A

allergic rxn after exposure to urushiol oils from poison ivy, oak, and sumac

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96
Q

intervene for contact dermatitis

A

OTC topical agents or benadryl

sx may be worse with inhalation or existing allergy

avoid contact

standard wound care, allergy tx based on severity

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97
Q

characteristics of giardia

A

protozoan parasite that causes giardiasis

lives in intestines

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98
Q

transmission of giardia

A

spread by water contaminated with fecal matter

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99
Q

sx giardia

A 
diarrhea, steatorrhea
abd cramping
bloating
weight loss
malabsoprtion
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100
Q

intervene for giardia

A

rehydrate

metronidazole, tinidazole, nitazoxanide

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101
Q

characteristics of tapeworms

A

taeniasis caused by Taenia

2-25 meters

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102
Q

transmission of tapeworms

A

raw/undercooked beef or pork

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103
Q

sx tapeworm

A 
GI discomfort
nausea
flatulence
diarrhea
hunger pains
may pass proglottids (tapeworm parts)
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104
Q

intervene for tapeworm

A

praziquantel

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105
Q

characteristics of pinworms

A

small, thin, white roundworm

lives in colon/rectum

females may leave through anus whle person sleeps to lay eggs

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106
Q

transmission of pinworms

A

oral-fecal

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107
Q

sx pinworm

A

mild sx or none

anal itching

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108
Q

diagnosing pinworm

A

tape test

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109
Q

intervene for pinworm

A

mebendazole, pyrantel pamoate, albendazole

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110
Q

types of lice

A

pediculus humanus capitis (head)

pediculus humanus corporis (body)

pthirus pubis (pubic)

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111
Q

transmission of lice

A

person to person

112
Q

sx lice

A

itching, sores from scratching

sleeplessness

113
Q

intervene for lice

A

topical meds, shamppoo
combine
wash clothes, linens, combs in hot water
vacuum floor, furniture

114
Q

define scabies

A

itch mite that buries in upper layer of skin

115
Q

transmission of scabies

A

direct, prolonged skin to skin contact

116
Q

sx scabies

A

intense pruritus, esp at night
papular itchy rash
vesicles, scales

key areas: hands and other moist areas (axilla, groin)

117
Q

intervene for scabies

A

premethrin cream head to toe and again one week later

crotamiton lotion/cream, not for children

wash clothes, linens in hot water

thoroughly clean, vacuum rooms

118
Q

transmission of ringworm/tineas

A

spread to people and animals via fomites

119
Q

sx ringworm/tineas

A

circular, red, scaly, itchy rash

central clearing

120
Q

intervene for ringworm/tineas

A

tineas pedis, corporis, cruris (feet, body, groin): otc/topical antifungal

tineas capitis (scalp): systemic antifungal (griseofulvin, terbinafine)

121
Q

define arterial gas embolism

A

high-pressure air forced into arterial circulation

122
Q

complications of arterial gas embolism

A

trapped air in lung expands, leading to rupture of lung tissue, releasing gas bubbles into arterial circulation

123
Q

causes of arterial gas embolism

A

divers ascending too quickly, panicky, or while holding breath

also normal ascents with COPD

124
Q

sx arterial gas embolism

A 
chest tightness, dyspnea
pink, frothy sputum
pneumothorax sx
limb paresthesia 
vertigo
altered LOC
visual disturbances
SZs
sensory loss
125
Q

intervene for arterial gas embolism

A

O2
needle decompression
hyperbarics
avoid Trendelenburg

126
Q

define decompression sickness

A

bubbles growing in tissues causing local damage aka “the bends”

due to inadequate decompression after exposure to increased pressure

127
Q

pathophysiology of decompression sickness

A

during diving, nitrogen absorbed by body tissues but during ascent if pressure is reduced too quickly, the nitrogen forms bubbles and enters bloodstream

128
Q

sx decompression sickness

A 
sob, crepitus, cough
numbness, tingling
HA
visual loss, diplopia
fatigue, dizziness, unconsciousness, SZs
paresthesias, paralysis
joint discomfort, progressive pain
129
Q

intervene for decompression sickness

A

O2, fluids, analgesia
urgent hyperbarics

consider antiplatelet, antithrombin meds and heliox (helium-oxygen)

130
Q

define heat cramps

A

sweat-induced electrolyte depletion r/t intense physical activity and hot environment

131
Q

sx heat cramps

A 
muscle cramps
weakness
thirst
nausea
tachycardia
pale, cool, moist skin
132
Q

intervene for heat cramps

A

electrolyte replacement
cool environment
rest

133
Q

define heat exhaustion

A

prolonged period of fluid loss r/t exposure to warm environment without fluid and electrolyte replacement

left untreated, may progress to heatstroke

134
Q

sx heat exhaustion

A 
rapid onset of heat cramps
anorexia, vmoiting
general malaise
muscle incoordination
HA, syncope
temp normal to elevated (98.6-104)
135
Q

intervene for heat exhaustion

A

IV fluid, electrolytes
cool environment
rest

136
Q

define heat stroke

A

temp at or above 105.8F or 40C

CNS, cardiac, cellular fxns affected

137
Q

causes of heat stroke

A

strenuous physical activity in hot environment and unable to dissipate body heat

non-exercise induced

138
Q

non-exercised induced causes of heat stroke

A

young and elderly more vulnerable

environmental

med related:

  • thyroid
  • sympathomimetics
  • haldol
  • antihistamines
  • anticholinergics
  • propanolol
139
Q

sx heat stroke

A 
rapid onset
N/V/D
hot, dry skin
tachycardia, tachypnea
decreased LOC
posturing, SZs, dilated/fixed pupils
hypotension, decreased urinary output
coagulopathies
140
Q

intervene for heat stroke

A 
cool rapidly
room temp IV fluids
monitor electrolytes, clotting
I/Os
control shivering (benzos)
141
Q

define frostbite

A

type of burn injury d/t formation of ice crystals in tissue, leading to cellular damage, vasospasms, arterial thrombosis

142
Q

frostbite overview

A

damage to cells irreversible

days to weeks to determine extent of underlying damage

may be associated with hypothermia

143
Q

sx frostbite

A

burning, numbness, tingling
white, waxy skin color
stinging, hot feeling after thawing
blisters

144
Q

intervene for frostbite

A 
assess for hypothermia
analgesia
circulating water immersion
debride nonhemorrhagic blisters
gently handle tissue
loose, bulky clothing
tetanus
145
Q

tissue handling in frostbite

A

do not rewarm or thaw if there is a possibility of re-freezing

frozen tissue should never be rubbed because further tissue damage will occur

146
Q

characteristics of mild frostbite

A 
brief exposure, early rewarming
bright red or normal skin color
warm digits
sensation
clear blisters
blisters to digit tips
147
Q

characteristics of deep frostbite injury

A

prolonged exposure, delayed rewarming

mottled/purple skin
cool digits
no sensation
hemorrhagic blisters
proximal blisters only
148
Q

primary cause of hypothermia

A

ambient environment

149
Q

secondary cause of hypothermia

A

medical condition that decreases body temperature

150
Q

mild hypothermia

A 
90-95F
vasoconstriction
shivering
cold sensation
coagulopathy
151
Q

moderate hypothermia

A 
82.4-90F
bradycardia
confusion, agitation
metabolic acidosis
cold-induced diruesis
152
Q

severe hypothermia

A

68-82.3F
coma
resp depression
profound hypovolemia

153
Q

profound hypothermia

A

68F
apnea
asystolic arrest

154
Q

intervene for hypothermia

A

passive rewarming
active external rewarming
active internal rewarming

155
Q

passive rewarming for hypothermia

A

dry skin, remove wet clothing

warm environment

156
Q

active external rewarming for hypothermia

A

forced-air warming system

warm water immersion

157
Q

active internal rewarming for hypothermia

A 
warm IV fluids
heated, humidified oxygen
peritoneal lavage w/ heated dialysate
rapid fluid infuser
cardiac bypass, HD
158
Q

complications of hypothermia

A

refractory v.fib until rewarmed

other dysrhythmias

159
Q

cardiac dysrhythmias in hypothermia

A

a.fib
osborn or J waves
bradycardia
v.fib

160
Q

intervene for cardiac dysrhythmias in hypothermia

A

volume replacement

rewarm body core before periphery to prevent rewarming shock (leads to fibrillation)

caution with IV meds

161
Q

induced emesis s/p ingestion

A

not routinely used
serious side effects
marginally effective

162
Q

contraindications for activated charcoal s/p ingestion

A

corrosive agent, hydrocarbons
decreased/absent bowel sounds
toxins not bound by charcoal

163
Q

toxins that are not bound by activated charcoal

A 
iron
lead
lithium
toxic alcohols
caustics
164
Q

dosing activated charcoal

A

multidosed for:

  • extended release meds
  • carbamazepine
  • dapsone
  • quinine
  • theophylline
  • enteric coated tablets

q4-6 hr for 12-24 hrs

165
Q

indications for gastric lavage s/p ingestion

A

life-threatening poisons

symptomatic pts w/in 1 hr ingestion or who ingested agent that slows GI motility

ingestion of sustained-release meds or massive or life-threatening amounts of a substance

166
Q

cathartics s/p ingestion

A

magnesium sulfate, magnesium citrate, sorbitol

added to activated charcoal to enhance GI elimination

contraindicated if bowel sounds are absnet

167
Q

whole bowel irrigation s/p ingestion

A

electrolyte solution

most common for ingested agents not well absorbed by charcoal

contraindicated in GI pathology

168
Q

indications for HD s/p ingestion

A

severe poisonings with sx:

  • metabolic acidosis
  • electrolyte abnormalities
  • renal failure
169
Q

contraindications for HD s/p ingestion

A 
substance highly protein-bound
rarely fatal agents
agents with antidotes
HD unstable pts
bleeding disorders
poor vascular access
170
Q

define toxidrome

A

set of toxic sx caused by particular class of medication

171
Q

define sympathomimetic toxidrome

A

mimic neurotransmitters of SNS

epi, dopamine, norepi, catecholamines

172
Q

drugs that are sympathomimetic

A 
cocaine
amphetamines
methamphetamine
ephedra
alkaloids
MDMA, ecstasy
albuterol
dopamine
tricyclic antidepressants
MAOIs
173
Q

sx sympathomimetic toxidrome

A 
HTN, tachycardia, tachypnea
hyperthermia
CNS excitation
tremors, SZs
hyperreflexia
mydriasis
diaphoresis
174
Q

intervene for sympathomimetic toxidrome

A

sedation
nonpharm cooling
BP, pulse control
pharm management

175
Q

pharm management of sympathomimetic toxidrome

A

benzos
nitroprusside
haldol
neurmuscular blocks

176
Q

complications of cocaine overdose

A 
ventricular arrhythmias
MI, aortic dissection
rhabdo, lactic acidosis
hyperglycemia
SZs, strokes
placental abruption, premature delivery
nasal septum perforation
177
Q

intervene for cocaine OD

A

same as sympathomimetic toxidrome but consider condition-specific complications

178
Q

sedative-hypnotic toxidrome

A

barbiturates depress CNS and may be classified as sedatives

non-barbituates may be considered hypnotics

179
Q

types of barbituates

A

phenobarbital

thiopental

180
Q

types of nonbarbituates

A

benzos

antihistamines

181
Q

sx sedative-hypnotic toxidrome

A

hypotension, bradycardia
bradypnea
hypothermia
arrhythmias

182
Q

intervene for sedative-hypnotic toxidrome

A 
aspiration precautions
early intubation
beta-adrenergic agonists
flumazenil for benzos
antiarrhythmics
183
Q

cholinergic toxidrome

A

cholinergic drugs mimic or enhance action of acetylcholine of PNS and have muscarinic and nicotinic effects

184
Q

examples of cholinergic substances

A 
pesticides/insecticides
organophosphates (sarin)
pilocarpine
bethanechol
choline
some mushrooms
185
Q

sx cholinergic toxidrome

A 
SLUDGE:
salivation
lacrimation
urination
defecation
GI upset
emesis
186
Q

intervene for cholinergic toxidrome

A

control hypoxemia 2nary resp distress

atropine

2PAM (Pralidoxime)
benzos for SZs

187
Q

pralidoxime (2PAM)

A

for cholinergic toxidrome

restores action of acetylcholinesterase to break down acetylcholine

administered with atropine to dry secretions

188
Q

anticholinergic toxidrome

A

blocks acetylcholine and inhibits parasympathetic nervous system

189
Q

types of anticholinergic medications

A 
antihistamiens
tricyclic antidrepressants
cyclobenzaprine
antispasmodics
mydriatics
ipratropium bromide
atropine
antiparkinson meds

also nightshade (Bella Donna) and Jimson weed (Devil’s snare)

190
Q

mnemonic to remember anticholinergic toxidrome

A 
blind as a bat
mad as a hatter
red as a beet
hot as Hades
dry as a bone
bowel and bladder lose their tone
heart runs alone
191
Q

sx anticholinergic toxidrome

A 
HTN, tachycardia
tachypnea, hyperthermia
mydriasis
decreased bowel sounds
dry mucous membranes, flushing
urinary retention
agitation, delirium, hallucinations
192
Q

intervene for anticholinergic toxidrome

A 
sedate with benzos
cooling
haldol
physostigmine
slow IV pushes
continuous EKG/tele
193
Q

physostigimine

A

for cholinergic toxidrome

PNS alkaloid that inhibits cholinesterase

rapid administration can result in resp failure and heart paralysis

194
Q

opioid toxidrome

A

opiates and narcotics that depress CNS

195
Q

sx opioid toxidrome

A

respiratory, CNS depression
miosis
hypotension, bradycardia
bradypnea, hypothermia

196
Q

intervene for opioid toxidrome

A

intubate, ventilate
narcan
-duration 30-60 min
-repeat dose may be needed

197
Q

opiate withdrawal

A

sudden cessation of opiates after physical dependence

198
Q

types of opiates

A 
heroin
morphine
hydrocodone
oxycodone
codein
199
Q

sx opiate withdrawal

A 
rhinorrhea, sneezing, yawning
lacrimation
abd, leg cramps
N/V/D
dilated pupils
200
Q

assessing opiate withdrawal

A

last dose
route of use
tox screen

201
Q

intervene for opiate withdrawal

A

supportive care

benzos for cramps, anxiety, insomnia

clonidine for lacrimation, diarrhea, tachycardia

opioid substitute (methadone)

202
Q

types of hallucinogenic

A

LSD
PCP
GHB (date rape drug)

203
Q

sx LSD toxidrome

A

sympathomimetic effects
euphoria
fear, anxiety, panic
hallucinations, paranoia, psychosis

204
Q

intervene for LSD toxidrome

A

reduce stimulation
restraints for safety
benzos for agitation
haldol for psychosis

205
Q

sx PCP toxidrome

A 
violent, combative behavior
increased strength
lack of pain sensation
nystagmus
miosis
206
Q

intervene for PCP toxidrome

A 
reduce stimulation
benzos for agitation
haldol for psychosis
antihypertensives
restraints
207
Q

sx GHB toxidrome

A

depressed LOC to coma with significant resp depression

hypertension, bradycardia
SZ

208
Q

intervene for GHB toxidrome

A

intubate, ventilate
benzos for agitation
sexual assault kit

209
Q

toxic inhalants

A

toxic ingestion via lungs

210
Q

methods of using toxic inhalants

A

sniffing - inhaling from container

huffing - soaking cloth in solvent and inhaling

bagging - fumes from a bag

211
Q

types of toxic inhalants

A 
aerosols
gases
solvents
cleaning products
food products
212
Q

sx toxic inhalation

A 
sudden sniffing death
CNS stimulation or depression
arrhythmias, cardiac arrest
eye, resp, GI irritation
wheezing
ataxia with wide gait
epistaxis
burns
long term use = organ damage
213
Q

intervene for toxic inhalation

A

well-ventilated space
decontaminate
intubate, ventilate
benzos

214
Q

interventions for alcohol ingestion in general

A

intubate, ventilate
HD
monitor for Wernicke-Korsakoff syndrome

215
Q

tx for ethylene glycol or methanol ingestion

A

ethanol or fomepizole to block metabolism of ethylene glycol and methanol

fomepizole preferred, don’t need to monitor for low BG and can be given with HD

sodium bicarb for acidosis

216
Q

tx for ethanol specific ingestion

A

IV fluids
monitor BG
nutritional support (B1, thiamine)

217
Q

Wernicke-Korsakoff syndrome

A 
in alcohol ingestion
lack of vitamin B1
mental confusion
taxia
ophthalmoplegia
218
Q

sx alcohol withdrawal/DT

A 
AMS, confusion, disorientation
hallucinations, agitation
tremors
tachycardia, tachypnea, HTN
hyperthermia
219
Q

delirium tremens

A

tremors
hallucinations
anxiety
disorientation

220
Q

intervene for alcohol withdrawal/DT

A

benzos

antispychotics

221
Q

types of alcohol

A

ethanol
isopropanol
ethylene glycol
methanol

222
Q

characteristics of ethanol

A

alcohol beverages
least toxic
leads to intoxication

223
Q

characteristics of isopropanol

A

rubbing alcohol
less toxic than others
metabolite is acetone

224
Q

sx isopropanol ingestion

A

fruit breath odor 2/2 acetone
hyperglycemia
urine ketones
CNS depression

225
Q

characteristics of ethylene glycol

A

antifreeze, deicing agents

odorless, syrupy liquid with sweet taste

226
Q

sx ethylene glycol ingestion

A 
intoxication
tachycardia, HTN
hyperventilation
metabolic acidosis
renal failure

large doses: nystagmus, ataxia, SZs, coma

227
Q

characteristics of methanol

A

windshield wiper fluid, canned fuels, solvents

light, volatile, flammable

sweeter than ethanol

228
Q

sx methanol ingestion

A

similar to ethanol but 10-30 hrs later

metabolites cause profound metabolic acidosis, destroy optic nerve
N/V
abd pain

229
Q

iron ingestion

A

usually via nutritional supplements

230
Q

assessing iron ingestion

A

multiple types of iron - specify type and amount

40-60mg/kg of elemental iron causes severe sx

231
Q

intervene for iron ingestion

A 
gastric lavage
NO activated charcoal
whole bowel irrigation
serum iron level
hypovolemic shock tx
chelation with deferoxamine
232
Q

deferoxamine

A

tx for iron ingestion via chelation

turns urine pink - continue tx until urine color normal

233
Q

initial stage of heavy metal toxicity

A

0-2 hours
N/V, abd pain
hematemesis, bloody stools
hypotension

234
Q

second stage of heavy metal toxicity

A

2-48 hrs
GI disturbances resolves
dehydration

235
Q

third stage of heavy metal toxicity

A

48-96 hrs
metabolic acidosis, coagulopathy
hemorrhage, shock
hepatic, renal failure

236
Q

define cyanide

A

cellular asphyxiant

237
Q

sources of cyanide

A

industrial processes
terrorism
foods
byproduct of long-term nitroprusside

238
Q

sources of industrial cyanide

A

insecticides
industrial fumigants
metal plating
plastic burning

239
Q

sources of cyanide in food

A

apricot pits
orange seeds
cassava

240
Q

types of cyanide exposure

A

inhalation
dermal
ingestion
parenteral

common byproduct of fires

241
Q

sx cyanide poisoning

A 
hypoxia, resp distress
HA, dizziness, SZs
metabolic acidosis
arrhythmias, hypotension
burning sensation in mouth
bitter almond breath
242
Q

intervene for cyanide poisoning

A 
15 LMP nonrebreather
amyl nitrate
intubate, ventilate
sodium nitrite
sodium thiosulfate
decon
vasopressors
benzos
243
Q

why is it easy to OD on acetaminophen?

A

found in many OTC and Rx meds in which it is not obvious that the med contains acetaminophen

244
Q

pathophysiology of acetaminophen toxicity

A

toxic to liver in small doses

metabolites destroy liver cells which leads to necrosis and damage

toxicity at levels > 140 mg/kg

alcohol abuse or liver disease at increased risk

245
Q

intervene for acetaminophen toxicity

A

gastric lavage if recent or above 7.5 grams

activated charcoal

level 4 hours after ingestion

contact poison center for chronic ingestion or past 24 hours

N-acetylcysteine if toxic level

246
Q

administration of N-acetylcysteine for acetaminophen ingestion

A

within 8 hours of ingestion for best results

can be started up to 24 hours after poisoning

247
Q

sx of acetaminophen ingestion at 0-24 hours

A

malaise
nausea
diaphoresis

248
Q

sx of acetaminophen ingestion at 24-48 hours

A

RUQ pain
elevated LFTs
decreased urine

249
Q

sx of acetaminophen ingestion at 72-96 hours

A 
malaise
hypoglycemia
jaundice, enlarged liver
coagulopathies
coma
250
Q

sx of acetaminophen ingestion at 7-8 days

A

recovery with potential liver damage

251
Q

type of salicylate

A

aspirin

252
Q

salicylate toxicity

A 
CNS
hematologic
cardiovascular
gastrointestinal
acid-base
electrolyte status
253
Q

sx salicylate toxicity

A 
tachypnea, tachycardia
N/V/abd pain
diaphoresis, fever, dehydration
tinnitus
hypoglycemia
electrolyte imbalance
AMS, SZs
hemorrhagic gastritis
coagulation abnormalities
254
Q

intervene for salicylate toxicity

A 
fluids, I/O, electrolyte monitoring
HD
activated charcoal
sodium bicarb
tx hypoglycemia
repeat labs q 6-12 hrs
255
Q

indications for HD in salicylate toxicity

A 
severe poisonings
renal failure
serum levels > 75 mg/dL
decreased renal fxn
significant acidosis
severe fluid/electrolyte disturbances
256
Q

NSAIDs overview

A

analgesics, antipyretics, antiinflammatories

ibuprofen, naproxen

safer than acetaminophen, less likely to be toxic

257
Q

NSAID toxicity

A

acute ingestion under 100 mg/kg is not toxic

over 300 mg/kg is severe

258
Q

sx NSAID toxicity

A 
drowsiness, lethargy, SZs
GI irritation
renal failure, hepatotoxicity
apnea
metabolic acidosis
259
Q

intervene for NSAID toxicity

A

monitor
gastric lavage
actvated charcoal
SZ precautions, benzos

260
Q

characteristics of tricyclic antidepressants

A

peripheral anticholinergic and CNS effects

261
Q

pathophysiology of tricyclic antidepressant toxicity

A

false low Na levels d/t being highly protein bound and lipid soluble

Na channel blockade

cannot be removed via HD

long elimination half-life

262
Q

sx of tricyclic antidepressant toxicity

A

cardiotoxicity
adrenergic compromise
anticholinergic activity

263
Q

cardiotoxicity in tricyclic antidepressant toxicity

A 
tachydysrthymias
prolonged PRI, QT
wide QRS
hypotension
AV bocks
264
Q

adrenergic compromise in tricyclic antidepressant toxicity

A

decrease LOC
syncope
SZs
coma

265
Q

anticholinergic activity in tricyclic antidepressant toxicity

A 
tachycardia
dry mouth
urinary retention
hyperthermia
mydriasis
266
Q

intervene for tricyclic antidepressant toxicity

A 
intubate
gastric lavage
activated charcoal
cathartic agents
sodium bicarb for pH
isotonic fluids
vasopressors, benzos prn
267
Q

overview of beta blocker and calcium channel blocker toxicity

A

negative chrono-, dromo-, and inotropic effects

severe pediatric toxicity with one tablet

sx may have rapid progression and be resistant to conventional therapy

onset may be late

268
Q

sx beta blocker/calcium channel blocker toxicity

A 
bradycardia, hypotension
cardiac conduction abnormalities
confusion, AMS, syncope
SZs, coma
N/V
hyperglycemia (CCB), hypoglycemia (BB)
269
Q

intervene for beta blocker/calcium channel blocker toxicity

A 
gastric lavage
activated charcoal
pacing for refractory brady
glucagon
calcium chloride
atropine
vasopressors
correct glucose abnormalities
270
Q

use of glucagon in beta blocker/calcium channel blocker toxicity

A

positive ino- and chronotropic effects

antidote for meds that reduce intracellular Ca

271
Q

use of calcium chloride in beta blocker/calcium channel blocker toxicity

A

calcium gluconate contraindicated due to decreased bioavailability of calcium

272
Q

digoxin overview

A

negative chronotropic
positive inotropic

meds and plants

273
Q

risk of digoxin toxicity

A

concurrent use of other cardiac meds or diuretics

presence of hypokalemia

274
Q

acute sx digoxin toxicity

A

peak 30 min to 12 hrs
arrhythmias, hypotension
hyperkalemia
lethargy, coma

275
Q

chronic sx digoxin toxicity

A

anorexia
N/V
yellow/green halos

276
Q

intervene for digoxine toxicity

A

serum levels
activated charcoal

treat electrolyte, glucose, volume abnormalities

atropine or TCP for brady
monitor K+, arrhythmias, CHF

digoxine-immune fab antidote

277
Q

indications to use digoxin-immune fab antidote in digoxin toxicity

A

large ingestion in previously health adults (10 mg)

bradycardia refractory to atropine

ventricular arrhythmias

levels above 10 ng/mL

hyperkalemia over 5.5

CEN (12 decks)

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