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TOXICOLOGY > General methods for treatment > Flashcards

General methods for treatment Flashcards

1
Q

who should we really avoid emesis in

A

someone losing consciousness or substances that can put someone into a coma or cause a seizure. puts patient at risk of aspiration
no gag reflex
corrosive agents

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2
Q

problem with activated charcoal studies

A

patients were all healthy volunteers not like actual people that present to emerg
unethical to make a proper study

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3
Q

complications of emesis

A

aspiration pneumonitis
bleedings
GIT rupture

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4
Q

contraindications to gastric lavage

A

corrosive gents

pertoleum distillate

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5
Q

complications of gastric lavage

A 
cardiac arrhythmia
low oxygen
laryngospasm
pharingeal injury
esophageal or gastric perforation
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6
Q

gastric lavage technique

A

largest diameter tube possible
patient in supine on left side with head down below level of the stomach
airway protected with a cuffed endotracheal tube
aspirate gastric contents
instill 250ml aliquots of warm water followed by draining
repeat until clear

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7
Q

how does activated charcoal work

A

physically adsorbs by hydrogen bonding, dipole and van der waals forces
has a large surface area to bind to then
binding decreases systemic absorption, can bind some poisons that have left the stomach

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8
Q

activated charcoal contraindications

A

ingestion of caustic (burn or corrode) substances

presence of ileus or bowel obstruction bc need to be able to eliminate the activated charcoal

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9
Q

activated charcoal complications

A 
vomiting
aspiraion pneumonitis 
constipation
GI obstruction 
charcoal empyema - gets into peritoneal cavity
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10
Q

activated charcoal technique

A

administered oral or by gastric tube

30-100g as a slurry in water

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11
Q

how does multiple dose activated charcoal work

A

ensures marked serum to GI lumen concentration gradient pulling more toxin from blood to GI - works for IV drugs

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12
Q

what is catharsis

A

whole bowel irrigation using cathartics (increases defecation)

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13
Q

whole bowel irrigation indication

A

ingestion of iron or zinc salts
ingestion of SR products
ingestion of crack vial
ingestion of drug packets (massive OD)

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14
Q

whole bowel irrigation and cathartics contraindications

A

uncooperative patients
presence of ileus or GI obtruction
GI bleeding or perforation

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15
Q

whole bowel irrigation and cathartics complications

A 
abdominal cramping
vomiting
profuse diarrhea
hyperchloremia 
**monitor electrolytes
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16
Q

whole bowel irrigation technique

A

administer large volumes isotonic nonabsorbable polyethylene glycol/electrolyte solution until rectal discharge looks like the fluid administered

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17
Q

actions of cathartics

A

less violent way to move th poison or poison/charcoal complex through the GIT
can help remove poison, decrease absorption

18
Q

examples of cathartics

A

sorbitol
magnesium citrate
magnesium or sodium sulfate

19
Q

how does dilution work

A

water or milk fluid admin

20
Q

when is dilution good

A

first few minutes after ingestion

value in ingestion of corrosive agents

21
Q

contraindications to dilution

A

coma or convulsions bc there is a risk of vomiting

ingestion of strong acid - reacts with water and stomach can explode

22
Q

ways to enhance elimination

A 
diuresis 
peritoneal dialysis
multiple dose activated charcoal
hemodialysis
hemoperfusion
hemofiltration
23
Q

indications for enhancement of elimination

A

patients who fail to respond to full supportive care
normal route of elimination of the toxin is impaired ex. renal dysfunction
patients sho the amount of toxin absorbed or plasma concentration indicate high risk of mortality
for patients who have concurrent disease, elderly, infants

24
Q

manipulation of pH for diuresis objective

A

increase renal clearance

25
Q

which poisons does manipulation of pH work on

A

poisons that are excreted in urine

26
Q

alkaline diuresis and what it works for

A

give sodium bicarb iv to increase urinary pH to 7-8

increased renal excretion of salicylate, isoniazid, phenobarbital

27
Q

acid diuresis and what it works on

A

give ammoniumchloride iv to reduce urinary pH to 4.5-5.5
weak bases such as amphetamines
no evidence of efficacy

28
Q

what is forced diuresis

A

volume expansion with sodium containing solutions

works is glomerular filtration is an important determinant of excretion

29
Q

riskd of forced diuresis

A

volume overload manifested by pulmonary and cerebral edema
metabolic alkalosis
hypokalemia

30
Q

how to do forced diuresis

A

furosemide iv

31
Q

monitoring of forced diuresis

A

monitor electrolytes
fluid balance
acidbase balance
response to diuretic

32
Q

which drugs can be eliminated with peritoneal extracorporeal techniques

A 
water soluble
low MW
poorly protein bound
low Vd
ex alcohol, lithium
33
Q

problems with hemodialysis

A

takes 4-8hrs
often not available
requires anticoagulation with heparin

34
Q

hemodialysis indications

A 
poison dialysable
patient deteriorating despite care
severe electrolyte problems
lethal blood levels
prolonged coma
risk of renal failure
35
Q

hemodialysis complications

A 
clotting and leaking of blood from around connections
embolus
hypotension
convulsions
arrhythmias
infections
36
Q

charcoal advantage over dialysis

A

can remove drugs that are highly protein bound

37
Q

what is charcoal hemoperfusion

A

cartridge containing a sorbent with a large surface area that gets changed every couple of hourse
requires anticoagulation
complications similar to hemodialysis

38
Q

how does hemofiltration work

A

movement of plasma across semipermeable membrane in response to hydrostatic pressure gradient
no dialysate on other side of membrane
small solutes are transported across the membrane following the water while larger solutes are excluded

39
Q

advantages of hemofiltration

A

continue therapy for 24hr
remove drugs that distribute slowly from tissue binding sites and from the intracellular compartment
fast

40
Q

disadvantages of hemofiltration

A

rate of removal of drugs may not be sufficient to benefit critically ill
complex
experienced ICU staff required for monitoring
clearances achieved are lower than in hemodialysis

41
Q

whats plasmapheresis and exchange transfusion used for

A

eliminate molecules with large MW

remove plasma proteins

42
Q

problems with plasmapheresis and exchange transfusion

A

risk of infections and allergic reactions

expensive

TOXICOLOGY (24 decks)

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