General Principles Flashcards
criteria used to determine whether the exposure is nontoxic are as follows:
(1) an unintentional exposure to a clearly identified single substance,
(2) an estimate of the dose is known, and
(3) a recognized information source (e.g., a poison control center) confirms the substance as nontoxic in the reported dose
True or false
Asymptomatic patients with nontoxic exposures may be discharged after a short period of observation, providing they have access to further consultation and a safe discharge destination.
True
What are the three antidotes  indicated before cardiopulmonary stabilization
Naloxone for opiate toxicity,
cyanide antidotes for cyanide toxicity, and
atropine for organophosphate poisoning
are often administered empirically as a cocktail in cases of altered mental status
TONG
thiamine
oxygen
naloxone
glucose
administered for sodium channel–blocker toxicity with cardiovascular complications, such as wide QRS complex tachydysrhythmias
Sodium bicarbonate
Drug-induced seizures are treated with titrated doses of__________________, with the exception that isoniazid-induced seizures require____________.
IV benzodiazepines
pyridoxine
second-line agents for benzodiazepine-resistant seizures (once isoniazid-induced seizures are excluded)
Propofol and barbiturates
What is the intervention for Calcium channel blocker or beta-blocker overdose?
High-dose insulin infusion
What is the intervention for Local anesthetic agents Lipophilic cardiotoxins overdose?
IV lipid emulsion
Antidote for  Hydrogen sulfide
Sodium nitrite (3% solution)
Antidote for  Hypermagnesemia
Calcium gluconate 10%
9 milligrams/mL elemental Ca
Antidote for  Calcium channel blockers
Calcium chloride 10%
27.2 milligrams/mL elemental Ca
Antidote for  Nitroprusside
Hydroxocobalamin
Antidotes for Clonidine
Naloxone
Antidote for Isoniazid
Pyridoxine
Used for Urinary alkalinization
Sodium bicarbonate
Wernicke’s syndrome Wet beriberi antidote
Thiamine
True or false
There is no role for phenytoin in the treatment of toxin-induced seizures; it has neither theoretical nor proven efficacy, and it may worsen toxicity.
True
Agitation is treated with titrated doses of___________
____________________are often used as second-line agents for toxin-induced agitation ‘
benzodiazepines
antipsychotic agents
True or false
 First genera- tion antipsychotics, such as haloperidol have been associated with QT- interval prolongation and cardiac dysrhythmias
True
Patients with core temperatures of ______C (>102.2°F) require aggressive active cooling measures to prevent complications
> 39°
core temperature ______C (<90°F) is an indication for active rewarming
<32°
Several toxidromes associated with hyperthermia are treated with specific pharmaceutical agents:
- sympathomimetic
- serotonin
- neuromuscular malignant syndrome
- benzodiazepines
- cyproheptadine
- bromocriptine
is a nontoxic, diagnostic, and therapeutic antidote. It is a competitive opioid antagonist administered IV, IM, or intranasally to reverse opioid-induced deleterious hypoventilation
Naloxone
Patients should be observed for_________ after adminis- tration of IV naloxone.
2 to 3 hours
True or false
 serum acetaminophen concentration is a routine screening test in poisoned patients because early acetaminophen poisoning is often asymptomatic and does not have a readily identifiable toxidrome at the time when antidotal treatment is most efficacious.
True
Identify the toxidrome
Altered mental status, mydriasis, dry flushed skin, urinary retention, decreased bowel sounds, hyperthermia, dry mucous membranes
Seizures, arrhythmias, rhabdomyolysis
Anticholinergic
Atropine, Datura spp., antihistamines, antipsychotics
Identify the toxidrome
 Salivation, lacrimation, diaphoresis, vomiting, urination, defecation, bronchorrhea, muscle fasciculations, weakness
Miosis/mydriasis, bradycardia, seizures
Cholinergic
Organophosphate and carbamate insecticides Chemical warfare agents (sarin, VX)
Identify the toxidrome
 CNS depression, ataxia, dysarthria, odor of ethanol
Ethanolic
Identify the toxidrome
 Dystonia, torticollis, muscle rigidity Choreoathetosis, hyperreflexia, seizures
Extrapyramidal
Risperidone, haloperidol, phenothiazines
Identify the toxidrome
 Hallucinations, dysphoria, anxiety Nausea, sympathomimetic signs
Hallucinogenic
Phencyclidine
Psilocybin, mescaline Lysergic acid diethylamide
Identify the toxidrome
 Altered mental status, diaphoresis, tachycardia, hypertension Dysarthria, behavioral change, seizures
Hypoglycemic
Sulfonylureas, insulin
Identify the toxidrome
Lead-pipe muscle rigidity, bradyreflexia, hyperpyrexia, altered mental status Autonomic instability, diaphoresis, mutism, incontinence
Neuromuscular malignant
Antipsychotics
Identify the toxidrome
Miosis, respiratory depression, CNS depression Hypothermia, bradycardia
Opioid
Codeine, heroin, morphine
Identify the toxidrome
Altered mental status, respiratory alkalosis, metabolic acidosis, tinnitus, tachypnea, tachycardia, diaphoresis, nausea, vomiting
Hyperpyrexia (low grade)
Salicylate
Aspirin
Oil of wintergreen (methyl salicylate)
Identify the toxidrome
 CNS depression, ataxia, dysarthria Bradycardia, respiratory depression
Sedative/hypnotic
Benzodiazepines Barbiturates
Identify the toxidrome
Altered mental status, hyperreflexia and hypertonia (>lower limbs), clonus, tachycardia, diaphoresis
Hypertension, flushing, tremor
Serotonin
SSRIs
MAOIs
Tricyclic antidepressants Amphetamines Fentanyl
St. John’s wort
Identify the toxidrome
Agitation, tachycardia, hypertension, hyperpyrexia, diaphoresis Seizures, acute coronary syndrome
Sympathomimetic
Amphetamines Cocaine Cathinones
Alkalis produce greater injury than acids due to deep tissue penetration via liquefaction so that prolonged irrigation Of how long may be required?
(1 to 2 hours)
primary indication for urinary alkalinization is
moderate to severe salicylate toxicity when criteria for hemodialysis have not been met.
Admission is indicated if__________________________. In most cases, a ______hour observation period is sufficient to exclude the development of serious toxicity.
the patient has persistent and/or severe toxic effects or will require a prolonged course of treatment
6-hour
