General Tox and toxidromes Flashcards
Why is there a delay in ASA absorption?
Bezoar
When is dilution indicated for toxics?
for pH changes
Local irritant
How can gases cause hypoxia?
Decrease partial pressure of oxygen
When is irrigation of the eyes for 2 hours indicated?
If caustic substance contact. Otherwise shorter timeframe is possible
How soon does an allergic reaction happen to a bee sting?
within 30 minutes
What should be done with venomous bites?
Keep extremity slightly below heart level, and transport. Nothing else.
What is the single most frequently involved substance in poisoning fatalities?
Acetaminophen
What are the 8 drugs that can kill a 10 kg toddler with one pill?
- Antimalarials
- CCBs /BBs
- Colchicine
- Clonidine
- Methyl Salicylates (oil of wintergreen)
- Opioids
- Sulfonylureas
- TCAs
What is the antiarrhythmic of choice for tox overdoses?
Lidocaine
What is the vasopressor of choice for tox patients?
Levophed
When is gastric lavage indicated for the treatment of overdoses?
If very recent overdose
What are the risks of gastric lavage?
Aspiration
GI hemorrhage/perforation
Arrhythmias
Pneumothorax
What are the drugs that are NOT absorbed by activated charcoal? (4)
- Alcohols
- Acids/alkalis
- Hydrocarbons
- Fe and other metals
What are the four major intoxications that call for dialysis?
Methanol
Ethylene glycol
Salicylates
Li
What are the three major indicated for multiple doses of activated charcoal? (3)
ER
Drugs that slow motility
enterohepatic circulation
When is whole bowel irrigation indicated?
Drug packets
Fe tablets
What EkG effect is common with methadone?
QTc prolongation
What must be done after giving a pt naloxone? Why?
Watch them for a few hours, since naloxone has a short half life
What motility agent can cause an opiate overdose in kids?
Lomotil
What is drug classically causes an opiate-like toxidrome?
Clonidine
What is the MOA of clonidine?
Alpha-2 agonist
What is the MOA of guanfacine?
Alpha-2 agonist
What are the components of the DUMBELS mnemonic for muscarinic intoxication?
Diarrhea Urination Miosis Bradycardia/bronchorrhea Emesis Lacrimation Salivation
What are the components of the MTWHFS mnemonic for nicotinic overdose?
Mydriasis Tachycardia Weakness HTN Fasciculations Seizures
What is the antidote for muscarinic intoxication? Nicotinic?
Muscarinic = atropine Nicotinic = 2PAM
What are the symptoms of anticholinergic poisoning?
No see
No spit
No pee
No shit
Hot as a hare…
What is the MOA of scopolamine?
Anticholinergic
Why is a cholinergic never indicated for the treatment of an anticholinergic poisoning?
Arrhythmias
What is the treatment for HTN and tachycardia in a tox pt?
Benzos (not BB since unopposed alpha)
What are the two symptoms that differentiate between anticholinergic poisoning and sympathomimetic poisoning?
Decreased BS in anticholinergic
Sweating in sympathomimetic
What are the components of the OTIS CAMPBELL mnemonic for drugs that cause toxic seizures?
Oragnophosphates TCAs Isoniazid Sympathomimetics camphor, cocaine Amphetamines Methylxanthines PCP Benzo withdrawal EtOH Li Lead
Coma with stable vital signs is classic for which overdose?
benzos
What are the three C’s over TCA overdose?
Coma
Convulsions
Cardiac arrhythmias
Why must all APAPs be stat?
Because “normal” levels will be found in overdoses that don’t present until later, and may qualify for treatment
What are the s/sx of phase 1 of acetaminophen OD, and what is the timeframe?
Nonspecific s/s
0-24 hours
What are the s/sx of phase 2 of acetaminophen OD, and what is the timeframe?
Acute liver injury
24-72 hours
What are the s/sx of phase 3 of acetaminophen OD, and what is the timeframe?
3-4 days
death, ARDS
maximal liver toxicity
What are the s/sx of phase 4 of acetaminophen OD, and what is the timeframe?
Liver regeneration phase, and back to baseline
5 days after
What are the five criteria for d/c a pt with acetaminophen OD?
- APAP non-detectable
- NAC has been administered for 24 hours (minimum)
- Pt is asx
- No lab evidence of organ damage
- Not prego
How much ASA is in a teaspoon of wintergreen?
7000 mg
What causes the fever with ASA intoxication?
Uncoupling of the e- chain
What must be added to bicarb in the treatment of ASA overdose?
K+
How well do ASA levels correlate with s/sx?
Not well
How toxic is a packet of silica gel?
Not very
How toxic is a book of matches in a kid?
Not very
How toxic is the liquid from a green glow stick?
Not very
How toxic if Hg from a thermometer?
Glass is more concerning
