Intoxications Flashcards
Can you treat acute cocaine toxicity (presenting with chest pain) with selective b-blockers?
NO!!
Contraindicated
What is a differentiating presentation in PCP toxicity?
Nystagmus
How do you differentiate sympathomimetic (cocaine, crystal meth) vs anticholingeric toxicity (amitriptyline)?
Sympathomimetic: WET
Anticholinergic: DRY
What ECG findings present with amitriptyline tox?
QT prolongation
What is the drug of choice for any drug induced psychosis?
Benzos
What is the drug of choice for any drug induced psychosis?
Benzos, benzos, benzos
What do you do if you give so much benzo that your patient becomes resp depressed?
Intubate
What are the stages of alcohol withdrawal?
stage 1 (onset 12-18 h afer last drink): “the shakes” tremor, sweating, agitation, anorexia,cramps, diarrhea, sleep disturbance
stage 2 (onset 7-48 h): alcohol withdrawal seizures, usually tonic-clonic, non-focal and brief
stage 3 (onset 48 h): visual, auditory, olfactory or tactile hallucinationsMake sure to ask about other alcohols: mouthwash, rubbing alcohol, methanol, ethylene glycol, aftershave
stage 4 (onset 3-5 d): delirium tremens, confusion, delusions, hallucinations, agitation,
What stage do DTs present?
Stage 4 (3-5 days)
When can benzos be used in delirium?
ONLY in alcohol related delirium
*otherwise will make delirium worse
Approach to acute intoxication with opioids:
ABC
Glucose IV
Naloxone 0.4mg up to 2mg IV for dx
+/-Intubation + mech vent
What is the half life of naloxone?
SHORT
< 1 hr
Pt presents with conjunctival injection
Cannabis
In Korsakoff’s syndrome, the most likely abnormality on mental status testing is
Impaired short-term recall
What drug is most effectively ameliorates the symptoms of heroin withdrawal?
Methadone
