Lecture 27 - Poisoned Patient Approach

Question 1

When Acetaminophen can no longer be processed in the Glutathione pathway, it builds up the intermediate metabolite _____. This is what causes tissue damage. _________ can be given as treatment.

Answer 1

NAPQI

N-acetyl-cysteine (NAC)

Question 2

Diphenhydramine overdose causes _______ toxidrome.

Answer 2

Anticholinergic toxidrome

Question 3

_______ is a lab test used to describe the risk of adverse effects and need for treatment of Acetaminophen overdose. Remember the “Rule of _____.”

Answer 3

Nomogram

“Rule of 150”

Question 4

Urinalysis can be used to detect drugs in a patient’s system, but which Opioids will it not detect?

Answer 4

Synthetic ones, like Fentanyl, not derived from Morphine. Basically, it detects only “natural” Opiates.

Question 5

EKGs are important diagnostic tools for poisoning. ______ prolongation indicates risk for ventricular tachycardia and can be caused by TCAs or quinidine. Long _____ can be caused by antipsychotics and can lead to Torssade de Pointe tachycardia. PR wave abdnormalities can indicate _____ _____ caused by Digoxin or Ca++ channel antagonists.

Answer 5

QRS prolongation

Long QT

Heart Block

Question 6

Radiographs are only useful in certain scenarios like ingestion of _____.

Answer 6

Metal

Question 7

GI decontamination is a means of managing a poisoned patient. Activated ______ is used for this purpose, though it cannot bind metals or alcohols and it must be given shortly after ingestion of the poisoning agent. Gastric emptying and Whole Bowel irrigation are other methods.

Answer 7

Activated Charcoal

Question 8

Once a drug is absorbed, the primary modality for poisoning management is _______. This is useful for _____-soluble drugs with low molecular weight and low protein binding with low volume of distribution. Urinary ______ is also useful –> increased pH of urine filtrate ionizes weak acids (e.g. Salicylates, phenobarbitol).

Answer 8

Hemodialysis

Water-soluble

Alkylation

Question 9

Antidoes are molecules that physically ____ and disable toxicants (i.e. Abs and chelators.)

Answer 9

Bind

Question 10

Remember that _______ care is the most important and initial step in treatment of a poison patient.

Answer 10

Supportive care (reestablishing body/organ system function.)