Management of Poisoned Patients

Question 1

1. clinical stabilization
2. clinical eval
3. prevention of further toxicant absorption
4. enhancement of toxicant elimination
5. administration of antidote
6. supporting care, monitor and followup

Answer 1

stepwise approach to poisoned patient

Question 2

ABCDt of managing poisoned patient?

Answer 2

airway, breathing, circulation, drugs, temperature

Question 3

TCAs, phenothiazines, beta blockers, calcium channel blockers, theophylline, and barbiturates can cause?

Answer 3

hypotension

Question 4

amphetamines, cocaine, TCAs, digitalis, and theophylline can cause?

Answer 4

arrhythmias

Question 5

cyanide, hydrogen sulfide, and carbon monoxide can cause?

Answer 5

cell hypoxia

Question 6

beta blockers, calcium channel blockers, clonidine, and sedative hypnotics cause?

Answer 6

hypotension and bradycardia

Question 7

TCAs, phenothiazines, theophylline, beta agonists, and vasodilators cause?

Answer 7

hypotension and tachycardia

Question 8

salicylates, carbon monoxide, and chemicals producing metabolic acidosis or cellular asphyxia cause?

Answer 8

rapid respiration

Question 9

sympathomimetics, anticholinergics, salicylates, uncouplers of oxidative phosphorylation cause (hypothermia/hyperthermia?)

Answer 9

hyperthermia

Question 10

phenothiazines and ethanol cause?

Answer 10

hypothermia

Question 11

opioids, phenothiazines, cholinesterase inhibitors, alpha blockers cause pupil _______

Answer 11

constriction (miosis)

Question 12

amphetamines, cocaine, LSD, anticholinergics, PCP cause pupil _______

Answer 12

dilation (mydriasis)

Question 13

vertical and horizontal nystagmus strongly suggests _______

Answer 13

phenylcyclidine

Question 14

organophosphates, iron, arsenic, theophylline, mushrooms cause ______ bowel sounds

Answer 14

hyperactive

Question 15

GCS score of _____ indicates severe head injury

Answer 15

8 or less

Question 16

-renal failure
-DKA
-lactic acidosis
-drug induced metabolic acidosis (salicylates, methanol, isoniazid, iron)
cause?

Answer 16

elevated anion gap (normal 12)

Question 17

Methanol
Acetone
Ethanol
Diuretics
Isopropanol
Ethylene glycol cause?

Answer 17

osmolar gap (normal 285)

Question 18

treatment for torsades?

Answer 18

magnesium sulfate

Question 19

constellation of clinical symptoms likely assoc’d with exposure to certain tox class of chemicals

Answer 19

toxidrome

Question 20

• increased BP
• increased pulse
• slight increase temp
• mydriasis
• hyperalert, increased reflexes

Answer 20

sympathomimetics

Question 21

• slight increase in BP
• increased pulse and temp
• mydriasis
• decreased bowel sounds
• altered mental status

Answer 21

anticholinergics

Question 22

• slight decrease or no change in BP
• decreased pulse
• miosis
• increased bronchial sounds
• increased bowel sounds
• altered mental status

Answer 22

cholinergic

Question 23

• decreased BP
• decreased pulse
• decreased temp
• miosis
• rales (late)
• decreased bowel sounds
• decreased level of consciousness

Answer 23

opioids

Question 24

-not recommended after 30 min to 4 hours

Answer 24

gastric lavage

Question 25

will adsorb many toxins if given in a slurry immediately before or after lavage

Answer 25

activated charcoal

Question 26

use cholestryamine (resin binding) for ______ toxicity

Answer 26

digoxin

Question 27

• procedure similar to prep for colonoscopy

- oral admin of PEG, removed rectally along with toxicant

Answer 27

whole bowel irrigation

Question 28

-change pH of urinary filtrate, resulting in ionization of weak acid, prevents reabsorption

Answer 28

ion trapping

Question 29

• used for salicylate poisoning
• pH increased using sterile sodium bicarb
• pH from 5 to 8

Answer 29

alkalinization of urine

Question 30

-effective for toxicants with low volume of distribution, low protein binding, high water solubility, low molecular weight

Answer 30

hemodialysis

Question 31

• blood passed through cartdige of adsorptive substane (mostly activated charcoal and cellulose or heparin containing gel)
• can be used for lipid soluble and HMW chemicals
• higher risk of thrombocytopenia
• used for theophylline, amanita poisoning, paraquat

Answer 31

hemoperfusion

Question 32

• patient blood delivered through hollow fiber tubes and plasma ultrafiltrate removed
• fluid and electrolytes replaced
• process continuous

Answer 32

continuous hemofiltration

Question 33

• removal of patient plasma and replacing with donor plasma
• used in NICU
• high molecular weight and plasma protein bound toxicants
• risk of allergic rxn

Answer 33

plasma exchange

Question 34

• repeated doses to improve total body clearance
• help elimination of drugs by removing drugs undergoing enterohepatic circulation
• builds sink for toxicant where chemical enter gut due to concentration gradient

Answer 34

multiple dose activated charcoal (MDAC)

Question 35

fomepizole antidote for?

Answer 35

ethylene glycol

Question 36

hydroxocobalamine antidote for?

Answer 36

cyanide poisioning

Question 37

acidifies urine?

Answer 37

ammonium chloride, increases excretion of weak organic base

Question 38

alkalinizes urine?

Answer 38

sodium bicarb, excretes weak acids

Question 39

chelating agent used for Wilson’s disease, cystinuria, chelates copper

Answer 39

penicillamine