Management of poisoned pts Flashcards
Managing poisoned pts
always treat the symptoms!
Airway- cleared of vomitus or obstruction
Breathing- observation, measurement of arterial gases, pulseoximetry
Circulation- pulse rate, bp, urinary output, draw blood for glucose and other labs
Drugs- dextrose (every pt with altered mental status), 100 mg of thiamine to alcoholic pts, naloxone, fluazenil for benzo overdose, lorazepam or diazepam for seizure control
Temperature- tepid sponge bath and fan
hypertension and tachycardia
amphetamines
cocaine
antimuscarinics
drugs that cause cardiac arrythmias
amphetamines cocaine tcas digitalis theophylline
drug that causes lung damage
paraquat
Glasgow coma scale
15 points
can be used to classify head injury
severe: 8 pts or less
Electrolyte analysis
Anion gap= [Na+]-([HCO3]+[Cl-])
Normal 12 +- 2
Elevated by- renal failure, DKA, shock induced lactic acidosis, drugs- salicylates, methanol, ethylene glycol, isoniazid, iron, metformin
DDx of elevated anion gap with metabolic acidosis
AT MUD PILES
Alcohol
Toluene
Methanol
Uremia
DKA
Paraldehyde Iron, Isoniazid Lactic acid Ethylene glycol Salicylates
Osmolar gap
Solvents
Normal is 285 mOSmol/Kg
MAE DIE:
Methanol, acetone, ethanol, diuretics, isopropanol, ethylene glycol
EKG
widening of QRS complex from tricylics and quinidines
Torsades de pointes
prolonged QT interval followed by vtach and QRS that spirals around isoelectric line
caused by: quinidines, tcas, antipsychotics, nonsedating antihistamines, cisapride, fluoroquinolones, hypokalemia, hypomagnesemia, bradycardia, ischemia, etc.
Torsades de pointes
prolonged QT interval followed by vtach and QRS that spirals around isoelectric line
caused by: quinidines, tcas, antipsychotics, nonsedating antihistamines, cisapride, fluoroquinolones, hypokalemia, hypomagnesemia, bradycardia, ischemia, etc.
treatment for torsades
magnesium sulfate
sympathomimetic toxidrome
inc bp inc pulse slight inc temp mydriasis hyperalert, inc reflexes
anticholinergic toxidrome
slight inc or no change in bp incr pulse incr temp mydriasis decr bowel sounds altered mental status
cholinergic toxidrome
decr pulse miosis incr bronchial sounds incr bowel sounds altered mental sounds
opioid toxidrome
decr bp decr pulse decr temp miosis rales in lungs (late) decr bowel sounds decr level of consciousness
removal and enhanced elimination
gastric lavage (not recommended after 30 minutes if empty stomach or 4 hours if full stomach)
induce emesis (same as above)
activated charcoal will inactivate and adsorb toxins
cholestyramine used for
digoxin
ion trapping
change pH of urinary filtrate resulting in ionization of weak acids, trapping them in filtrate and preventing reabsorption
classically used for salicylate poisoning
pH increased using sterile sodium bicarbonate
(acidifying urine has major side effects)
hemodialysis
blood dialysis remove toxicant
effective for toxicants with low protein binding, high water solubility, low molecular weight
hemoperfusion
blood passed through cartridge of adsorptive substance (Active charcoal)
can be used for lipid soluble and high molecular weight chemicals
theophylline, paraquat poisoning
continuous hemofiltration
plasma ultrafiltrate removed
fluids and electrolytes replaced
continuous and helps remove toxic chemical from non vascular tissue compartment to vasculature
plasma exchange
removal of pt plasma and replacing with donor plasma
mainly for neonatal icu
hmw and plasma protein bound toxicants
multiple dose activated charcoal
repeated doses of activated charcoal
for those drugs undergoing entero-enteric or enter-hepatic circulation
antidote for cyanide
hydroxocobalamine
atropine for
organophosphates and nerve gas type agents
digoxin overdose
fab fragments
ipecac syrup
oral emetic
