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IC Part 2 > Management of poisoned pts > Flashcards

Management of poisoned pts Flashcards

1
Q

Managing poisoned pts

A

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

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2
Q

hypertension and tachycardia

A

amphetamines
cocaine
antimuscarinics

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3
Q

drugs that cause cardiac arrythmias

A 
amphetamines
cocaine
tcas
digitalis
theophylline
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4
Q

drug that causes lung damage

A

paraquat

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5
Q

Glasgow coma scale

A

15 points
can be used to classify head injury
severe: 8 pts or less

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6
Q

Electrolyte analysis

A

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

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7
Q

DDx of elevated anion gap with metabolic acidosis

A

AT MUD PILES
Alcohol
Toluene

Methanol
Uremia
DKA

Paraldehyde
Iron, Isoniazid
Lactic acid
Ethylene glycol
Salicylates
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8
Q

Osmolar gap

A

Solvents
Normal is 285 mOSmol/Kg

MAE DIE:
Methanol, acetone, ethanol, diuretics, isopropanol, ethylene glycol

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9
Q

EKG

A

widening of QRS complex from tricylics and quinidines

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10
Q

Torsades de pointes

A

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.

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11
Q

Torsades de pointes

A

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.

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12
Q

treatment for torsades

A

magnesium sulfate

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13
Q

sympathomimetic toxidrome

A 
inc bp 
inc pulse
slight inc temp 
mydriasis 
hyperalert, inc reflexes
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14
Q

anticholinergic toxidrome

A 
slight inc or no change in bp 
incr pulse
incr temp 
mydriasis 
decr bowel sounds
altered mental status
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15
Q

cholinergic toxidrome

A 
decr pulse
miosis
incr bronchial sounds
incr bowel sounds
altered mental sounds
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16
Q

opioid toxidrome

A 
decr bp 
decr pulse 
decr temp 
miosis
rales in lungs (late) 
decr bowel sounds
decr level of consciousness
17
Q

removal and enhanced elimination

A

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

18
Q

cholestyramine used for

A

digoxin

19
Q

ion trapping

A

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)

20
Q

hemodialysis

A

blood dialysis remove toxicant

effective for toxicants with low protein binding, high water solubility, low molecular weight

21
Q

hemoperfusion

A

blood passed through cartridge of adsorptive substance (Active charcoal)
can be used for lipid soluble and high molecular weight chemicals

theophylline, paraquat poisoning

22
Q

continuous hemofiltration

A

plasma ultrafiltrate removed
fluids and electrolytes replaced
continuous and helps remove toxic chemical from non vascular tissue compartment to vasculature

23
Q

plasma exchange

A

removal of pt plasma and replacing with donor plasma
mainly for neonatal icu
hmw and plasma protein bound toxicants

24
Q

multiple dose activated charcoal

A

repeated doses of activated charcoal

for those drugs undergoing entero-enteric or enter-hepatic circulation

25
Q

antidote for cyanide

A

hydroxocobalamine

26
Q

atropine for

A

organophosphates and nerve gas type agents

27
Q

digoxin overdose

A

fab fragments

28
Q

ipecac syrup

A

oral emetic

IC Part 2 (27 decks)

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