Managing Poisened Patients Flashcards
1
Q
Important parts of the history in a poisoned patient
A
- What did they take, how much and when?
2. Why did they take it
2
Q
Cause of miosis (small pupils)
A
Opiates
3
Q
Cause of mydriasis (large pupils)
A
Sympathomimmetics and anticholinergics (e.g. ecstasy, amphetamines)
4
Q
Potential cause of jaundice in OD patient
A
paracetamol OD / alcholic liver disease
5
Q
Things to look for on examination of someone who has OD
A
- pupil size, conjunctival haemorrhage, jaundice
- self harm, track marks
- extensive bruising from long lie (risk of rhabdomyolysis)
6
Q
Rhabdomyolysis
A
- hypoxic skeletal muscle damage –> release of muscle cell contents: creatine kinase, myoglobin and K+
7
Q
Effects/complications of rhabdomyolysis
A
- hyperkalaemia
- myoglobin precipitation in kidney –> renal failure
- coca-cola urine due to myoglobin
8
Q
Investigations in OD patient
A
- urine toxicology, specific drug assays
- imaging
- 02 sats, temp, ECG/cardiac monitor
- Bloods: U&E, creatine kinase, creatinine, LFT’s, clotting
9
Q
Diagnostic feature cluster for opiate OD
A
- coma
- miosis
- reduced respiratory rate
10
Q
Diagnostic feature cluster for stimulant OD
A
- agitation and delirium
- mydriasis
- hyperthermia
- tachycardia and arrhythmias
11
Q
Diagnostic feature cluster for salicylates
A
- n&v
- tinnitus and deafness
- sweating and hyperventilation
- metabolic acidosis
12
Q
Diagnostic feature cluster for anticholinergics including TCA’s
A
coma, hypertonia, mydriasis, tachycardia
13
Q
Managment methods of OD
A
- symptomatic and supportive measures
- Reducing absorption
- Enhancing elimination
- specific antidotes
14
Q
Methods to reduce absorption of drug after OD
A
- gastric lavage
- single dose activated charcoal
- whole bowel irrigation
15
Q
Gastric lavage
A
- rarely used
- pump stomach with water via NG tube to reduce absorption of drug
- has to be done within an hour
