MTB Flashcards
How long after pill ingestion can gastric lavage be attempted
2 hours after ingestion
Toxicities that cause Miosis
Clonidine Barbs Opiates Cholinergics Pontine stroke
Toxicities that cause Mydriasis
Sympathomimetics
Anticholinergics
Toxicity with dry skin
Anticholinergics
Toxicity seen with wet skin
Anticholinergics
Sympathomimetics
Toxicity seen with blisters
Barbituates
CO poisoning
When is gastric lavage dangerous
AMS - Aspiration
Caustic ingestion - burning of esophagus/oropharynx
What percentage of pills are removed with gastric lavage
1 hour = 50%
2 hour = 15%
When do we use Ipecac in the ER
Never
Wrong answers in ER questions
Ipecac
Cathartics
Forced diuresis = almost always wrong
Whole bowel irrigation - almost always wrong
When do we do whole bowel irrigation and what do we use
Polyethylene glycol-electrolyte solution
Massive Iron ingestion
Lithium
Swallowing drug filled packets
When answer is not clear and cause of OD is asked, answer
- Acetaminophen
- ASA
MCC death by OD
Best initial management in pt with AMS and toxicity
Opiate antagonist - naloxone
Glucose
Presentation of acute benzo withdrawl
Seizures
CI in benzo withdrawl
Flumazenil
When do we give charcoal
MOA
Route of admin
Can be given to anyone w pill OD - benign
Blocks absorption of poisons
Given thru NG tube
What amount of acetaminophen causes toxicity
Fatality?
8-10 grams
Fatality if greater than 12-15 grams
Next step in management if a clearly toxic amount of acetaminophen has been ingested
N-Acetylcysteine
Next step in management if a clearly toxic amount of acetaminophen has been ingested and it is over 24 hours
Nothing
Next step in management if amount of acetaminophen that has been ingested is unclear
Get drug level
Does charcoal make N-acetylcysteine ineffective
No
Does alcohol increase or decrease amount of acetaminophen needed to cause toxicity
Decreases amount
ASA Overdose Presentation
Tinnitus Hyperventilation Resp Alkalosis progressing to Metabolic Acidosis Increased Anion gap Renal toxicity AMS
ASA effect on coagulation
Increases PT
TX for ASA toxicity
Alkalinize the urine to increase rate of excretion
Blood gas in ASA toxicity
Varies depending on time
Benzos and TCA effect taken together
Benzos can prevent seizures from TCA toxicity
TCA toxicity finding on EKG
Widening of QRS complex
TCA Toxicity Presentation
Seizures
Arrhythmia
Dry mouth, Constipation, Urinary retention
TX for TCA Toxicity
Sodium Bicarbonate
Bicarb protects the heart
Caustic ingestion damages what
Mechanical damage to oropharynx, esophagus, stomach
Perforation
Management for Caustic ingestion
Flush out w high volume water
Endoscopy to assess degree of damage
Management for Caustic ingestion
- ABC
- Remove contaminated clothing and irrigate exposed skin, Flush out w high volume water
- Endoscopy to assess degree of damage
MCC of death in fires
CO poisoning
Management for Caustic ingestion Perforation
- ABC
- Remove contaminated clothing and irrigate exposed skin, Flush out w high volume water
- CXR if Respiratory Sx’s
- Endoscopy to assess degree of damage within 24 hrs
CO poisoning HX
Gas heaters
Wood-burning stoves
Automobile exhaust
ABG in CO Poisoning
Causes lactic acidosis
pH Low
pCO2 Low
HCO3 Low
Most accurate DX test for CO Poisoning
Carboxyhemoglobin Level
Best initial TX for CO Poisoning
Remove pt from exposure
Give 100% Oxygen
Hyperbaric oxygen if severe
Severe Sx’s of CO Poisoning
CNS Sx’s
Cardiac Sx’s
Metabolic Acidosis
What causes methemoglobinemia
Benzocaine + other anesthetics
Nitrites + Nitroglycerin
Dapsone
Presentation of methemoglobinemia
Dypsnea Cyanosis HA, confusion, seizures Metabolic Acidosis (SAme as CO poisoning)
Difference b/t methemoglobinemia and CO poisoning
CO: Blood is RED
Meth: Blood is BROWN
What is pCO2 in methemoglobinemia
Normal
Most accurate test for methemoglobinemia
Methemoglobin level
Best initial TX for methemoglobinemia
100% oxygen
Most effective TX for methemoglobinemia
Methylene Blue
Cyanosis + Normal pO2
methemoglobinemia
Presentation of Organophosphate poisoning
Salivation Lacrimation Polyuria Diarrhea Bronchospasm, bronchorrhea, Resp arrest
Management of Organophosphate poisoning
- Atropine
- Remove clothing, wash patient
- Pralidoxamine = reactivates acetylcholinesterase
MOA Atropine
Blocks effects of acetylcholine that is already in body
Dries up respiratory secretions
Indications for Dialysis
Renal Failure CHF ARDS Persistent CNS sx's Hemodynamic Instability Severe acid/base or electrolyte imbalance Hepatic Failure w coagulopathy Salicylate level > 100 mg/dL
