Overdose Flashcards

1
Q

Paracetamol OD Mx

A

<1h –> activated charcoal
NAC if staggered OD, time of ingestion unclear, plasma levels within treatment threshold (at/over line connecting 100mg/L at 4h and 15mg/L at 15h)
NAC is infused over 1 hour

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2
Q

TCA OD Mx

A

IV bicarbonate

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3
Q

What are the ECG signs of a TCA overdose?

A

Sinus tachycardia
Widening of QRS complex
QT prolongation

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4
Q

What type of alkalosis/acidosis do you get in TCA overdose?

A

Metabolic acidosis

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5
Q

What are the early features of TCA OD?

A

Dry mouth, blurred vision, NV, dilated pupils, agitation, sinus tachycardia

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6
Q

What are the severe features of TCA OD?

A

Arrhythmias, seizure, coma

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7
Q

Salicyclate OD Mx

A

IV bicarbonate, haemodialysis

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8
Q

What kind of acidosis/alkalosis do you get in salicyclate OD?

A

Mixed respiratory alkalosis and metabolic acidosis

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9
Q

What are the features of salicyclate OD?

A

Tinnitus, hyperventilation, lethargy, sweating, NV, hypo/hyperglycaemia, seizures, coma

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10
Q

Beta blocker OD Mx

A

Atropine if bradycardic

Glucagon for resistant cases

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11
Q

Opiate OD Mx

A

Naloxone

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12
Q

Benzo OD Mx

A

Flumazenil (only if iatrogenic)

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13
Q

Lithium OD Mx

A

Mild-mod: normal saline

Severe: haemodialysis

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14
Q

Warfarin OD Mx

A

Vit K, prothrombin complex concentrate

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15
Q

Heparin OD Mx

A

Protamine sulphate

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16
Q

Ethylene glycol poisoning Mx

A

Fomepizole

17
Q

Methanol poisoning Mx

A

Fomepizole, ethanol, haemodialysis

18
Q

Digoxin OD Mx

A

Digoxin specific binding antibody

19
Q

Iron OD Mx

A

Desferroxamine

20
Q

Lead poisoning Mx

A

Dimercaprol

21
Q

CO poisoning Mx

A

100% oxygen, hyperbaric oxygen

22
Q

Cyanide

A

Hydroxocobalamin

23
Q

How does warfarin work?

A

It prevents vitamin K being activated, activated vitamin K is a cofactor for clotting factors 2, 7, 9 and 10

24
Q

When is warfarin indicated?

A

VTE (target 2.5, 3.5 if recurrent)
AF (target 2.5)
Mechanical heart valve

25
Q

What are SEs of warfarin?

A

Purple toes
Haemorrhage
Skin necrosis
Teratogenic

26
Q

What is the management of patient on warfarin with major bleed?

A

Stop warfarin
5mg vit K IV
Prothrombin complex concentrate

27
Q

What is the management of a patient with INR >8, minor bleeding?

A

Stop warfarin
1-3mg vit K IV
Repeat dose if still too high after 24 hours, restart warfarin when INR <5

28
Q

What is the management of a patient with INR >8 with no bleeding?

A

Stop warfarin
1-5mg vit K PO
Repeat dose if INR still too high after 24 hours, restart warfarin when INR <5

29
Q

What is the management of patient with INR 5-8 with minor bleeding?

A

Stop warfarin

1-3mg vit K IV, restart warfarin when INR <5

30
Q

What is the management of patient with INR 5-8 with no bleeding?

A

Withhold 1-2 doses of warfarin and reduce subsequent maintenance dose of warfarin

31
Q

Is warfarin safe in breastfeeding?

A

Yes