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Emergency & Acute > Overdose > Flashcards

Overdose Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What resource is good to look up management of OD?

A

TOXBASE

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2
Q

Paracetamol OD causes the build up of what toxic metabolite?

A

NAPQI

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3
Q

Define a staggered OD

A

OD taken over >1 hour

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4
Q

What amount of paracetamol = significant toxicity?

A

> 150 mg/kg

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5
Q

Give 2 factors increasing the risk of liver damage in paracetamol OD

A

Malnutrition and alcohol (previous damage)

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6
Q

How may paracetamol OD present (<24 hours)

A

Nausea, vomiting, sweating

abdo pain?

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7
Q

What are the late signs of paracetamol OD? (i.e. if untreated)

A

Liver failure!!

Jaundice, confusion, coagulopathy, hypoglycaemia

After 3-5 days

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8
Q

When should you measure plasma levels of paracetamol

A

After 4 hours

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9
Q

If someone presents <1 hour post-paracetamol OD, what can you give them?

A

Activated charcoal 1g/kg

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10
Q

What do you give for paracetamol OD as soon as you get the 4 hour reading back?

A

NAC (N-acetylcysteine)

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11
Q

When is NAC most effective?

A

<8 hours

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12
Q

How is NAC given?

A

24 hour infusion

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13
Q

How does NAC work?

A

Increases the amount of glutathoine so NAPQI can be broken down

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14
Q

Do you still give NAC if paracetamol OD presents late?

A

YES!!

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15
Q

Someone presents 8-24 hours post-paracetamol OD - what do you give them?

A

NAC straight away!

If the amount is >150mg/kg, even before the serum conc comes back

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16
Q

How do you manage a staggered OD?

A

Give NAC immediately if amount >150 mg/kg - serum levels not reliable in this context

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17
Q

What triclyclic is most likely to cause lethal intoxication?

A

1st generation (e.g. amitriptyline)

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18
Q

What are the anti-cholinergic features of tricyclic OD?

these present early

A 
Dry mouth
Dilated pupils
Tachycardia
Urinary retention
Myoclonic jerks
Blurred vision
Hypotension
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19
Q

Is the response in tricyclic OD sympatetic or parasympathetic?

A

SYMPATHETIC response because it blocks parasympathetic

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20
Q

What are the effects of blocking sodium channels in tricyclic OD?

A

Cardiac arrhythmias + seizures

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21
Q

What are the features of severe tricyclic OD?

A

coma, respiratory depression, hypoxia, metabolic acidosis

22
Q

What amount of tricyclic can cause death?

A

1000mg

23
Q

ECG changes in tricyclic OD

A 
Broad QRS (seen before ventricular arrhythmias occur)
Tachycardia
Torsardes de pointes
24
Q

What would an ABG indicate in tricyclic OD?

A

metabolic acidosis

25
Q

What is the general approach to any OD?

A

ABCDE!

26
Q

What is the initial management of tricyclic OD if there are ECG changes?

A

IV sodium bicarbonate!!

for prolonged QRS

27
Q

What would you do if someone presents <1 hour of tricyclic OD with NO ECG changes?

A

Gastric lavage/ activated charcoal (50g)

N.B. Always give the bicarb first if there are ECG changes

28
Q

How would you treat seizures in tricyclic OD?

A

IV benzos

e.g. 5-10mg diazepam

29
Q

If arrhythmias persist after giving bicarb, what else can be given?

A

lidocaine

30
Q

Give 2 examples of amphetamines

A

MDMA

Speed

31
Q

How does amphetamine OD present? (sympathomimetic)

A

Dilated pupils
Hyperthermia
Hypertension
Hyperthermia

32
Q

How does amphetamine OD present? (central effects)

A

Agitation
Paranoia
Seizures

33
Q

Give complications of amphetamine OD

A

intracranial haemorrhage
Vasospasm
DIC
AKI

34
Q

What is creatinine kinase a sign of in tricyclic/ amphetamine OD?

A

Rhabdomyolysis

35
Q

What body temperature is a poor progostic factor in amphetamine OD?

A

Hyperpyerxia >42

36
Q

What would you give to control seizures/ agitation in amphetamine OD?

A

5-10mg diazepam or 1-2mg lorazepam

37
Q

In amphetamine OD what would you give if someone is psychotic?

A

Haloperidol

38
Q

In amphetamine OD, if indicated how would you manage temperature control?

A

Cool with sponge /chilled IV fluids

Chlorpromazine: can help lower temp, may lead to hypotension + sedation

39
Q

How may somoene with opiate OD present?

A 
Pinpoint pupils
Reduced RR
Drowsiness
Cyanosis
Coma
40
Q

What common feature of opiate OD can cause AKI?

A

Rhabdomyolysis

41
Q

What is the drug for opiate OD?

A

NALOXONE (opiate antagonist)

42
Q

how is naloxone given?

A

0.4mg at 2-3 minute intervals until the patient is rousable + resp distress is corrected

43
Q

Why are repeat injections of naloxone required?

A

It has a shorter half life than opioids (can be given as IV infusion)

44
Q

What problem may occur if giving naloxone to someone who is opiate-dependant?

How would you manage this?

A

Could precipitate an acute withdrawal reaction
(avoid giving enough to completely reverse opiate effects)

Diazepam

45
Q

How may salicylate OD present? (ears!)

A

Tinitus

46
Q

If someone presents within 1 hour of salicylate OD, what can be given?

A

Charcoal

47
Q

What can be given in salicylate OD?

A

Sodium bicarb

48
Q

What is the treatment of choice in severe salicylate poisoning?

A

Haemodialysis

49
Q

What is the reversal agent for benzodiazepine (e.g. diazepam) OD?

A

Flumazenil

50
Q

Why shouldn’t flumazenil be given if benzo OD is mixed with tricyclics?

A

Flumazenil lowers the seizure threshold

51
Q

What is the king’s college criteria for liver transplant?

A 
FOR PARACETAMOL OVERDOSE!!
Arterial pH <7.3 after 24 hours
OR all 3 of:
PT >100
Creatinine >300
Encephalopathy

Emergency & Acute (21 decks)

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