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Emergency Medicine > Overdose and poisoning > Flashcards

Overdose and poisoning Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Toxic substances have?

A

Dose dependent toxic potentials

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2
Q

When are serum levels important with regards to drugs?

A

Acetaminophen or aspirin overdose

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3
Q

What is the first step to overdose and poisoning treatment?

A

A -B - C

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4
Q

What is administered for altered mental status, or coma with regards to overdose?

A
  • Naloxone
  • Glucose
  • Thiamine
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5
Q

How is hypotension first treated?

A

Fluid bolus

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6
Q

What is the duration of naloxone?

A

30-60 min

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7
Q

First line tx for seizures?

A

Benzos

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8
Q

Gi decontamination methods?

A

Activated charcoal within first hour

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9
Q

Dispo for overdose?

A

MEDADVICE/MEDEVAC - consult with MO and poison control

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10
Q

What is toxidrome with regards to anticholinergics?

A

Group of symptoms

* Dry as a bone, red as a beet, hot as a hare, blind as a bat, mad as a hatter and stuffed as a pipe

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11
Q

What causes anticholinergic overdose?

A

Antihistamines (primarily diphenhydramine)

phenothiazines, muscle relaxers, antidepressants, and Jimson weed

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12
Q

So what are the common symptoms of anticholinergics?

A

Inhibition of PNS:

(a) Absent bowel sounds, mydriasis, hyperthermia, dry skin/mucus membranes, urinary retention, confusion/agitation, tachycardia, flushed skin

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13
Q

Tx for anticholinergic toxidrome?

A

Monitor, IV, O2

  • Activated charcoal
  • Benzos for seizures or acute agitation
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14
Q

Dispo for anticholinergic toxidrome?

A

MEDADVICE/MEDEVAC

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15
Q

SSRI overdose most adverse effect?

A

serotonin syndrome

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16
Q

Does SSRI have a high therapeutic to toxic ratio?

A

Yes, you can take a lot safely

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17
Q

Side effects of SSRI overdose?

A

headache, sedation, insomnia, dizziness,
nausea and vomiting, fatigue, tremor, nervousness, diarrhea and
anorexia

  • Not typically life threatening
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18
Q

Tx for SSRI overdose?

A

Supportive care

MEDADVICE/MEDEVAC

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19
Q

Serotonin syndrome?

A
  • Potentially fatal
  • Cognitive and behavioral - confusion
  • Autonomic - hyperthermia
  • Neuromuscular - myoclonus**
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20
Q

Tx for serotonin syndrome?

A

(a) D/C all serotoninergic agents and provide supportive care
(b) MEDEVAC to closest Emergency Department or facility with a higher level of care as this is a potentially fatal conditions that requires a higher level of care
(c) Monitor all patients with muscle rigidity, seizures or hyperthermia for rhabdomyolysis
(d) For muscle rigidity or seizures administer benzodiazepines

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21
Q

What are considered sedatives and hypnotics?

A

barbiturates and benzodiazepines

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22
Q

What do these sedatives and hypnotic do?

A

depress CNS activity

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23
Q

What is the most common sign of overdose of sedatives and hypnotic drugs?

A

Respiratory depression

  • dizziness
  • slurred speech
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24
Q

Tx for sedative and hypnotic drug overdose?

A
  • ABCs
  • Activated charcoal
  • Poison control and MEDEVAC
25
Q

What is the most frequent ingested intoxicant?

A

Ehtanol

26
Q

What does ethanol overdose cause

A

CNS and respiratory depression

27
Q

What should also be evaluated for altered mental status?

A

Glucose levels

28
Q

Tx for ethanol overdose?

A

Monitor and wait for them to sober up

29
Q

What is the Mu receptor responsible for?

A

analgesia, sedation, respiratory depression

and cough suppression

30
Q

What do opioids work on?

A

CNS, PNS and GI tract

31
Q

What are the 3 primary receptors opioids work on?

A

Mu, Kappa, Delta

32
Q

Symptoms of opioids use

A

Miosis
Brady
Hypothermia
Resp arrest

33
Q

Tx for opioids?

A

Activated charcoal <1 hour
Naloxone

Consider MEDEVAC

34
Q

Sympathomimetic drugs?

A

Cocaine, amphetamines, stimulants

35
Q

Difference between sympathomimetics and anticholinergics?

A

Sympath - still sweat and there is a pupillary response

Anticholinergics - not angry, dry skin, no pupillary response

36
Q

Sxs of sympath overdose?

A

(a) May demonstrate psychomotor agitation
(b) Mydriasis
(c) Diaphoresis
(d) Tachycardia
(e) Tachypnea
(f) Hypertension
(g) Hyperthermia
(h) AMS
(i) Watch for seizures and rhabdo
(j) May have chest pain, headache, dyspnea or focal neuro complaints
(k) Cocaine even at low doses can produce coronary vasoconstriction leading to chest pain (exacerbated by cigarette smoking)

37
Q

Tx for sympath overdose?

A 
ABCs
ECG
Benzos for tachy, hypertension, agitation
Active cooling
ASA, Nitro for chest pain

** DO NOT GIVE BETA BLOCKERS ***

38
Q

What is contraindicated for cocaine use?

A

Beta blockers

39
Q

salicylates?

A

aspirin

40
Q

When are peak hours of asa?

A

6 hours

41
Q

1) 150mg/kg - mild - N/V GI irritation
2) 150-300mg/kg moderate - vomiting, tachypnea, tinnitus, sweating
3) > 300mg/kg – severe

A

Acid base levels

42
Q

Symptoms of salicylate overdose?

A

1) Tachypnea
2) Tinnitus
3) N/V
4) Acid base abnormalities
5) AMS
6) Pulmonary edema
7) Arrhythmia
8) Hypovolemia
9) Thrombocytopenia
10) Hepatic effects

43
Q

Tx for asa overdose?

A

1) Emergent priorities Airway, breathing, Circulation, Cardiac monitoring, IV access
2) Administer activated charcoal 1gm/kg to minimize absorption
3) IV fluids (NS/LR) for volume depletion
4) Check glucose and administer supplemental glucose if low
(maintain above 80)
5) If available on specific platform administer Sodium Bicarbonate
1- 2mEq/kg and arrange for MEDEVAC. This causes alkalization of urine and increase Salicylate elimination.
6) Discuss with higher echelon/SMO for specific treatment regimen.
7) Maintain continuous cardiac monitoring
8) Patients may ultimately require hemodialysis therefore prompt discussion with higher echelon of care is essential

44
Q

What is most popular OTC overdose?

A

acetaminophen

45
Q

Mortality rate for Tylenol if liver failure is related?

A

> 28%

46
Q

Stage 1 Tylenol?

A

first 24 hours - nonspecific. N/V, malaise, anorexia

47
Q

Stage 2 Tylenol?

A

day 2-3 - N/V may improve and evidence of toxicity may develop. RUQ pain, elevated bilirubin/jaundice

48
Q

Stage 3 Tylenol?

A

day 3-4 - progression to hepatic failure. Lactic acidosis, coagulopathy, renal failure, encephalopathy, N/V

49
Q

Stage 4 Tylenol?

A

Congrats you survived Stage 3 Tylenol overdose

those who survive will begin to recover

50
Q

Toxicity of Tylenol may occur with what amount?

A

> 140mg/kg or > 7.5 gm over 24 hours.

51
Q

When to draw labs for Tylenol?

A

4 hours

52
Q

Tx for Tylenol overdose?

A

ABCs

NAC - specific antidote for Tylenol overdose - give within 8 hours

53
Q

What’s a good indicator for Tylenol overdose?

A

LFTs

54
Q

Dosing of NAC?

A

IV, 150mg/kg loading dose, followed by 50mg/kg over the next 4 hours, then 100mg/kg over next 16 hours. Ideally initiate loading dose and medevac to higher echelon under consultation with poison control and MO.

55
Q

Organophosphates/insecticides (Cholinergic toxidrome) and nerve agents do what?

A

bind irreversibly to and inhibit cholinesterases in the nervous system and skeletal muscle.

56
Q

What does the term “aging” refer to?

A

irreversible binding of compound to the cholinesterase. Antidotes are ineffective once this occurs.

57
Q

Clinical features of Insecticides (malathion, parathion); Nerve agents (VX, sarin)?

A 
SLUDGE
S - salivation
L - lacrimation
U - urinary incontinence
D - defectation
G - GI pain
E - emesis
58
Q

Symptoms of Insecticides (malathion, parathion); Nerve agents (VX, sarin)?

A

bronchorrhea, miosis, muscle spasms/fasciculation’s, bradycardia, weakness.

59
Q

Tx for Insecticides (malathion, parathion); Nerve agents (VX, sarin)?

A

(a) Decontamination
1) PPE
2) Wash patient with soap/water
3) Handle and dispose of run off
4) Handle and dispose of hazardous waste
(b) Monitoring
1) Cardiac monitor, pulse ox, supplemental O2
(c) No benefit to gastric lavage, AC, urinary alkalinazation
(d) Atropine** 1mg in adult. Repeat Q 5 min until respiratory secretions improve
1) MOA- competes with Ach at receptors preventing cholinergic activation
(e) Pralidoxime -2-PAM. Should NOT be administered without concurrent Atropine. Treats neuromuscular dysfunction.

Emergency Medicine (13 decks)

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