Overdoses and toxicities Flashcards
within 30 min of ingestion
gastric lavage (up to 2 hours may still be helpful)
altered mental status of unclear etiology in ED
naloxone and glucose in case of opoid OD or DM
antidote for opiates
naloxone
antidote for tylenol and courses of action
charcoal ok
NAC if within 24 hours
blood level if unsure how much taken
iron (radioopaque pills in belly on x-ray)
IV deferoxamine and fluids
pill overdose
charcoal
tinnitus, hyperventilation, resp alkalosis then metab acidosis
aspirin
treat with sodium bicarb to alkalinize urine
tricyclic antidepressant
prolonged QT leading to torsades de pointe
seizures
anticholinergic-dry skin and mucous mem, urinary retention
give SODIUM BICARB to prevent arrythmias
NEVER DO
ipecac/induce vomiting
cathartics (sorbitol) to cause diarrhea
force diuresis
no flumazenil for benzos (causes withdrawal-more deadly)
cholinergic
SLUDGE
ex. organophospahates and nerve gas
tx: atropine, pralidoxime (reactivates Ach-esterase) for insecticides etc
antichoinergic
dry as a bone, red as a beet, mad as a hatter etc
ex: tricyclic antidepressants
CO poisoning
wood stove, fires, car exhaust
normal O2 sat, RED, red blood, dizziness
carboxyhemoglobin holds onto O2 and won’t let go
metabolic (lactic) acidosis
check carboxyhemoglobin level and blood gases
tx: 100% O2 or hyperbaric O2
Methemoglonemia
won’t pick up O2-acidosis
normal O2, brown blood, dizziness
caused by drugs: benzocaine, anesthetics, nitrites, dapsone
tx; 100% O2 and methylene blue
digoxin toxicity
exacerbated by hypokalemia (same binding site-less K+= more digoxin)
symptoms: nausea, vomit, ab pain, causes hyPERkalemia, yellow halos, rhythm disturbance
arrythmia
dx: digoxin level, ekg
digoxin binding antibodies and fix potassium
lead
abdominal pain, ATN, anemia (sideroblastic-Prussian blue), wrist drop, CNS abnormalities
dx: lead level, increased FEP
Tx: chelating-succimer, EDTA, dimercaprol
Mercury
oral-neurological problems-jittery, nervous, hallucinations
inhaled-lung toxicity-fibrosis
tx: chelate with dimercaprol and succimer
Methanol
paint thinner
ocular toxicity due to formaldehyde, osmolar gap and anion gap
tx: fomepizole, dialysis
Ethylene glycol
antifreeze
oxalate
renal toxicity, crystals in urine, hypocalcemia, anion and osmolar gap
tx: fomepizole, dialysis
Dog/cat bite
worry about pasturella
give amoxicillin/clavulanate
tetanus booster if >5 years since last
rabies if stray animal or strange behavior
Human bite
worry about eikenella
give amoxicillin/clavulanate
tetanus booster if >5 years since last
Beta blocker overdose
Bradycardia and hypotension Plus diffuse wheezing
Tx- airway, fluids,atropine, and IV glucagon
