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Nayla clinical disciplines > Overdoses part 1 > Flashcards

Overdoses part 1 Flashcards

1
Q

What is a Dystonic reaction

A

idiosyncratic reaction NOT dose dependent 2/2 Phenothiazines (phenergan, compazine), Butyrophenones (haldol), and Reglan
–Sudden onset abnormal head, neck, and jaw posture
Spastic contracture of lips, tongue, face, throat
Trismus, torticollis, tongue protrusion
Oculogyric crisis (cant move eyes vertically

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2
Q

What are Sx of a dystonic reaction

A

hypotension, decerased LOC, miosis, seizure, coma, urinary retention

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3
Q

What are effects of an APAP OD

A

Centrolobular necrosis
Irreversible hepatic necrosis if pH <7.3, bili>4, Cr>3.4, or encephalopathy
-0-24: n/v, pallor, diaphoresis
-24-48: RUQ pain, high LFT
-72-96: LFT peak, coagulopathy, encephalopathy
-4-14d: recover or die

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4
Q

How do you treat APAP OD

A

N-acetyl cysteine w/in 8 hours (reduce NAPQI back to APAP)
can give PO or IV (smells like rotten eggs)
+/- reglan for nausea

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5
Q

How do you tract APAP OD

A

Rumack-Matthew Nomogram (s/p 4 hours after SINGLE ingestion)

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6
Q

What are effects of an ASA OD

A 
Vomiting 
GGI bleed
Hypotension
Prolonged PT
Agitation
Lethargy
Tachypnea
Leukocytosis 
**Metabolic Acidosis + Respiratory Alkalosis**
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7
Q

How do you treat an ASA OD

A

Gastric lavage
Multi-dose charcoal q4hr
NS at 2-3x maintenance
NaHCO3 bolus + KCl D5W

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8
Q

When would you need to dialyze an ASA OD patient

A 
Renal failure 
CNS toxicity
Worsening 
Hypokalemia (cant make urine alkaline) 
Serum ASA >100mg
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9
Q

How can you track ASA OD

A

Done Nomogram for single ingestion (NOT liquid, chronic, or enteric coated)

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10
Q

What are anticonvulsants we studied

A

Phenytoid
Carbamazepine
Barbituates
Valporate

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11
Q

What are effects of Phenytoin OD

A 
*Horizontal Nystagmus 
slurred speech
ataxia
hallucinations
hyperreflexia
seizure
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12
Q

How do you treat Phenytoin OD

A 
Supportive 
MDAC (multi dose activated charcoal)
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13
Q

How should you never administer phenytoin

A

IM or with dextrose

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14
Q

What are effects of Carbamazepine OD

A

Anticholinergic
wide QRS
long PR/QT, bradycardya

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15
Q

How do you treat Carbamazepine OD

A

Supportive

MDAC

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16
Q

What are effects of Barbituate OD

A 
CNS depression
Hypothermia
Hypoglycemia
Aspiration PNA
urine retention
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17
Q

How do you treat Barbituate OD

A 
Supportive 
Glucose
Narcan
Charcoal
Urinary alkalinization
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18
Q

What are Sx of Valporate OD

A 
*Drowsy, Confused, AMS
High ammonia
Hyperglycemia 
slow reactive pin point pupils 
Hepatotoxic
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19
Q

How do you treat Valporate OD

A

Supportive
Charcoal
L-Carnitine (if high ammonia)

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20
Q

What are effects of Lithium toxicity (SS, low anion gap)

A 
Hand tremor
Fatigue 
no concentration
Polyuria
Anorexia, N/V/D
Rash
Seizure
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21
Q

How do you treat Lithium OD

A

Benzo (NOT dilantin)
Aggressive IV NS
Hemodialysis if >3.5)
charcoal does not work

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22
Q

What are effects of Ethanol OD

A 
CNS depression 
slurred speech
nystagmus 
hypoglycemia
Metabolic acidosis + anion gap
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23
Q

How do you treat Ethanol OD

A 
IV fluids (banana bag w/ MVI, thiamine, folate) 
**Charcoal does not work**
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24
Q

What are effects of Isopropanol OD (rubbing alcohol, paint thinner)

A

Increased Osmolar gap w/o changing anion gap!

25
Q

How do you treat Isopropanol OD

A

IV fluids
ventilation
HD if hypotension refractory to fluids
charcoal does not work

26
Q

What are effects of Methanol toxicity

A 
CNS depress
Blind
Abd pain
Hypotension
Anion cap Metabolic acidosis + Osmolar gap
27
Q

How do you treat Methanol OD (wood varnish)

A 
IVF 
Fomepizole 
Ethanol 10% in D5W
HD if blind or pH <7.15
*charcoal does not work*
28
Q

What are effects of Ethylene Glycol OD (anti-freeze)

A 
CNS depression 
Tachy tachy 
HTN
Flank pain
Renal failure 
Hypocalcemia (tetany, long QT) 
Anion gap Metabolic acidosis
29
Q

What will you see on Urine Fluorescence in Ethylene Glycol toxicity

A

Calcium Oxalate crystals

30
Q

How do you treat Ethylene Glycol OD

A 
IVF
Fomepizole 
Ethanol 10% in D5W 
HD is severe met acidosis w/ nephrotoxicity 
*charcoal does not work*
31
Q

What are effects of CCB OD

A 
*AV Dissociation, Increased PR interval 
hypotension
bradycardia
ileus
High Na/hyperglycemia
32
Q

How do you treat CCB OD

A 
WBI 
CaCl (or CaGluconate) bolus in central line 
Glucagon 
Epinephrine 
Insulin and glucose 
NaHCO3 (if wide QRS) 
Pacemaker
33
Q

What is the only dialyzable BB

A

Atenolol

34
Q

What are effects of BB OD

A 
Hypotension
bradycardia
coma
Increased PR and QRS 
High K, hyperglycemia
35
Q

How do you treat BB OD

A

Glucagon
Insulin-glucose
Epinephrine
pacemaker

36
Q

What are effects of Digoxin Toxicity

A 
*Proximal Atrial tachycardia w/ block 
Vision change (see yellow halos) 
Acute: High K + GI Sx in
Chronic: Low K + arrhythmia
Vtach in different directions 
n/v, weak, syncope, AMS
37
Q

How do you treat Digoxin OD

A

Avoid Ca
Digibind (if K>5.5, heart block, plant, or animal toxicity)
Vasopressor, atropine, external pacing

38
Q

When are digoxin levels falsely elevated

A

newborns
pregnant moms
chronic renal failure
hepatobiliary disease

39
Q

What are effects of TCA OD

A

Anticholinergic effects
cardiac arrest, arrhythmia, hypotension, pulm edema, mydriasis
Increased QRS&QT, RAD, sinus tach

40
Q

How do you treat TCA OD

A 
Fluids 
NaHCO3
Alpha agonist (NO dopamine) 
Benzos, Barbituates 
Vent support 
charcoal 
Avoid CCB, BB, physiostigmine
41
Q

TCA + ___= death

A

Procainamide (class Ia)

42
Q

What is the MC arrhythmia in TCA OD

A

Supraventricular with wide QRS

43
Q

What are effects of Cyanide OD

A

Tachycardia+HTN–> Bradycardia+hypotension–> asystole
HA–>Sz–>coma
Dyspnea–>apnea

44
Q

How do you treat Cyanide OD

A

100% O2
Hydroxocobalamin
+/- Cyanide kit (amyl nitrate + sodium nitrite + sodium thiosulfate)

45
Q

What are effects of carbon monoxide OD

A

Asymptomatic
*Cherri red skin
HA, n/v, no dexterity, flu Sx
(must test carboxyHgb level)

46
Q

How do you treat carbon monoxide OD

A

Hyperbaric oxygen in COHgb>40%, preggers, neuro sx, coma, ischemia on ECG, refractory despite O2

47
Q

What are effects of hypoglycemia

A

Diaphoresis, Nausea, AMS

Whipple’s Triad: hypoglycemia (<60) + Sx of hypoglycemia + Resolution of Sx w/ glucose admin

48
Q

What agents can cause hypoglycemia

A 
Insulin 
Sulfonylurea 
Bigaunides (metformin, glucophage) -->met acidosis
Thiozolidinediones 
Benzoc acid
49
Q

How do you treat hypoglycemia

A 
Glucose replacement 
Feed patient 
Glucagon (not for alcoholic, young, old, or malntr) 
Octreotide 
Charcoal
50
Q

How do you treat Dystonic reactions

A

Benadryl (3-4 days to prevent recurrence)

Benztropine (not kids)

51
Q

Repeat: brief overview of effects of dystonic reactions

A 
Hypotension
Miosis
decreased LOC 
brady/tachy
sz
coma
urinary retention
52
Q

What is the MCC of peds morality 2/2 poisoning

A

eat da poop

jk shawn, it’s iron

53
Q

What are effects of Iron OD (stages)

A

I (6-12h): GI; vomit, diarrhes, abd pain, pallor, lethargy, Metabolic acidosis, hypoglycemia, leukocytosis
II (6-24): hypovolemia, Metabolic acidosis, lethargy, hypotension
III: organ failure; periph neuropathy, encephalopathy, myocardial depresison, renal/hepatic fail, ischemic bowel

54
Q

How do you treat Iron OD

A 
\+ KUB or >20 ingested= Lavage
WBI 
2oz MOM per g ingested 
Deferixamine 
If ASx s/p 6 hr, Dc home
55
Q

What is your popcorn lab finding in iron OD

A 
Basophilic stippling (WBC) on microscopy 
Vin Rose urine
56
Q

What does alkali ingestion cause

A

Liquid Necrosis

57
Q

What does Acid ingestion cause

A

Coagulation Necrosis (eschar)

58
Q

Any caustic ingestion causes what effect

A 
Visible burn
dysphonia
drooling
coughing 
vomiting
59
Q

How do you manage a caustic ingestion

A

ABC, routine tox labs, upright CXR
Endoscopic eval
NG tube, steroids, or abx
no charcoal

Nayla clinical disciplines (8 decks)

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