PADIS

Question 1

what is the PADIS team?

Answer 1

one of a few different poison centres across the country (5 now)
tox consultations across Canada
staffed by specially trained and certified healthcare professionals
- medical toxicologists
- tox fellows
- info specialists (pharmacists and RNs with subspecialty training)

Question 2

PADIS roles

Answer 2

• exposure to drugs, chemicals or toxins via any route possible
• “I’ve done somhing I dont usually do”
• “Have I taken too much? I’m concerned I poisoned myself”
• “How can I prevent posioning?”
• “I am caring for an overdose/poisoned patient and I want to review maanagment”

Question 3

day to day activities of PADIS team

Answer 3

• patient care (over telephone or bedside consulation)
• education (gneral public and HCPs)
• research/collab
• surveillance (tracking trends/outbreaks)
• prevention

Question 4

toxicovigilance

Answer 4

the active process of identifying and evaluating the toxic risks existing in a community and evaluating the measures taken to reduce or eliminate them

Question 5

toxicovigilance canada

Answer 5

antidote registry
reachback support
public outreach and communication
tox lab response network
Canadian surveillance system for poison info
situational awareness and early warning

Question 6

risks of public health concern include poisoning outbreaks due to:

Answer 6

• contamination
• emergency use of new drugs
• mass chemical exposures/terrorist events
• unusual patterns or trends

Question 7

1 drug PADIS sees

Answer 7

analgesis
- tylenol
- ibuprofen, etc.

Question 8

2 drug PADIS sees

Answer 8

antidepressants
sedative/hypnotics/antipsychotics

Question 9

non-drug exposures PADIS sees

Answer 9

household cleaning substances
cosmetics/eprsonal care producs
alcohols
foreignbodies/toys/misc
plants
chemicals
pesticides
fumes/gases/vapors
hydrocarbons
othr/unknown

Question 10

majority of cases PADIS sees

Answer 10

unintentional and children
- only 1/4 intentional
- ingestion

Question 11

telephone risk assessment

Answer 11

• what is patient’s current clinical status
• HPI = what did they take, when, intent, etc.
• physical xam
• initial investigations

Question 12

toxic-specific questions in telephon risk assessment

Answer 12

what was ingested?
how much?
what was timeo f ingestion? staggered/all at once?
any coingestants?
access to toher meds?
any self-decontam events?
pill counts? how much was patient prescribed and when?
how has their clinical picture changed over time?

Question 13

HEENT exam

Answer 13

head and neck exams
- pupils? = reactive, mydriatic, miotic
- rhinorrhea, secretions?
- temperature?

Question 14

skin exam

Answer 14

flushed? dry? diaphoretic? discolered?

Question 15

CNS exam

Answer 15

rigidity, spasticity?
clonus/hyper-reflexia?
altred mentation/delirium?
cerebellar signs?

Question 16

GI exam

Answer 16

nausaea vomiting diarrhea?
ab pain? bowel sounds?

Question 17

CVS exam

Answer 17

evidence of pulmonary edema? injury?

Question 18

full set of vitals for tox exam

Answer 18

temp
glucose
HR
BP
RR
O2 sats
GCS
= what has the trend been?

Question 19

process of preventing systemic absorption into the body

Answer 19

decontamination
- SDAC (charcoal), gastric lavage (stomach pump), WBI

Question 20

process of speeding up metabolism and elimination of an already absorbed substance

Answer 20

enhance elimination
- can be ex- or in-vivo
- hemodialysis, MDAC, urinary alkalinization, intra-lipid (IV fat emulsion)

Question 21

what is the difference between fever and hyperthermia?

Answer 21

fever = normal response of body; changes body thermometer to drive up inflammatory cascades

hyperthermia = thermometer broken and body cannot generate heat; generation of heat comes from external sources; DEADLY

Question 22

this controls temp and muscle hyperactivity (H&B pt)

Answer 22

sedation
benzos!!!
also consider intubation and paralysis

Question 23

what should be done aout elevated temperature?

Answer 23

tylenol??? NOOOOOO
not if thermometer is broken ; do other things to cool patient down

Question 24

when do we stop cooling? what are our targets?

Answer 24

<39 C within 20 to 30 mins
this is a TRUE emergency

Question 25

how to aggressively cool hyperthermic patients?

Answer 25

chemical sedation helps (benzos, etc.)
also:
- body bag + ice/water
- fanning and misting
- exposure
- cooled (4C) IV fluids
- cool packs to the axilla, groin, neck (major blood vessel highways)
- further sedation and paralysis

Question 26

ilicit opioids contain numerous adulterants

Answer 26

sulfonylureas = anti-diabetic pt = prooud hypoglycemia for days
baking soda
xylazine = horse tranquilizer

causes a much more altered pt…

Question 27

symptoms of opioid ingestion

Answer 27

drowsy, somnolent
pinpoint or miotic pupils
bradycardiA and hypotensionn
bradypnea, hypopnea
hypoxia (decreased O2)
hypercarbia (increased CO2)

Question 28

this completely reverse effects of any opioids

Answer 28

naloxone

Question 29

RRSIDEAD

Answer 29

resuscitation
risk assessment
supportive care
investigations
decontamination
enhances elimination
antidotes
disposition

Question 30

what is included in a tox panel?

Answer 30

CBC + Diff
electrolytes and extended lytes
creatinine, urea, eGFR
VBG/ABG with co-oximetry, lactate

ASA, EtOH, actaminophen serum levels, serum osmoles (accessible and have antidotes)
LFTs and transaminases

ECG = QRS, QTc
+/- CXR

Question 31

urine tox screens

Answer 31

rarely helpful in acute management of tox patients

Question 32

urine drugs of abuse can be used to screen or qualitatively test for:

Answer 32

• amphetamines
  barbiturates
  benzos
  cocaine
  cannabinoids
  opiates (fentanyl not picked up)
  oxycodone
  methadone, etc.

Question 33

the process of preventing systemic absorption into the body

Answer 33

decontamination
ex: SDAC, gastric lavage, WBI

Question 34

enhanced elimination

Answer 34

process of speeding uo metbaolism and elimination of an already absorbed substance
can be ex-vivo o in-vivo
- hemodialysis, MDAC, urinary alkalinization, intra-lipid (IV fat emulsion)

Question 35

toxicology of hot and bothered pt

Answer 35

sympathomimetics
anticholinergics
serotonergic (serotonin syndrome)
antipsychotics (neuroleptic malignant syndrome)
ETC uncouplers (ASA, DNP)
drugs that predispose to ppor environmental responses
malignant hyperthermia

Question 36

hot and bothered patient non-tox causes

Answer 36

infectious
structural
endo/metabolic
environmental

Question 37

Kratom

Answer 37

tropical evergreen native to SE Asia

ingestion = stimulant and opioid effects
- has been touted as a treatment for opioid withdrawal but no evidence supporting this