PADIS Flashcards
what is the PADIS team?
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)
PADIS roles
- 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”
day to day activities of PADIS team
- patient care (over telephone or bedside consulation)
- education (gneral public and HCPs)
- research/collab
- surveillance (tracking trends/outbreaks)
- prevention
toxicovigilance
the active process of identifying and evaluating the toxic risks existing in a community and evaluating the measures taken to reduce or eliminate them
toxicovigilance canada
antidote registry
reachback support
public outreach and communication
tox lab response network
Canadian surveillance system for poison info
situational awareness and early warning
risks of public health concern include poisoning outbreaks due to:
- contamination
- emergency use of new drugs
- mass chemical exposures/terrorist events
- unusual patterns or trends
1 drug PADIS sees
analgesis
- tylenol
- ibuprofen, etc.
2 drug PADIS sees
antidepressants
sedative/hypnotics/antipsychotics
non-drug exposures PADIS sees
household cleaning substances
cosmetics/eprsonal care producs
alcohols
foreignbodies/toys/misc
plants
chemicals
pesticides
fumes/gases/vapors
hydrocarbons
othr/unknown
majority of cases PADIS sees
unintentional and children
- only 1/4 intentional
- ingestion
telephone risk assessment
- what is patient’s current clinical status
- HPI = what did they take, when, intent, etc.
- physical xam
- initial investigations
toxic-specific questions in telephon risk assessment
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?
HEENT exam
head and neck exams
- pupils? = reactive, mydriatic, miotic
- rhinorrhea, secretions?
- temperature?
skin exam
flushed? dry? diaphoretic? discolered?
CNS exam
rigidity, spasticity?
clonus/hyper-reflexia?
altred mentation/delirium?
cerebellar signs?
GI exam
nausaea vomiting diarrhea?
ab pain? bowel sounds?
CVS exam
evidence of pulmonary edema? injury?
full set of vitals for tox exam
temp
glucose
HR
BP
RR
O2 sats
GCS
= what has the trend been?
process of preventing systemic absorption into the body
decontamination
- SDAC (charcoal), gastric lavage (stomach pump), WBI
process of speeding up metabolism and elimination of an already absorbed substance
enhance elimination
- can be ex- or in-vivo
- hemodialysis, MDAC, urinary alkalinization, intra-lipid (IV fat emulsion)
what is the difference between fever and hyperthermia?
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
this controls temp and muscle hyperactivity (H&B pt)
sedation
benzos!!!
also consider intubation and paralysis
what should be done aout elevated temperature?
tylenol??? NOOOOOO
not if thermometer is broken ; do other things to cool patient down
when do we stop cooling? what are our targets?
<39 C within 20 to 30 mins
this is a TRUE emergency
how to aggressively cool hyperthermic patients?
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
ilicit opioids contain numerous adulterants
sulfonylureas = anti-diabetic pt = prooud hypoglycemia for days
baking soda
xylazine = horse tranquilizer
causes a much more altered pt…
symptoms of opioid ingestion
drowsy, somnolent
pinpoint or miotic pupils
bradycardiA and hypotensionn
bradypnea, hypopnea
hypoxia (decreased O2)
hypercarbia (increased CO2)
this completely reverse effects of any opioids
naloxone
RRSIDEAD
resuscitation
risk assessment
supportive care
investigations
decontamination
enhances elimination
antidotes
disposition
what is included in a tox panel?
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
urine tox screens
rarely helpful in acute management of tox patients
urine drugs of abuse can be used to screen or qualitatively test for:
- amphetamines
barbiturates
benzos
cocaine
cannabinoids
opiates (fentanyl not picked up)
oxycodone
methadone, etc.
the process of preventing systemic absorption into the body
decontamination
ex: SDAC, gastric lavage, WBI
enhanced elimination
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)
toxicology of hot and bothered pt
sympathomimetics
anticholinergics
serotonergic (serotonin syndrome)
antipsychotics (neuroleptic malignant syndrome)
ETC uncouplers (ASA, DNP)
drugs that predispose to ppor environmental responses
malignant hyperthermia
hot and bothered patient non-tox causes
infectious
structural
endo/metabolic
environmental
Kratom
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
