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poison Flashcards

1
Q

An unresponsive patient has lost his or her ________ and is at risk for airway obstruction as well as aspiration

A

airway reflexes

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2
Q

Coma Cocktail

(reversible causes of “coma”

A
  • Opioids: Narcan 0.4 to 2mg IV
  • Hypoxia–> 100% O2 nonrebreather
  • Hypoglycemia: POC D stick

if these do not reverse the symptoms, then intubation should be performed.

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3
Q

Key Historical Data in poison

A

What was ingested?
How much was ingested?
When was ingested?
Why? (accidental or intentional)?

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4
Q

classic presentations of poison are called _________

A

Toxidromes

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5
Q

classic anticholinergic syndrome:

A 
Mad as a hatter (AMS)
Blind as a bat (big-mydriasis)
Hot as Hades
Red as a beat
Dry as a bone

*Rx mostly supportive.

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6
Q

Possible toxins with anticholinergic properties include the following

A

TCA’s
Antihistamines
Overactive bladder medication

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7
Q

classic cholinergic syndrome

A

SLUDGE

  • Salivation
  • Lacrimation
  • Urination
  • Diaphoresis
  • GI upset/ defecation
  • Excessive bradycardia or tachycardia (muscarinic or nicotinic)
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8
Q

Cholinergic poisoning Treatment:

A

Atropine, pralidoxime, decontaminate

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9
Q

Sympathomimetic toxidrome

A
  • Tachycardia
  • Hypertension
  • Mydriasis
  • Diaphoresis
  • Hyperthermia
  • Agitation
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10
Q

Sympathomimetic toxidrome poisons

A

OTC cold agents (containing ephedrine)
cocaine, amphetamines, MDMA
dietary supplements (ephedra)

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11
Q

Sympathomimetic toxidrome treatment

A
  • Sedation
  • Hydration
  • Rx complications–> rhabdomyalysis and hyperthermia
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12
Q

Opioid Classic signs:

A

Apnea
Hypoxia
Unresponsiveness
Flash pulmonary edema (rare)

May appear to require intubation. Administration of Nalaxone can reverse the apnea and obviate the need for intubation

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13
Q

Discharge after naloxone

A

Naloxone will wear off before the opiate so the patient can NOT be discharged without a period of observation.

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14
Q

Unlike other toxic ingestions, acute ______ overdose can present asymptomatic and can be missed/ fatal if not tested.

A

acetaminophen

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15
Q

some poisonings–> presence of an anion gap metabolic acidosis is key to diagnosis

Causes of Anion Gap Metabolic Acidosis

A 
M = Methanol
U = Uremia
D = DKA
P = Paraldehyde
I = Iron, Isoniazid
L = Lactate (many causes CO, sepsis, blood loss?)
E = Ethylene Glycol
S = Salicylates
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16
Q

Physical exam for poison

A

vitals
pupil size
skin color and moisture
overall mental status.

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17
Q

Decontamination Methods for poison

A

Activated Charcoal
Whole Bowel Irrigation
Gastric Lavage (rare)

18
Q

Activated Charcoal

A
  • PO to absorb toxins in GI tract (excreted without being digested.)
  • Best in 1st hour but still works after that
  • Avoid in pts w/ somnolence –> risk of aspiration
19
Q

Charcoal does not bind ___________.

A

metals (such as iron)
alcohols
hydrocarbons

20
Q

Whole bowel irrigation involves the administration of

A

osmotically balanced polyethylene glycol electrolyte solution
Flushes GI to prevent the absorption of toxins.

It is used in cases where charcoal is not effective, with certain sustained release products, and in cases of illicit drug packet ingestions (body packers).

21
Q

Whole bowel irrigation used when

A
  • cases where charcoal is not effective
  • certain sustained release products
  • cases of illicit drug packet ingestions (body packers).
22
Q

Gastric Lavage

A

Rarely used/ significant risks
good for:
-recently ingest lethal substances
-intubated overdose following recent ingestion

23
Q

Gastric Lavage involves the application of

A 
large bore (36 – 40 French) orogastric tube 
 flushing the stomach with aliquots of water to obtain pill fragments.
24
Q

Ipecac

A
  • should not be used anymore
  • not effective in removing toxin
  • reduces effectiveness of better decontamination methods
25
Q

Many patients with potential ingestions may be observed for _______ and then dispositioned if clinically asymptomatic

A

six hours

dc home or psychiatric facility-provided the ingestion is not an extended release agent

26
Q

it is imperative that an _________ level is checked on all overdose patients

A

acetaminophen

  • measured on Rumak nomogram
  • toxic plasma level at four hours is 150.
27
Q

four main stages of an acute acetaminophen overdose.

A

symptoms usually involve nausea, vomiting in the first two stages.

28
Q

In an acute overdose, acetaminophen is metabolized by

A
  • metabolized into NAPQI which combines with glutathione –> excreted.
  • When glutathione is gone, NAPQI–> hepatic toxicity.
29
Q

In an acute overdose, treatment is

A
  • decontamination with repeated doses of activated charcoal,

- antidote N-acetylcysteine (Mucomyst)

30
Q

Unlike the Rumak nomogram of acetaminophen, the _______ is associated with aspirin ingestions

A

Done nomogram

it is typically not used to determine toxicity and treatment.

31
Q

Patients with an acute overdose of aspirin are usually present

A 
ill appearing
breathing fast
vomiting
confused
sometimes febrile.
32
Q

The toxic effects of aspirin

A

involve an uncoupling of oxidative phosphorylation.

causes a profound anoin gap metabolic acidosis

33
Q

The general approach to aspirin overdose is

A

airway managment
gastric decontamination
sodium bicarbonate
hemodialysis

34
Q

In addition to their anticholinergic properties, TCAs cause :

A
  • a direct a-adrenergic blockade
  • inhibition of norepi/ 5HT reuptake
  • blockade of fast Na channels in myocardial cells
35
Q

Treatment of TCA overdose includes _________ in the asymptomatic patient.

A

close monitoring for a period of at least six to eight hours

36
Q

Treatment of TCA with QRS widening

A

Sodium bicarbonate
Seizures -benzo

Newer recommendations for lipid therapy exist in the treatment of severe toxicity.

37
Q

three major alcohols that are considered “toxic”.

A

metabolic acidosis:

  • methanol
  • ethylene glycol

no metabolic acidosis
-isopropanol

38
Q

________ alcohol is usually not life threatening and can be managed by supportive care.

A

Isopropanol

rarely hemodialysis may be required.

39
Q

All alcohols are metabolized by

A

alcohol dehydrogenase (ADH). Therefore, the initial treatment for methanol and ethylene glycol involves the blockade of ADH.

40
Q

treatment of toxic methanol and ethylene

A

blockade of ADH w/ ethanol or fomepizole

hemodialysis

Sodium bicarbonate and glucose may also be necessary.

41
Q

isopropanol, methanol, and ethylene glycol sources

A

Isopropyl- solvents, mouthwashes, rubbing alcohols.

Methanol - windshield fluid.

Ethylene Glycol - antifreeze.

aaa EM Exam (27 decks)

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