Poison and Environmental Exposure Flashcards
1
Q
Lead Poisoning/Lead Toxicity
A
x
2
Q
risk
A
x
3
Q
who is at high risk?
A
international adoptees, painted toys and decorations made before 1976, homes built prior to 1978
4
Q
what are other groups of high risk?
A
hx of PICA, low SES
5
Q
who can also be at high risk at this day and age?
A
hand mouth behavior children (eating cement and woodwork)
6
Q
syx
A
x
7
Q
what are syx of lead poisoning?
A
anorexia, decreased activity, irritability, vague abd pain, insomnia
8
Q
screening
A
x
9
Q
how do you screen for lead poisoning?
A
with capillary lead testing
10
Q
if you have elevated capillary lead testing, what is the next step?
A
venous lead level (because you can have contaminant of capillary sample of child’s finger)
11
Q
dx
A
x
12
Q
what lead levels are considered mild?
A
5-44 ug/dL
13
Q
what lead levels are considered mod?
A
45-69 ug/dL
14
Q
what other dx test can you use in moderate lead toxicity?
A
xray-shows lead lines (deposition on the metaphyses of long bones)
15
Q
what lead levels are considered severe?
A
> =70ug/dL
16
Q
what does peripheral blood smear typically show?
A
basophilic stippling (blue cytoplasmic granules within RBC)
17
Q
trx
A
x
18
Q
what is first line trx if mild lead levels?
A
no meds, repeat lead level in 1 month
19
Q
what is first line trx if mod lead levels?
A
Meso-2,3 -dimercaptosuccinic acid (DMSA, succimer)
20
Q
what is first line trx if severe lead levels?
A
Dimercaprol (british anti-lewisite) plus calcium disodium edetate (EDTA)
21
Q
management
A
x
22
Q
what is the initial lab study that should be done when assessing for lead toxicity?
A
CBC, serum iron, and ferritin levels, and reticulocyte count-all to detect presence of anemia and iron deficiency
23
Q
what are other management options to do?
A
notify public health department, nutritional counseling, env surveillance (identify adn remove lead sources)
24
Q
complications
A
x
25
what are the complications of lead exposure?
neurobehavioral impairment (i.e ADHD)
26
Infant Botulism
x
27
cause
x
28
what is the cause of infant botulism?
clostridium botulinum (spores are harmless to adults)
29
pathophys
x
30
what is the pathophys of infant botulism?
spores colonize intestines and produce a neurotoxin that inhibits presnaptic ACh release at NMJ
31
syx
x
32
what are syx?
constipation, oculobulbar weakness (ptosis, pupillary constriction, poor suck, absent gag reflex), descending flaccid paralysis
33
PE
x
34
what are physical exam findings?
hypotonia, diminished or absent DTR, decreased strength, symmetric descending paralysis
35
risk
x
36
what are risk factors associated with foods or environmental factors?
honey, dust/soil
37
dx
x
38
how do you dx infant botulism?
stool C botulinum spores or toxin
39
trx
x
40
what are the treatments for infant botulism?
botulism immune globulin (BIG-IV)
41
Botulism
x
42
cause
x
43
what is the cause?
Clostridium Botulinum
44
syx
x
45
what are syx?
blurry vision due to accommodation failure and impaired pupillary responses, mild dysarthria, descending paralysis
46
Carbon Monoxide Poisoning
x
47
risk
x
48
what groups at risk?
smoke inhalation, defective heating systems, motors operating in poorly ventilated areas, improperly vented fuel burning devices (kerosene heaters)
49
syx
x
50
what is a classic presentation?
several people who share a common environment develop concurrent symptoms
51
what are syx?
flu like symptoms, frontal headaches that began during the night and slowly worsened, malaise, nausea, and dizziness
52
what are syx in more severe cases?
seizure, syncope, coma, and/or MI, arrythmias
53
PE
x
54
what are findings on Spo2?
normal
55
Dx
x
56
arterial blood PO2 would show what?
unchanged by CO exposure (unlike oxyhemoglobin, which is severely reduced)
57
how do you dx it?
ABG- carboxyhemoglobin level
58
what are some associated EKG and lab findings?
EKG-T wave inversions, ST-T changes
| cardiac enzymes-if ischemia or CAD
59
trx
x
60
what is the trx for carbon monoxide poisoning?
- high flow 100% Oxygen
| - intubation/hyperbaric oxygen therapy (severe)
61
Herbal Supplement
x
62
Ginkgo Biloba
x
63
what are the uses?
memory enhancement (memory booster), dementia, macular degeneration, peripheral vascular disease
64
what are the side effects?
increased bleeding risk (inhibition of platelet activating factor)
65
what are other side effects of ginkgo biloba?
seizures, headaches, irritability, restlessness, diarrhea, nausea, and vomiting
66
Ginseng
x
67
what are the uses?
improved mental performance
68
what are the side effects?
increased bleeding risk, headache, insomnia, and GI syx
69
Saw Palmetto
x
70
what are the uses?
BPH
71
what are the side effects?
mild stomach discomfort, increased bleeding risk
72
what does the data show for saw palmetto and BPH?
Saw Palmetto has not been shown to significantly improve urinary symptoms or flow measures.
In addition, saw palmetto does not appear to affect prostate-specific antigen levels or prostate size.
73
Black Cohosh
x
74
what are the uses?
PMS (hot flashes, vag dryness)
75
what are the side effects?
hepatic injury
76
St John's Wort
x
77
what are the uses?
depression, insomnia
78
what are the side effects?
drug interactions: antidepressants (serotonin syndrome), OCs, anticoagulants (decreased INR), digoxin
HTN crisis, gastrointestinal distress, dizziness, fatigue, photosensitivity, and dry mouth. Long term side effects: anorgasmia, urinary frequency, and swelling.
79
Kava
x
80
what are the uses?
anxiety, inosmnia, menopause
81
what are the side effects?
severe liver damage (elevated LFTs)
82
Licorice
x
83
what are the uses?
stomach ulcers, bronchitis/viral infections
84
what are the side effects?
HTN, hypokalemia (hyperaldosterone like effect)
85
Echinacea
x
86
what are the uses?
Trx and prevention of cold and flu
87
what are the side effects?
anaphylaxis (more likely in asthmatics)
88
Ephedra
x
89
what are the uses?
trx of cold and flu
weight loss and improved athletic performance
90
what are the side effects?
HTN, arrythmias/MI, sudden death, stroke, seizure
91
Scombroid Poisoning
x
92
risk
x
93
what are the risks leading to scombroid poisoning?
ingestion of improperly stored seafood (>15degree C storage leads to histamine release)
94
syx
x
95
what are syx of scombroid poisoning?
flushing, throbbing headache, palpitations, abd cramps, diarrhea, and oral burning
96
what is the timing of symptoms?
10-30 min after ingesting fish
97
PE
x
98
what are physical exam findings?
skin erythema, wheezing, tachycardia, hypotension
99
Pufferfish poisoning
x
100
syx
x
101
what are syx of pufferfish poisoning?
prominence of neuro syx (perioral tingling, incoordination, weakness, etc)
102
Ethylene Glycol Ingestion
x
103
PE
x
104
what is the classic physical exam finding?
kussmaul's respiration (rapid and deep breathing pattern)
105
syx
x
106
what are other syx of ethylene glycol ingestion?
n/v, slurred speech, ataxia, nystagmus, lethargy
107
what are syx of further toxicity?
tachypnea, agitation, confusion, flank pain, renal failure, pulmonary edema, changes in mental status, and eventually, progression to a coma.
108
trx
x
109
what is the appropriate trx for ethylene glycol ingestion?
fomepizole infusion (inhibits alcohol dehydrogenase)
110
Salicylate Toxicity
x
111
syx
x
112
what are brain syx?
tinnintus, dizziness, AMS, cerebral edema, seizure
113
what are lung syx?
tachypnea, pulm edema
114
what are stomach syx?
n/v,
115
what are heart syx?
arrythmia
116
what are liver syx?
hepatitis
117
what are systemic syx?
metabolic acidosis, fever
118
PE
x
119
what are PE findings?
tachypnea, hyperthermia, AMS
120
dx
x
121
what are lab findings?
tachypnea w resp alkalosis, lactic acidosis (resp alkalosis that leads to met acidosis)
122
what is normal anion gap?
14-Aug
123
pathophys
x
124
what is the pathophys of salicylate toxicity?
stimulation of medullary respiratory center and chemoreceptor trigger zone (leads to resp alkalosis and nausea) and the inhibition of cellular metabolism (leads to lactic acidosis)
125
trx
x
126
what is the trx for salicylate toxicity?
alkalinization of blood and urine with sodium bicarb drip, supplemental glucose. Dialysis if needed
127
if presentation is early enough (within 2 hours), what can also be used?
activated charcoal
128
Anticholinergic Toxicity
x
129
cause
x
130
what is a cause?
TCA
131
PE
x
132
what are PE findings?
nonreactive mydriasis, skin erythema, anhidrosis,
133
syx
x
134
what are common syx?
altered mental status, and urinary retention.
135
trx
x
136
what is the trx for anticholinergic toxicity?
physostigmine
137
Cholinergic Toxicity
x
138
pathophys
x
139
what is the pathophys?
inhibition of acetlcholinesterase, leads cholinergic toxicity
140
risk
x
141
what is a risk factor for it?
organosphosphate poisoning (pesticides)
142
syx
x
143
what are sudden onset of symptoms suggestive of cholinergic toxicity?
garlic-like odor from clothing
144
what are syx of cholinergic toxicity?
DUMBELS-diarrhea, urination, miosis (pinpoint pupils bilaterally), bronchospasm/bradycardia, emesis, lacrimation, and salivation
145
what are symptoms of the nicotinic effects
nicotine effects: muscle weaknesss, paralysis, fasciculations
146
what are symptoms of CNS effects?
respiratory failure, seizure, coma
147
trx
x
148
what is initial management?
emergent resuscitation (eg O2, fluids, intubation)
149
what is trx?
atropine (competitive inhibitor of ACh), pralidoxime (a cholinesterase reactivating agent)
150
what if it is within 1 hour of exposure?
activated charcoal
151
Serotonin Syndrome
x
152
syx
x
153
what are syx of serotonin syndrome?
tachycardia, hyperthermia, and nausea and vomiting
154
PE
x
155
what are PE findings?
clonus, hyperreflexia, slow horizontal eye movements (ocular clonus), tremor, and rigidity.
156
Burns and Smoke Injury
x
157
risk
x
158
who is at risk?
anyone exposed to smoke or superheated air
159
management
x
160
what is the first step in management?
ABCs (airway, breathing, circulation)
161
complication
x
162
what is the most concerning complication?
supraglottic edema
163
Hypothermia
x
164
syx
x
165
what are mild syx?
tachycardia, tachypnea, ataxia dysarthria, increased shivering
166
what are moderate syx?
bradycardia, lethargy, hypoventilation, decrased shivering, atrial arrhythmias
167
what are severe syx?
coma, cardiovascular collapse, ventricular arrhythmias
168
dx
x
169
what is considered mild temps?
32-35 C
170
what is considered mod temps?
28-32 C
171
what is considered severe temps?
<28C
172
trx
x
173
what is general trx plan?
warmed (42 C) crystalloid for hypotension
| ET in comatose patients
174
what are some rewarming techniques for mild temps?
passive external warming (remove wet clothing, cover with blankets)
175
what are some rewarming techniques for moderate temps?
active external warming (warm blankets, heating pads, warm baths)
176
what are some rewarming techniques for severe temps?
active internal rewarming (warm pleural or peritoneal irrigation, warmed humidified oxygen)
177
complications
x
178
hypothermia is associated with extensive____ abnormalities?
biochemical
179
what are some of those biochemical abnormalities?
metabolic acidosis (decreased tissue perfusion), resp acidosis (hypoventilation), azotemia (decreased renal perfusion), hyperkalemia (cellular lysis), hyperglycemia (loss of insulin effect <30 C)
180
what are other biochemical abnormalities?
elevated lipase (cold induced pancreatitis), elevated hematocrit (hemoconcentration), coagulopathy (impaired coag pathways), leukopenia, thromobocytopenia (splenic sequestration)
181
how do you manage extensive abnormalities?
continuation with warmed IV fluids
182
Heat Stroke
x
183
syx
x
184
what are common syx?
fatigue, headache, dizziness, agitation or confusion,
185
PE
x
186
what are PE physical findigns?
hyperthermia, tachycardia, loss of consciousness, seizure, hot dry skin that is flushed not sweaty
187
risk
x
188
who is at highest risk?
infants, elderly, outdoor workers
189
define
x
190
Heat exhaustion vs Heat stroke?
Generally with heat exhaustion, a patient is sweating a lot, whereas with heat stroke, they've stopped sweating and are actually dry.
191
trx
x
192
what is the trx for heat stroke?
augmentation of evaporating cooling (naked patient sprayed with tepid water mist or covered with wet sheet while large fans circulate air to maximize heat loss)
193
what are other adjunctive therapies?
ice packs, ice water lavage, or cold IV
194
how quickly should you lower core body temp?
dropped by 0.2C/min
195
Adverse events
x
196
epid
x
197
how common are adverse events in hospital?
5-15%
198
types
x
199
what are the 4 types of adverse events in hospitals?
operative and post-procedure, adverse drug, and general care(eg, falls, pressure ulcers) events , and hospital-acquired infections.
200
frequency
x
201
Among patients not undergoing surgery, the most frequent adverse event is?
adverse drug event, which account from 1/5 of all events ( 5%-7% of all hospitalized patients )
202
frequency of hospital acquired infxn?
4%
203
frequency of pressure ulcers in hospital?
1%-5%
204
frequency of falls in hospital ?
1-2%
