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Poison and Environmental Exposure > Poison and Environmental Exposure > Flashcards

Poison and Environmental Exposure Flashcards

1
Q

Lead Poisoning/Lead Toxicity

A

x

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2
Q

risk

A

x

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3
Q

who is at high risk?

A

international adoptees, painted toys and decorations made before 1976, homes built prior to 1978

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4
Q

what are other groups of high risk?

A

hx of PICA, low SES

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5
Q

who can also be at high risk at this day and age?

A

hand mouth behavior children (eating cement and woodwork)

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6
Q

syx

A

x

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7
Q

what are syx of lead poisoning?

A

anorexia, decreased activity, irritability, vague abd pain, insomnia

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8
Q

screening

A

x

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9
Q

how do you screen for lead poisoning?

A

with capillary lead testing

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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)

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11
Q

dx

A

x

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12
Q

what lead levels are considered mild?

A

5-44 ug/dL

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13
Q

what lead levels are considered mod?

A

45-69 ug/dL

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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)

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15
Q

what lead levels are considered severe?

A

> =70ug/dL

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16
Q

what does peripheral blood smear typically show?

A

basophilic stippling (blue cytoplasmic granules within RBC)

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17
Q

trx

A

x

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18
Q

what is first line trx if mild lead levels?

A

no meds, repeat lead level in 1 month

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19
Q

what is first line trx if mod lead levels?

A

Meso-2,3 -dimercaptosuccinic acid (DMSA, succimer)

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20
Q

what is first line trx if severe lead levels?

A

Dimercaprol (british anti-lewisite) plus calcium disodium edetate (EDTA)

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21
Q

management

A

x

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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

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23
Q

what are other management options to do?

A

notify public health department, nutritional counseling, env surveillance (identify adn remove lead sources)

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24
Q

complications

A

x

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25
Q

what are the complications of lead exposure?

A

neurobehavioral impairment (i.e ADHD)

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26
Q

Infant Botulism

A

x

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27
Q

cause

A

x

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28
Q

what is the cause of infant botulism?

A

clostridium botulinum (spores are harmless to adults)

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29
Q

pathophys

A

x

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30
Q

what is the pathophys of infant botulism?

A

spores colonize intestines and produce a neurotoxin that inhibits presnaptic ACh release at NMJ

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31
Q

syx

A

x

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32
Q

what are syx?

A

constipation, oculobulbar weakness (ptosis, pupillary constriction, poor suck, absent gag reflex), descending flaccid paralysis

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33
Q

PE

A

x

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34
Q

what are physical exam findings?

A

hypotonia, diminished or absent DTR, decreased strength, symmetric descending paralysis

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35
Q

risk

A

x

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36
Q

what are risk factors associated with foods or environmental factors?

A

honey, dust/soil

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37
Q

dx

A

x

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38
Q

how do you dx infant botulism?

A

stool C botulinum spores or toxin

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39
Q

trx

A

x

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40
Q

what are the treatments for infant botulism?

A

botulism immune globulin (BIG-IV)

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41
Q

Botulism

A

x

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42
Q

cause

A

x

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43
Q

what is the cause?

A

Clostridium Botulinum

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44
Q

syx

A

x

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45
Q

what are syx?

A

blurry vision due to accommodation failure and impaired pupillary responses, mild dysarthria, descending paralysis

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46
Q

Carbon Monoxide Poisoning

A

x

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47
Q

risk

A

x

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48
Q

what groups at risk?

A

smoke inhalation, defective heating systems, motors operating in poorly ventilated areas, improperly vented fuel burning devices (kerosene heaters)

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49
Q

syx

A

x

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50
Q

what is a classic presentation?

A

several people who share a common environment develop concurrent symptoms

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51
Q

what are syx?

A

flu like symptoms, frontal headaches that began during the night and slowly worsened, malaise, nausea, and dizziness

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52
Q

what are syx in more severe cases?

A

seizure, syncope, coma, and/or MI, arrythmias

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53
Q

PE

A

x

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54
Q

what are findings on Spo2?

A

normal

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55
Q

Dx

A

x

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56
Q

arterial blood PO2 would show what?

A

unchanged by CO exposure (unlike oxyhemoglobin, which is severely reduced)

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57
Q

how do you dx it?

A

ABG- carboxyhemoglobin level

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58
Q

what are some associated EKG and lab findings?

A

EKG-T wave inversions, ST-T changes

cardiac enzymes-if ischemia or CAD

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59
Q

trx

A

x

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60
Q

what is the trx for carbon monoxide poisoning?

A
  • high flow 100% Oxygen

- intubation/hyperbaric oxygen therapy (severe)

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61
Q

Herbal Supplement

A

x

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62
Q

Ginkgo Biloba

A

x

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63
Q

what are the uses?

A

memory enhancement (memory booster), dementia, macular degeneration, peripheral vascular disease

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64
Q

what are the side effects?

A

increased bleeding risk (inhibition of platelet activating factor)

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65
Q

what are other side effects of ginkgo biloba?

A

seizures, headaches, irritability, restlessness, diarrhea, nausea, and vomiting

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66
Q

Ginseng

A

x

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67
Q

what are the uses?

A

improved mental performance

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68
Q

what are the side effects?

A

increased bleeding risk, headache, insomnia, and GI syx

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69
Q

Saw Palmetto

A

x

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70
Q

what are the uses?

A

BPH

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71
Q

what are the side effects?

A

mild stomach discomfort, increased bleeding risk

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72
Q

what does the data show for saw palmetto and BPH?

A

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.

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73
Q

Black Cohosh

A

x

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74
Q

what are the uses?

A

PMS (hot flashes, vag dryness)

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75
Q

what are the side effects?

A

hepatic injury

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76
Q

St John’s Wort

A

x

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77
Q

what are the uses?

A

depression, insomnia

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78
Q

what are the side effects?

A

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.

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79
Q

Kava

A

x

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80
Q

what are the uses?

A

anxiety, inosmnia, menopause

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81
Q

what are the side effects?

A

severe liver damage (elevated LFTs)

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82
Q

Licorice

A

x

83
Q

what are the uses?

A

stomach ulcers, bronchitis/viral infections

84
Q

what are the side effects?

A

HTN, hypokalemia (hyperaldosterone like effect)

85
Q

Echinacea

A

x

86
Q

what are the uses?

A

Trx and prevention of cold and flu

87
Q

what are the side effects?

A

anaphylaxis (more likely in asthmatics)

88
Q

Ephedra

A

x

89
Q

what are the uses?

A

trx of cold and flu

weight loss and improved athletic performance

90
Q

what are the side effects?

A

HTN, arrythmias/MI, sudden death, stroke, seizure

91
Q

Scombroid Poisoning

A

x

92
Q

risk

A

x

93
Q

what are the risks leading to scombroid poisoning?

A

ingestion of improperly stored seafood (>15degree C storage leads to histamine release)

94
Q

syx

A

x

95
Q

what are syx of scombroid poisoning?

A

flushing, throbbing headache, palpitations, abd cramps, diarrhea, and oral burning

96
Q

what is the timing of symptoms?

A

10-30 min after ingesting fish

97
Q

PE

A

x

98
Q

what are physical exam findings?

A

skin erythema, wheezing, tachycardia, hypotension

99
Q

Pufferfish poisoning

A

x

100
Q

syx

A

x

101
Q

what are syx of pufferfish poisoning?

A

prominence of neuro syx (perioral tingling, incoordination, weakness, etc)

102
Q

Ethylene Glycol Ingestion

A

x

103
Q

PE

A

x

104
Q

what is the classic physical exam finding?

A

kussmaul’s respiration (rapid and deep breathing pattern)

105
Q

syx

A

x

106
Q

what are other syx of ethylene glycol ingestion?

A

n/v, slurred speech, ataxia, nystagmus, lethargy

107
Q

what are syx of further toxicity?

A

tachypnea, agitation, confusion, flank pain, renal failure, pulmonary edema, changes in mental status, and eventually, progression to a coma.

108
Q

trx

A

x

109
Q

what is the appropriate trx for ethylene glycol ingestion?

A

fomepizole infusion (inhibits alcohol dehydrogenase)

110
Q

Salicylate Toxicity

A

x

111
Q

syx

A

x

112
Q

what are brain syx?

A

tinnintus, dizziness, AMS, cerebral edema, seizure

113
Q

what are lung syx?

A

tachypnea, pulm edema

114
Q

what are stomach syx?

A

n/v,

115
Q

what are heart syx?

A

arrythmia

116
Q

what are liver syx?

A

hepatitis

117
Q

what are systemic syx?

A

metabolic acidosis, fever

118
Q

PE

A

x

119
Q

what are PE findings?

A

tachypnea, hyperthermia, AMS

120
Q

dx

A

x

121
Q

what are lab findings?

A

tachypnea w resp alkalosis, lactic acidosis (resp alkalosis that leads to met acidosis)

122
Q

what is normal anion gap?

A

14-Aug

123
Q

pathophys

A

x

124
Q

what is the pathophys of salicylate toxicity?

A

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
Q

trx

A

x

126
Q

what is the trx for salicylate toxicity?

A

alkalinization of blood and urine with sodium bicarb drip, supplemental glucose. Dialysis if needed

127
Q

if presentation is early enough (within 2 hours), what can also be used?

A

activated charcoal

128
Q

Anticholinergic Toxicity

A

x

129
Q

cause

A

x

130
Q

what is a cause?

A

TCA

131
Q

PE

A

x

132
Q

what are PE findings?

A

nonreactive mydriasis, skin erythema, anhidrosis,

133
Q

syx

A

x

134
Q

what are common syx?

A

altered mental status, and urinary retention.

135
Q

trx

A

x

136
Q

what is the trx for anticholinergic toxicity?

A

physostigmine

137
Q

Cholinergic Toxicity

A

x

138
Q

pathophys

A

x

139
Q

what is the pathophys?

A

inhibition of acetlcholinesterase, leads cholinergic toxicity

140
Q

risk

A

x

141
Q

what is a risk factor for it?

A

organosphosphate poisoning (pesticides)

142
Q

syx

A

x

143
Q

what are sudden onset of symptoms suggestive of cholinergic toxicity?

A

garlic-like odor from clothing

144
Q

what are syx of cholinergic toxicity?

A

DUMBELS-diarrhea, urination, miosis (pinpoint pupils bilaterally), bronchospasm/bradycardia, emesis, lacrimation, and salivation

145
Q

what are symptoms of the nicotinic effects

A

nicotine effects: muscle weaknesss, paralysis, fasciculations

146
Q

what are symptoms of CNS effects?

A

respiratory failure, seizure, coma

147
Q

trx

A

x

148
Q

what is initial management?

A

emergent resuscitation (eg O2, fluids, intubation)

149
Q

what is trx?

A

atropine (competitive inhibitor of ACh), pralidoxime (a cholinesterase reactivating agent)

150
Q

what if it is within 1 hour of exposure?

A

activated charcoal

151
Q

Serotonin Syndrome

A

x

152
Q

syx

A

x

153
Q

what are syx of serotonin syndrome?

A

tachycardia, hyperthermia, and nausea and vomiting

154
Q

PE

A

x

155
Q

what are PE findings?

A

clonus, hyperreflexia, slow horizontal eye movements (ocular clonus), tremor, and rigidity.

156
Q

Burns and Smoke Injury

A

x

157
Q

risk

A

x

158
Q

who is at risk?

A

anyone exposed to smoke or superheated air

159
Q

management

A

x

160
Q

what is the first step in management?

A

ABCs (airway, breathing, circulation)

161
Q

complication

A

x

162
Q

what is the most concerning complication?

A

supraglottic edema

163
Q

Hypothermia

A

x

164
Q

syx

A

x

165
Q

what are mild syx?

A

tachycardia, tachypnea, ataxia dysarthria, increased shivering

166
Q

what are moderate syx?

A

bradycardia, lethargy, hypoventilation, decrased shivering, atrial arrhythmias

167
Q

what are severe syx?

A

coma, cardiovascular collapse, ventricular arrhythmias

168
Q

dx

A

x

169
Q

what is considered mild temps?

A

32-35 C

170
Q

what is considered mod temps?

A

28-32 C

171
Q

what is considered severe temps?

A

<28C

172
Q

trx

A

x

173
Q

what is general trx plan?

A

warmed (42 C) crystalloid for hypotension

ET in comatose patients

174
Q

what are some rewarming techniques for mild temps?

A

passive external warming (remove wet clothing, cover with blankets)

175
Q

what are some rewarming techniques for moderate temps?

A

active external warming (warm blankets, heating pads, warm baths)

176
Q

what are some rewarming techniques for severe temps?

A

active internal rewarming (warm pleural or peritoneal irrigation, warmed humidified oxygen)

177
Q

complications

A

x

178
Q

hypothermia is associated with extensive____ abnormalities?

A

biochemical

179
Q

what are some of those biochemical abnormalities?

A

metabolic acidosis (decreased tissue perfusion), resp acidosis (hypoventilation), azotemia (decreased renal perfusion), hyperkalemia (cellular lysis), hyperglycemia (loss of insulin effect <30 C)

180
Q

what are other biochemical abnormalities?

A

elevated lipase (cold induced pancreatitis), elevated hematocrit (hemoconcentration), coagulopathy (impaired coag pathways), leukopenia, thromobocytopenia (splenic sequestration)

181
Q

how do you manage extensive abnormalities?

A

continuation with warmed IV fluids

182
Q

Heat Stroke

A

x

183
Q

syx

A

x

184
Q

what are common syx?

A

fatigue, headache, dizziness, agitation or confusion,

185
Q

PE

A

x

186
Q

what are PE physical findigns?

A

hyperthermia, tachycardia, loss of consciousness, seizure, hot dry skin that is flushed not sweaty

187
Q

risk

A

x

188
Q

who is at highest risk?

A

infants, elderly, outdoor workers

189
Q

define

A

x

190
Q

Heat exhaustion vs Heat stroke?

A

Generally with heat exhaustion, a patient is sweating a lot, whereas with heat stroke, they’ve stopped sweating and are actually dry.

191
Q

trx

A

x

192
Q

what is the trx for heat stroke?

A

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
Q

what are other adjunctive therapies?

A

ice packs, ice water lavage, or cold IV

194
Q

how quickly should you lower core body temp?

A

dropped by 0.2C/min

195
Q

Adverse events

A

x

196
Q

epid

A

x

197
Q

how common are adverse events in hospital?

A

5-15%

198
Q

types

A

x

199
Q

what are the 4 types of adverse events in hospitals?

A

operative and post-procedure, adverse drug, and general care(eg, falls, pressure ulcers) events , and hospital-acquired infections.

200
Q

frequency

A

x

201
Q

Among patients not undergoing surgery, the most frequent adverse event is?

A

adverse drug event, which account from 1/5 of all events ( 5%-7% of all hospitalized patients )

202
Q

frequency of hospital acquired infxn?

A

4%

203
Q

frequency of pressure ulcers in hospital?

A

1%-5%

204
Q

frequency of falls in hospital ?

A

1-2%

Poison and Environmental Exposure (1 decks)

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