Poisoned pt Flashcards
Learn the basic clinical approach to potentially poisoned patients 2. Learn the significance of common patterns of intoxication 3. Learn the basic approaches to decontamination 4. Learn the specific antidotes for selected intoxications 5. Learn the rationale for removal of absorbed toxicants
initial considerations for all pts
airway, C spine protection, ventilation and circulation
all pts with altered mental status should get
thiamine
glucose
if thiamine and glucose don’t work, pt gets
naloxone
Things to get in a hx
try to identify the agent of poisoning
what were they dping immediatly propr to becoming ill
sweating, pupilarty constriction, lacrimation, wheezing, cramping, vomiting, beadycardia, hypotension, diarrhea, depressed respiration
cholinergic/anticholinesterase syndrome
can cause cholinergic/anticholinesterase syndrome
organophostphates, carbamates
dry mouth, dysphagia, blurred near vision, tachycardia, dry skin, hyperthermia, flushing, tachycardia, seziures, hallucinations, delusions
anticholerginic (antimuscurinic) syndrome
can cause anticholerginic (antimuscurinic) syndrome
atropine, scopallamine, TCAs, jimson weed, some mushrooms
dysphonias, dysphagia, rigidty, tremor, toricollis, lanyngospasm
extrapyramidal syndrome
can casue extrapyramidal syndrome
antidopamenogeric drugs, also strycninie and tetanus
hypoxia, headache, altered mental status, n/c, cardiac dysfunction, acidoscis
hemoglobinopathy syndrome
causes hemoglobinopathy syndrome
CO (especially in the winter)
flu like sx
metal fever
pinpoint pupils, respiratpry depression, and hypotension
opoid intox
nervous, tremor, sweating, hypertension, tachycardia
sympathomimetic excess
mydriasis, piloerection, runny nose, lacrimation
opioid withdrawal
withdrawal from these can cause life threataning sx
non opioid CNS depressant withdrawal
altered mental atatis, hypereflexia, spacity, hypertsnsion and hyperthermia
serotonin sydrome
can cause wide QRS
TCAs, phenothiazinesm antidysrythmics
can cause sinus bradycardia
digitalis, beta blockers, CCBs, cholingernic toxicants
metabolic acidosis can be caused be
asprin, methaon, ethylene glycol, iron
tx for seziures in a toxicological setting
benzos, then phenobarbitol and diprivan if needed
tests to order in suspected poisoning
electrilytes, BUN, creatinine, glucose, blood gases, LFTs, EKG. EXTRA BLOOD
serum levels needed to manage:
acetominephen, ethenol. iron, theiphylline, digoxin, asprin, alchohols
can neurilize iodine
starch
can neutralize HF
calcium saklts
antidote for iron
deferozamine
antidote for organophosphates/carbamates
atropine
antidote for cyanide
hydroxocobalmin
antidote for methanol or ethykene glycol
ethanol or methyl pyrazole
anitdote for CO
O2
sntidoe for TCA
sodium bicarb
when you can attempt elimination for poisoning
refractory hyptension/seziures/arrhyhmias in theophylline
deterioration despite full supportive care
overwhelming dose (ex: methanol)
impairment of elimination routes (ex: kidney failure)
severe disease preceding poisoning
ways of treating posining by elimination
repeated doses of charcol, forced diurssis, ion trapping in urine, hemodyalsis, hemoperfusion, hemofiltration, plasmapherisis, exchange transfusion
