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Pediatric Board Review > Poisoning > Flashcards

Poisoning Flashcards

1
Q

What doesn’t activated charcoal adsorb?

A

Metals - iron, heavy metals
Alcohols
Caustics
Lithium

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2
Q 
Organophosphate insecticides
Carbamate insecticides
Nerve gas
Myasthenia gravis medications
Mushrooms (not amanita)
A

Cholinergic

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3
Q

Cholinergic Symptoms

A 
SLUDGE - fluid from every orifice
S alivation
L acrimation
U rination
D efecation
G astrointestinal
E ye-miosis (small pinpoint)
Other...
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4
Q 
Antihistamines
Antipsychotics
Atropinics
Tricyclic antidepressants
Amanita mushrooms
Jimson weed, deadly nightshade
A

Anticholinergic substances

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5
Q

Anticholinergic Toxidrome

A 
Blind as a bat (mydriasis) - dilated pupils
Hot as a hare (hyperthermia)
Red as a beet (vasodilation)
Dry as a bone (anhidrosis)
Mad as a hatter (delirium)
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6
Q

4 stages of acetaminophen toxicity

A

1 - 0-24 hrs - N/V, anorexia
2 - 12-24 hrs - asymptomatic
3 - 2-7 days - fulminant hepatic failure
4 - 1-2 weeks - recovery

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7
Q

Rx: acetaminophen overdose

A

N-acetylcysteine +/- charcoal

Initiate up to 24hrs after ingestion

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8
Q

Ethanol
Ethylene glycol - antifreeze
Isopropranol - rubbing alcohol
Methanol

A

Alcohols

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9
Q

Alcohol Toxidrome

A 
Inebriation
CNS depression
Seizures
Hypoglycemia
Miosis (variable)
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10
Q

Sx methanol

A

Blindness, pancreatitis, fixed dilated pupils

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11
Q

Sx isopropanol

A

Gastritis

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12
Q

Sx ethylene glycol

A

Renal failure

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13
Q

Rx: alcohol ingestion

A 
Ethanol/isopropanol - supportive
Ethylene glycol/methanol
     >20 - ethanol
     >50 - hemodialysis
     Alternative - Fomepizole (alcohol dehydrogenase inhibitor that prevents toxic metabolites)
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14
Q

Anticholinergic Rx

A

Charcoal
Physostigmine controversial - seizures, bradycardia, cardiac arrest
Benzodiazepines for agitation, seizures

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15
Q

Symptoms of Beta-blocker ingestion

A 
Respiratory depression
Bradydysrhythmias
Hypotension
Hallucinations
Seizures
Hypoglycemia
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16
Q

Rx B-blockers

A

Activated charcoal
Whole bowel irrigation
Glucagon for hypoglycemia, hypoTN and bradycardia
Atropine - bradycardia
Milrinone
Epinephrine - massive doses required to overcome beta-blockade

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17
Q

Ammonia > 5%
Sodium hypochlorite >5%
Laundry detergents
Drain openers

A

Alkali caustics

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18
Q

Drain openers
Toilet bowl cleaners
Rust removers
Oven cleaners

A

Acid caustics

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19
Q

Sxs of caustic ingestions

A 
Mucosal burns
Pain
Drooling
Stridor
Refusal to eat or drink
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20
Q

Rx Caustics

A 
Endoscopy
Steroids? - no benefit
Airway support
Esophageal rest
Esophageal replacement
Increased risk for esophageal carcinoma with alkali (1000-3000x)
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21
Q

Battery ingestion rx

A

Esophageal - remove
Gastric - f/u xray, 4-7days
>23mm diameter - xray - 48hrs
Persistent gastric - remove

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22
Q

Sx of hydrocarbon ingestion

A

Dyspnea, tachypnea, hypoxemia
Wheezing, cough
CNS depression
N/V, abdominal pain

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23
Q

Hydrocarbon Rx

A

Observation
Admit if symptomatic, abn CXR or hypoxemia
Decontamination?

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24
Q

Iron toxicity

A

60mg/kg - moderate/severe

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25
Q

Iron toxicity serum levels

A

500mcg/kg - severe

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26
Q

Sxs of iron toxicity

A

WBC > 15,000
Glucose >150
V/D
Positive abdominal XR

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27
Q

4 Phases of Iron Toxicity

A

1 - <12hrs - N/V, diarrhea, GI bleed, rarely shock
2 - 6-36hrs - asymptomatic
3 - 12-48hr - liver failure, shock, metabolic acidosis, encephalopathy, death
4 - 4-8wks - pyloric or antral scarring and stenosis

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28
Q

Rx Iron Ingestion

A

Charcoal ineffective
Emesis if <6hrs (delayed gastric emptying)
Whole bowel irrigation
Deferoxamine 15mg/kg/hr IV - orange/pink urine, stop when iron clears

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29
Q

NSAID Ingestion

A 
N/V, abd pain
GI bleeding
Seizures
Apnea
Metabolic Acidosis
Renal failure
Hepatic failure
30
Q

Rx NSAIDs

A

Activated charcoal
Symptomatic therapy
Dialysis not effective

31
Q

Sx Opioid Ingestion

A

Miosis
Respiratory depression
CNS depression - codeine, meperidine and dextromethorphan cause CNS irritability - stupor and delerium

32
Q

Rx Opioid ingestion

A

ABCs
Activated charcoal
Naloxone - half life 60-90min - don’t treat and turf

33
Q

Sx Organophosphates

A

SLUDGE

Delayed neurotoxicity - paresthesias, weakness, ataxia, personality changes, cognitive impairment

34
Q

Rx Organophosphates

A 
Skin decontamination
Activated charcoal
Supportive care
Atropine
Pralidoxime (2 PAM) - acetylcholinesterase reactivator
35
Q

Sx salicylates

A 
Fever
N/V
Tinnitus
Lethargy, coma, seizures
Respiratory alkalosis
Metabolic acidosis
Hyperglycemia
36
Q

Dx salicylate ingestion

A

ABG for acid/base status

Serum level

37
Q

Rx Salicylates

A 
Activated charcoal
Whole bowel irrigation
Rehydration
Alkalinization - decreases CNS penetration and enhances excretion
Hemodialysis - renal failure, acidosis
38
Q

Sx TCA

A

CCC - comas, convulsions, cardiac

Peripheral anticholinergics - dry, tachycardia, hypertension, urinary retention (blind as a bat)

CNS - confusion, agitation, lethargy, coma, seizures

Cardiac - prolonged PR, QRS, QTc; heart block; torsades de points, hypotension

39
Q

TCA Eval

A

QRS nL x 6hrs - d/c
QRS >0.1s - seizure risk
QRS >0.16s - dysrhythmia risk

40
Q

Rx TCA

A

Activated charcoal
Seizures - benzos or barbituates
Sodium bicarbonate
Ventricular dysrhythmias - lidocaine or magnesium

41
Q

Antidotes = Acetaminophen

A

N-acetylcysteine

42
Q

Antidotes = Benzodiazepines

A

Flumazenil

43
Q

Antidotes = Digitalis

A

specific Fab

44
Q

Antidotes = Iron

A

deferoxamine

45
Q

Antidotes = INH

A

Pyridoxine

46
Q

Antidotes = Narcotics

47
Q

Antidotes = organophosphates

A

Atropine/Pralidoxime

48
Q

Antidotes = TCA

A

Sodium bicarbonate

49
Q

Antidotes = Ethylene glycol

A

fomepizole

50
Q

Antidotes = Arsenic

A

BAL, penicillamine

51
Q

Antidotes = B blockers

52
Q

Antidotes = carbon monoxide

A

hyperbaric oxygen

53
Q

Antidotes = coumadin

54
Q

Antidotes = Cyanide

A

Sodium nitrite/thiosulfate

55
Q

Antidotes = ethylene glycol/methanol/ethanol

A

Fomepizole

56
Q

Antidotes = heparin

A

protamine sulfate

57
Q

Antidotes = lead

A

BAL, EDTA, DMSA, penicillamine

58
Q

Antidotes = Mercury

59
Q

Antidotes = Methemoglobinemia

A

Methylene blue

60
Q

Antidotes = narcotics

61
Q

Antidotes = Phenothiazines

A

Diphenhydramine

62
Q

Antidotes = Rattlesnake bite

A

Crotalid antivenom

63
Q

Symptoms of this substance use includes:

  • drowsiness
  • decreased inhibition
  • lightheadedness
  • disorientation
64
Q

Most common fatal complication of inhalant use

A

Cardiac arrhythmia

65
Q

Most common effect of chronic inhalant abuse

A

Encephalopathy

66
Q

Tachycardia
Tremulousness
HTN
Mydriasis

67
Q

Disinhibition and agitation
Hallucinations
Generalized muscle weakness
Nystagmus

A

Volatile inhalants

68
Q

Combative
Tachycardia
Mydriasis

A

Amphetamines

69
Q

Combative

Both vertical and horizontal nystagmus

70
Q

Dry mouth
Dilated pupils
Drowsiness
Distortion of time

71
Q

Gynecomastia

A

Chronic marijuana use

Pediatric Board Review (17 decks)

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