Poisoning

Question 1

Ingestions not to be treated with Charcoal

Answer 1

Alcohol, iron, caustics, hydrocarbons, ethylene glycol, lithium, heavy metals

Question 2

Activated charcoal dose

Answer 2

1gm/kg body weight, First dose in 70% sorbitol NOT subsequent doses

Question 3

Multiple doses of charcoal potentially useful for

Answer 3

theophylline, phenobarbital, salicylate, digoxin (drugs with eneterohepatic circulation or delayed absorption)

Question 4

urine alkalization

Answer 4

helpful with Aspirin poisoning

Question 5

• hyperthermia, tachycardia, hypertension tachypnea, vasodilatation (red)
• Agitations, Hallucinations, Delirium (mad)
• MYDRIASIS (bat)
• dry, flushed skin (bone)

Answer 5

ANTICHOLINERGICS
antihistamines
antipsychotics
atropine
TCAs
amanita mushrooms
deadly nightshade, jimson weed

Question 6

• Bradycardia
• Confusion, Delirium, Seizures, Coma
• MIOSIS
• diaphoresis
  SLUDGE

Answer 6

CHOLINERGICS
organophosphate insecticides
carbamate insecticides
nerve gas 
myasthenia gravis medications

Question 7

• Hypothermia, Bradycardia, Hypotension, hypotension, low RR
• Sedation, Coma
• MIOSIS
• Dry Pale skin

Answer 7

OPIODS, SEDATIVE, HYPNOTICS

Question 8

Increased osmolar gap

Answer 8

alcohols

Question 9

increase anion gap

Answer 9

acids

Question 10

4 stages of acetaminophen toxicity

Answer 10

Satge 1 (0-24hrs) nausea, anorexia, vomiting
Stage 2 (12- 48hrs) asymptomatic
Stage 3 (2- 7 days) fulminant hepatic failure
Stage 4 (1-2 weeks) die/recovery/livertransplant

Question 11

Rx of acetaminophen toxicity

Answer 11

1. Charcoal
2. N-acytylcysteine (mucomyst) initiate upto 24hrs after ingestion. Oral dose - 140 mg/kg then 70 q4 times 17 doses.
   IV dose 150mg/kg over 1 hour, 50 mg/kg over 4 hrs, then 100mg/kg over 16 hours. Total 300mg/kg over 21 hrs.

Question 12

Rx of anticholinergics

Answer 12

Charcoal
physostigmine
Benzodiazepines

Question 13

respiratory depression,
bradydysrhythmias
hypotension
hallucinations
seizures
hypoglycemia

Answer 13

Beta blockers

Question 14

Rx of beta blockers

Answer 14

Activate charcoal
whole bowel irrigation
glucagon (recerses -- hypoglycemia, hypotension, bradycardia)
atropine (bradycardia)
milrinone
epinephrine (cardiac arrest)

Question 15

Button Batteries - electrical discharge, pressure leakage
May be asymptomatic

Mx

Answer 15

• Xray AP - lateral nasopharynx to anus (12mm)
• Esophageal location - remove emergently
• distal (stomach) left in place, reimage in 48 hrs
• if 15mm remove endoscopically

Question 16

Coin ingestion Mx

Answer 16

• Xray AP - lateral nasopharynx to anus
• Esophageal and asymptomatic - observe 24 hrs
• Remove endoscopically if >24 hrs or symptomatic

Question 17

rare earth magnets

Answer 17

• Xray to locate and quantify the magnet

- Abdominal X ray if positive obtain lateral

Question 18

Mucosal burns, pain, drooling, stridor, refusal to eat/drink

Answer 18

caustic ingestions

Question 19

Caustic ingestions alkaline

Answer 19

ammonia >5% solution
sodium hypochlorite >5% solution (bleach)
laundry detergents, drain openers

Question 20

Caustic ingestions Acids

Answer 20

drain openers, toilet bowel cleaners, rust removers, oven cleaners

Question 21

Rx of Caustic ingestion

Answer 21

Endoscopy, airway support if steroids,

Question 22

Mx of single rare earth magnet -

Answer 22

no metals or magnets near child, x rays to confirm passage

Question 23

Mx of mutiple rare earth magnets

Answer 23

symptomatic- surgical removal
asymptomatic - golytlee, x rays
if no progression over 24 hrs - surgical removal