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Core Pediatrics > Poisoning > Flashcards

Poisoning Flashcards

0
Q

Give the antidote to the ff toxin/poison:

Black widow spider

A

Latrodectus antivenin

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1
Q

SUBSTANCES POORLY ADSORBED BY ACTIVATED CHARCOAL

A 
Alcohols
		Caustics: alkalis and acids
		Cyanide
		Heavy metals (e.g., lead)
		Hydrocarbons
		Iron
		Lithium
  • Charcoal is most likely to be effective when given within 1hr of ingestion
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2
Q

Give the antidote to the ff toxin/poison:

Botulinum toxin

A

Botulin antitoxin

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3
Q

Give the antidote to the ff toxin/poison:

Calcium channel antagonists

A

Glucagon and/or insulin and glucose

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4
Q

Give the antidote to the ff toxin/poison:

Dystonic reactions

A

Diphenhydramine and/or benztropine

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5
Q

Give the antidote to the ff toxin/poison:

Fluoride, calcium channel blockers

A

Calcium salts

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6
Q

Give the antidote to the ff toxin/poison:

Heparin

A

Protamine

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7
Q

Give the antidote to the ff toxin/poison:

Methotrexate, trimethoprim, pyrimethamine

A

Folinic acid

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8
Q

Give the antidote to the ff toxin/poison:

Rattlesnake envenomation

A

Crotab-specific Fab antibodies

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9
Q

Give the antidote to the ff toxin/poison:

Sodium channel blockade (tricyclic antidepressants, type 1 antiarrhythmics)

A

Sodium bicarbonate

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10
Q

What poison/toxin is associated with the following PE finding?

Odor of Bitter almonds

A

Cyanide

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11
Q

What poison/toxin is associated with the following PE finding?
Odor of acetone

A

Isopropyl alcohol, methanol, paraldehyde, salicylates

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12
Q

What poison/toxin is associated with the following PE finding?
Odor of Alcohol

A

Ethanol

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13
Q

What poison/toxin is associated with the following PE finding?
Odor of Wintergreen

A

Methyl salicylate

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14
Q

What poison/toxin is associated with the following PE finding?
Odor of Garlic

A

Arsenic, thallium, organophosphates, selenium

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15
Q

Toxin associated with the ff OCULAR SIGNS:

Miosis

A

Opioids (except propoxyphene, meperidine, and pentazocine), organophosphates and other cholinergics, clonidine, phenothiazines, sedative-hypnotics, olanzapine

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16
Q

Toxin associated with the ff OCULAR SIGNS:

Mydriasis

A

Atropine, cocaine, amphetamines, antihistamines, TCAs, carbamazepine, serotonin syndrome, PCP, LSD, post-anoxic encephalopathy

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17
Q

Toxin associated with the ff OCULAR SIGNS:

Nystagmus

A

Phenytoin, barbiturates, sedative-hypnotics, alcohols, carbamazepine, PCP, ketamine, dextromethorphan

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18
Q

Toxin associated with the ff OCULAR SIGNS:

Lacrimation

A

Organophosphates, irritant gas or vapors

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19
Q

Toxin associated with the ff OCULAR SIGNS:

Retinal hyperemia

A

Methanol

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20
Q

Cutaneous signs manifested with ingestion of the ff toxins:

Organophosphates, salicylates, cocaine and other sympathomimetics, serotonin syndrome, withdrawal syndromes

A

Diaphoresis

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21
Q

Cutaneous signs manifested with ingestion of the ff toxins:

Thallium, arsenic

A

Alopecia

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22
Q

Cutaneous signs manifested with ingestion of the ff toxins:

Boric acid, elemental mercury, cyanide, carbon monoxide, disulfuram, scombroid, anticholinergics

A

Erythema

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23
Q

Cutaneous signs manifested with ingestion of the ff toxins:

Methemoglobinemia (e.g., benzocaine, dapsone, nitrites, phenazopyridine), amiodarone, silver

A

Cyanosis (unresponsive to oxygen)

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24
Q

Oral signs manifested with ingestion of the ff toxin:

Organophosphates, salicylates, corrosives, ketamine, PCP, strychnine

A

Salivation

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25
Q

Oral signs manifested with ingestion of the ff toxin:

Corrosives, oxalate-containing plants

A

Oral Burns

26
Q

Oral signs manifested with ingestion of the ff toxin:

Lead, mercury, arsenic, bismuth

A

Gum lines

27
Q

GI symptom associated with ingestion of the ff toxin:

Antimicrobials, arsenic, iron, boric acid, cholinergics, colchicine, withdrawal

A

Diarrhea

28
Q

GI symptom associated with ingestion of the ff toxin:

Arsenic, iron, caustics, NSAIDs, salicylates

A

Hematemesis

29
Q

Cardiac signs associated with ingestion of the ff toxins:

Sympathomimetics (e.g., amphetamines, cocaine), anticholinergics, antidepressants, theophylline, caffeine, antipsychotics, atropine, salicylates, cellular asphyxiants (cyanide, carbon monoxide, hydrogen sulfide), withdrawal

A

Tachycardia

30
Q

Cardiac signs associated with ingestion of the ff toxins:

β-Blockers, calcium channel blockers, digoxin, clonidine and other central α2 agonists, organophosphates, opioids, sedative-hypnotics

A

Bradycardia

31
Q

Cardiac signs associated with ingestion of the ff toxins:

Sympathomimetics (amphetamines, cocaine, LSD), anticholinergics, clonidine (early), monoamine oxidase inhibitors

A

Hypertension

32
Q

Cardiac signs associated with ingestion of the ff toxins:

β blockers, calcium channel blockers, cyclic antidepressants, iron, phenothiazines, barbiturates, clonidine, theophylline, opioids, arsenic, amatoxin mushrooms, cellular asphyxiants (cyanide, carbon monoxide, hydrogen sulfide), snake envenomation

A

Hypotension

33
Q

CNS signs associated with ingestion of the ff toxins:

Alcohol, anticonvulsants, benzodiazepines, barbiturates, lithium, dextromethorphan, carbon monoxide, inhalants

A

Ataxia

34
Q

CNS signs associated with ingestion of the ff toxins:

Opioids, sedative-hypnotics, anticonvulsants, cyclic antidepressants, antipsychotics, ethanol, anticholinergics, clonidine, GHB, alcohols, salicylates, barbiturates

A

Coma

35
Q

CNS signs associated with ingestion of the ff toxins:

Sympathomimetics, anticholinergics, antidepressants (especially TCAs, bupropion, venlafaxine), isoniazid, camphor, lindane, salicylates, lead, organophosphates, carbamazepine, tramadol, lithium, ginkgo seeds, water hemlock, withdrawal

A

Seizures

36
Q

CNS signs associated with ingestion of the ff toxins:

Sympathomimetics, anticholinergics, LSD, PCP, hallucinogens, lithium, dextromethorphan, steroids, withdrawal

A

Delirium/psychosis

37
Q

CNS signs associated with ingestion of the ff toxins:

Lead, arsenic, mercury, organophosphates

A

Peripheral neuropathy

38
Q

SCREENING LABORATORY CLUES IN TOXICOLOGIC DIAGNOSIS

ANION GAP METABOLIC ACIDOSIS (MNEMONIC = MUDPILES)

A 
Methanol, metformin
		Uremia*
		Diabetic ketoacidosis
		Paraldehyde, phenformin
		Isoniazid, iron, massive ibuprofen
		Ethylene glycol, ethanol
		Lactic Acidosis (i.e. cyanide, carbon monoxide)
		Salicylates
39
Q

SCREENING LABORATORY CLUES IN TOXICOLOGIC DIAGNOSIS

ELEVATED OSMOLAR GAP

A

Alcohols: ethanol, isopropyl, methanol, ethylene glycol

40
Q

SCREENING LABORATORY CLUES IN TOXICOLOGIC DIAGNOSIS

HYPOGLYCEMIA (MNEMONIC = HOBBIES)

A 
Hypoglycemics, oral: sulfonylureas, meglitinides
		Other: quinine, unripe ackee fruit
		Beta Blockers
		Insulin
		Ethanol
		Salicylates (late)
41
Q

SCREENING LABORATORY CLUES IN TOXICOLOGIC DIAGNOSIS

RADIOPAQUE SUBSTANCE ON KUB (MNEMONIC = CHIPPED)

A 
Chloral hydrate, calcium carbonate
		Heavy metals (lead, zinc, barium, arsenic, lithium, bismuth, as in Pepto-Bismol)
		Iron
		Phenothiazines
		Play-Doh, potassium chloride
		Enteric-coated pills
		Dental amalgam
42
Q

COMMON AGENTS CAUSING SEIZURES (MNEMONIC = CAPS)

A

Camphor, carbamazepine, carbon monoxide, cocaine, cyanide
Aminophylline, Amphetamine, anticholinergics, antidepressants (cyclic)
Pb (lead) [also lithium], pesticide (organophosphate), phencyclidine, phenol, phenothiazines, propoxyphene
Salicylates, strychnine

43
Q

Triad of altered mental status, autonomic instability, and neuromuscular hyperactivity (hyperreflexia, tremors, clonus in the lower extremities more than the upper extremities)

A

serotonin syndrome

44
Q

Two antidotes are useful in treating cholinesterase inhibitor poisoning (organophosphates and carbamates)

A

atropine and pralidoxime

  • DUMBBELS
  • Clinical manifestations of organophosphate and carbamate toxicity relate to the accumulation of acetylcholine at peripheral nicotinic and muscarinic synapses and in the CNS
46
Q

Give the antidote:

Acetaminophen/Paracetamol

A

N-Acetylcysteine PO

*Most effective if given within 8 hr of ingestion

47
Q

Give the antidote:

Anticholinergics ie ipatropium

A

Physostigmine IV/IM
Note: Do not use if conduction delays on ECG
may cause Bradycardia, asystole, seizures, bronchospasm, vomiting, headache

48
Q

Give the antidote:

Benzodiazepines

A

Flumazenil IV

49
Q

Give the antidote:

β-Blockers

A

Glucagon IV

50
Q

Give the antidote:

Calcium channel blockers

A 
Insulin IV (Follow serum potassium and glucose closely)
Calcium salts IV
51
Q

Give the antidote:

Carbon monoxide

A

Oxygen inhalational

52
Q

Give the antidote:

Cyanide

A

Amyl nitrate inhalational
Sodium nitrate IV
Sodium thoisulfate IV
Hydoxocobalamin IV (adults)

53
Q

Give the antidote:

Digitalis

A

Digoxin-specific Fab antibodies (Digibind; Digifab) IV

54
Q

Give the antidote:
Ethylene glycol

Methanol
A

Fomepizole IV
Infuse slowly over 30 min; increase doses to q4h if being dialyzed

If Fomepizole is not available, treat with an ethanol infusion
55
Q

Give the antidote:

Iron

A

Deferoxamine IV

56
Q

Give the antidote:

Isoniazid (INH)

A

Pyridoxine IV

57
Q

Give the antidote:

Lead and other heavy metals (e.g., arsenic, inorganic mercury)

A
  1. BAL (dimercaprol) deep IM
    - *Local injection site pain and sterile abscess, nausea, vomiting, fever, salivation, nephrotoxicity
    - Caution: Prepared in peanut oil; contraindicated in patients with peanut allergy
  2. Calcium disodium EDTA IV
  3. Dimercaptosuccinic acid (succimer, DMSA, Chemet) PO
58
Q

Give the antidote:

Methemoglobinemia

A

Methylene blue, 1% solution IV

59
Q

Give the antidote:

Opioids

A

Naloxone IV

60
Q

Give the antidote:

Organophosphates

A
  1. Atropine IV/ET
    - Tachycardia, dry mouth, blurred vision, urinary retention
  2. Pralidoxime (2PAM) IV
    - Nausea, dizziness, headache, tachycardia, muscle rigidity, bronchospasm (rapid administration)
61
Q

Give the antidote:

Salicylates

A

Sodium bicarbonate IV

  • Follow potassium closely and replete as necessary
  • Avoid severe alkalosis (pH >7.55)
62
Q

Give the antidote:

Sulfonylureas

A

Octreotide IV/SC

63
Q

Give the antidote:

Tricyclic antidepressants

A

Sodium bicarbonate
*Indications: QRS widening (>100 ms), hemodynamic instability

Avoid severe alkalosis (pH >7.55)

Follow potassium

Core Pediatrics (20 decks)

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