Poisoning Flashcards
symptoms of TCA (SNRI and block Ach)
1) anticholinergic effects –> dry mouth, dizzy, sinus achy, urinary retention
2) more serious –> seizures, arrhythmias, coma
Ix for TCA OD
1) ECG most important
-get widened QRS –> indicates risk of seizures or if even more wide shows risk of ventricular fibrillation
2) can do ABG
Tx of anaphylactic reaction to NAC
stop infusion and start at slower rate (no adrenaline)
how does salicylate OD present (aspirin)
they irritate the gastric lining and cause ototoxicity so present with N+V, epigastric pain and tinnitus
-later symptoms –> coma, confusion, tachypnoea and warm peripheries
Ix for salicylate poisoning
ECG, CBG, CBG, plasma salicylicate and paracetamol conc, U+E (may get hyperkalaemia), LFT, coag
MX of salicylate acid poisoning
there is no antidote so IV sodium bicarb to alkalinise urine and haemodialysis if severe
what kind of injury to alkali vs acidic agents cause
alkali –> liquefactive necrosis –> oesophageal injury
acidic –> coagulative necrosis –> gastric injury
Complications of corosive substance ingestion
-upper GI perforation
-aspiration pneumonitis
-infection
-strictures
MX of corrosive substance ingestion
urgent upper GI endoscopy if any symptoms and high dose PPI
-if asymptomatic can discharge after a period of oral fluid and observation
signs of CO poisoning
headache, N+V, vertigo, confusion, pink skin, arrhythmias
Dx of CO poisoning
VBG or ABG
MX of CO poisoning
100% high flow O2 via a non rebreather mask or hyperbaric O2
early features of paracetamol OD
N+V
Rf for paracetamol OD
glutathione deficiency (malnourishment)
Ix for paracetamol OD
-paracetamol levels at 4 hours, U+E, LFT, glucose, clotting, VBG
MX of paracetamol OD
1) if presenting within 8 hours of the OD –> take bloods 4 hrs after ingestion
2) if presenting after 8 hours, take levels but start Tx straight away if ingested >150mgkg
-if <150mg/kg then wait for results
3) if presenting over 24 hours and any symptoms –> start Tx
NAC most effective if given within 8 hours
criteria for liver transplant from paracetamol OD
Kings college
1) pH <7.3 >24 hours from ingestion
OR all of the following
1) raised PT
2)creatinine >300
3) grade III or IV encephalopathy
symptoms of local anaesthetic toxicity
perioral numbness, metallic taste, confusion, drowsiness –> this can progress into seizures and cardiac arrest
Mx of local anaesthetic toxicity
20% lipid emulsion
what drug is taken 3 times a day, is safe with alcohol and can be used to help reduce cravings
acamprosate
what drug can be used to reduce cravings / reduce the pleasurable experience of drugs or alcohol
naltrexone
features of delirium tremens (peak at 72 hours)
visual and auditory hallucinations, coarse tremor, tachycardia, fever
