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ER > Poisoning > Flashcards

Poisoning Flashcards

1
Q

Miosis COPS

A
  • Cholinergics, Clonidine
  • Opiates, Organophosphates
  • Phencyclidine,phenothiazine, pilocarpine
  • Sedatives (barbiturates)
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2
Q

Mydriasis AAAS

A
  • Anticholinergics (atropine)
  • Antihistamines
  • Antidepressants (cyclic)
  • Sympathomimetics (amphetamine, cocaine, LSD)
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3
Q

Diaphoretic Skin SOAP

A
  • Sympathomimetics
  • Organophosphates
  • Aspirin (salicylates)
  • PCP (phencyclidine)
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4
Q

Red Skin

A
  • Carbon monoxide

- Boric acid

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5
Q

Blue Skin

A
  • Methemoglobinemia (TX: methylene blue)
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6
Q

Xray pill fragments (CHIPES)

A
  • Chloral hydrate, calcium
  • Heavy metals
  • Iron
  • Phenothiazines
  • Enteric-coated preparations
  • Sustained-released tablets
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7
Q

High Anion gap MUD PILES

A 
Methanol
Uremia
DKA
Phenols
Iron/INH
Lactate
Ethanol/Ethelene glycol (high osmolar gap)
Salicylates
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8
Q

Activated Charcoal contrandicated

CHEMICAL CamP

A
  • Caustic
  • Hydrocarbons (most water soluble compounds)
  • Electrolytes
  • Metals
  • Iron
  • Cyanide
  • Alcohols (including ethanol)
  • Lithium
  • Camphor (used in Vicks VapoRub)
  • Phosphorus
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9
Q

Tylenol overdose timelin

A

0-24hrs- nausea/vomiting or none
24-48hrs-asymptomatic ? RUQ pain, LFT mildly increase
48-96hr- Peak SX, AST>20,000, high PT
4-14 day- recovery w/ resolution sx or death

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10
Q

Anticholinergic overdose

A 
SX: DRY as a bone
RED as a beet
BLIND as a bat
MAD as a hatter
HOT as a hare

TX- Charcoal

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11
Q

Carmazepine

A

SX: within 6-24hrs
severe–> coma,seizure, rep depression
mild–> drowsiness,vomiting, ataxia, slurred
speech,nystagmus
DX- levels 2-4hrs after with f/u levels (peak 24-72hrs) & BUN/Cr
TX- charcoal

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12
Q

Clonidine (alpha 2 adrenergic agonist)

A

SX-within 1 hr, resolve 24hr
CNS & rep depression, bradycardia, hypo or pradoxically hyperTN
TX: Atropine, pressors, activated charcoal/bowel irrigation (pt ingest patch), Naloxone

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13
Q

Ibuprofen

A

SX-within 4 hrs, resolve 24hr
level >100 GI irritation, lethargy, ataxia–> level >400 anion gap metabolic acidosis, renal failure, coma, seizures
TX- activated charcoal

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14
Q

Iron- Phases

A

20mg/kg mild, 40mg/kg mod, >60mg/kg sev

1) GI (30min-6hrs)
- severe hematemesis & bloody diarrhea
2) Stability (6-24hrs)
3) Systemic toxicity (within 48hrs)
- hypovol shock, severe metabolic acidosis
4) Hepatotoxicity (2-3 day)
- coagulation disruption worsens GI bleed
5) GI/pyloric scarring (2-6 weeks post-ingestion)

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15
Q

Iron- DX & TX

A

DX- 4hrs after ingestion >500 toxic level

TX- IV deferoxamine +/- whole bowel irrigation

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16
Q

Phenothiazide (promethazine, prochlorperazine, chlorpromazie)

A

SX-
Dose dependent: anticholinergic, Temp +/- , BP +/-, “cogwheel rigidity” of neck/biceps/quadriceps
Dose in-dependent: spasms neck, tongue thrusting, oculogyric crisis
TX- charcoal, IV Benadryl (dystonia)

17
Q

Salicylate

A

SX:
- GI- N/V
- Resp- hypernea 2nd respiratory alkalosis
- CNS (if severe) agitation, confusion, coma, TINNITUS
DX-
- positive anion gap w/ metabolic acidosis w/ mix pic of repiraory alkalosis
- low glucose/K
-Level >30 ? toxic, >40 symptomatic, >100 serious
TX-charcoal, alkalinize urine pH>8 (improve elimination)

18
Q

Theophylline

A

SX:
- 20-50 N/V, muscle tremors
- >60 seizures, arrhythmias
DX:
- HIGH glucose, calcium
- LOW potassium (ass metabolic acidosis), phosphate
TX- charcoal multiple doses, hemodialysis

19
Q

TCA CCCA

A

SX- within 30min- 6hrs
- Coma
- Convulsions
-Caridiac dysrhythmias (tachy, Hyper or HypoTN, wide QRS, prolonged QT)
- Acisodis
TX- charcoal, Na bicarb (alkalize serum 7.45-7.5 to prevent dysrhythmias), lidocaine (dysrhythmias)

20
Q

Pt had CO poisoning from house fire with persistent metabolic acidosis

A

-cyanide poisoning

21
Q

Alkaline agents

A
  • Bleach, ammonia, cleaners oven/drains,hair relaxers
  • tasteless
  • severe deep liquefaction necrosis
  • SX: scaring with strictures
22
Q

Acidic

A
  • toilet bowl cleaner, grout cleaner,battery liquid, metal clea
  • Bitter taste
  • Superficial coagulation necrosis
  • SX: thick eschars, severe gastritis, metabolic acidosis, ARF, perforation
23
Q

Caustic Ingestion

A

DX-
- CXR/AXR- ?pneumomediastinum & aspiration pneumonitis
- Endoscopy
TX- dilute milk/water, NO charcoal

24
Q

Hydrocarbon

A
  • turpentine, kerosene, gasoline, lamp oil
    -SX- resp issues including severe resp distress w/ pulmonary aspiration & mild CNS depression, fever
    TX- dermal decontamination, observe 6-8hrs
25
Q

Methanol

A

-metabolized formic acid via alcohol dehydrogenase which inhibits mitochondrial resp
SX:
- initial- N/V, HA
-in 24hr- blurry vision & photophobia, optic nerve damage–> blindness, severe metabolic acidosis
TX; Na bicarb (metabolic acidosis), IV ethanol/fomepizole, folate( enhances break down formic acid), hemodyalis (>25)

26
Q

Ethylene toxins & TX

A

-metabolized glycolic & oxalic acid via alcohol dehydrogenase
- oxalic chelates Ca–> calcium oxalate crystals (seen urine w/ Woods lamp)
TX:Na bicarb (metabolic acidosis), IVethanol/fomepizole, thiamine/pyridoxine (shunt metabolism), hemodyalis (>25)

27
Q

Ethylene- Stages

A

1) 1-12 hrs- “drunk”
2) 12-36 hrs- resp: tachypnea, cyanosis, pulm edema, ARDS
3) 2-3 days- cardiac failure, seizures, cerebral edema, ARF

28
Q

Organophosphates DUMBELS

A

-inhibit cholinesterase
SX: Diarrhea, Urination, Miosis, Bronchospasm, Emesis, Lacrimation, Salivation
- “Nicotinic effects”- twitching,seizures, weakness, slurred speech, confusion, coma,
TX- dermal decontamination, activated charcoal , Atropine (repeat), Pralidoxine (2-PAM-hydrolyzes bond)

29
Q

Plants

A
  • Digitalis- foxglove, lily valley
  • Atropine- jimson, deadly nightshade
  • Cyanide- pear/apple/peach seeds
  • Liver toxicity- mushrooms
30
Q

B-Blocker vs Calcium Channel Blocker

A

bradycardia, hypoTN, arrhythmias

- B blocker-CNS depression & hypoglycemia

ER (3 decks)

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