Poisoning Flashcards
Which gender is poisoning most common in?
Females
What is the commonest age group of poisoning?
15 - 24 y/o
What percentage of poisonings are clinically serious?
5%
Which groups of patients are most successful at suicide as a result of poisoning most?
Older patients
Young males
Which drugs are the most common method of poisoning?
Paracetamol
Which drugs are increasingly causing death from poisoning?
Opiates
Analgesics
Psychotropic drugs
What is most commonly used in the poisoning of children?
Household products
Most deaths are from Carbon monoxide
What steps may be needed for managing poisoning?
Resuscitation Supportive care Decontamination Identification Antidotes Enhance elimination Management of complications Psychosocial support
Most cases: simple resuscitation and supportive care
When would intubation be considered in resuscitation?
If unable to breath for themselves or if loss of gag reflex
What things should be excluded if a patient has arrhythmias?
Exclude:
- hypoxia
- acidosis
- electrolyte imbalance
What drugs should be given to control convulsions?
IV lorazepam
What are the methods of decontamination?
Reduced absorption
- forced emesis
- gastric lavage
- activated charcoal (within 1 hour of ingestion)
- catharsis
- whole bowel irrigation
Enhances elimination
- urine alkalinisation
- forced diuresis
- renal dialysis
- haemoperfusion
What drugs could present with the following clinical symptoms?
- coma
- hypertonia
- myoclonus
- mydriasis
- sinus tachycardia
TCAs
Antihistamines
Orphenadrine
Thioridazine
What drugs could present with the following clinical symptoms?
- coma
- miosis
- reduced RR
Opiates
What drugs could present with the following clinical symptoms?
- N&V
- Tinnitus
- Deafness
- Sweating
- Hyperventilation
- Vasodilation
- Metabolic acidosis
Salicylates
What drugs could present with the following clinical symptoms?
- coma
- hypotonia and hyporeflexia
- hypotension
- plantar response: extensor or absent
Benzodiazepines +/- alcohol
Barbiturates
Severe TCAs
What drugs could present with the following clinical symptoms?
- hyperthermia
- tachycardia
- delirium
- agitation
- mydriasis
MDMA
What is the antidote of paracetamol?
N-acetyl cysteine
Methinonine (alternative)
What is the antidote of benzodiazepines?
Flumazenil
What is the antidote of opiates?
Naloxone
What is the antidote of beta-blockers?
Glucagon
What is the antidote of iron?
Desferrioxamine
What is the antidote of paraquat?
Fullers earth
What is the antidote of methanol?
Ethanol
What is the antidote of digoxin?
Digoxin-specific antibodies
What are some of the symptoms of TCA poisoning?
Drowsiness Dry mouth Mydriasis Tachycardia Hyperreflexia Extensor plantars Ataxia Confusion Fits and coma Metabolic acidosis Respiratory failure Myocardial depression Arrythmias
Which patients are high risk following paracetamol poisoning?
Patients on enxyme inducing drugs
Alcoholics
HIV patients
Anorexia nervosa patients/malnutrition patients
What are the features of paracetamol toxicity?
Anorexia, N&V after 24 hours
Abdo pain
Hyper/hypoglycaemia
Metabolic acidosis
Jaundice / encepalopathy
Renal failure
What are the clinical symptoms of Carbon monoxide poisoning?
Headache
N&V
Vertigo
Subjective weakness
Altered level of consciousness
What are the physical signs of carbon monoxide poisoning?
Skin: cherry red lips and nail beds - uncommon
CVS: sinus tachycardia
CNS: Signs can be very varied resembling a CVA, drug overdose, or loss ofconsciousness
Also cortical blindness, aphasia, Parkinsonian or manic depressive states
What is the treatment for Carbon monoxide poisoning?
Remove patients from CO containing atmosphere
100% oxygen until asymptomatic and COHb < 10%
