Poisoning Flashcards
What are the key aspects of historical data in ingestions?
what was ingested?
How much?
When?
Why?
What are the key elements of the physical exam in ingestions?
vital signs!! mental status pupils skin color track/marks/skin poppers presence of sweat bladder size (urinary retention?)
Describe the anticholinergic toxidrome.
mad as a hatter (AMS) blind as a bat (mydriasis) Hot as Hades Red as a beat Dry as a bone (no sweating, urinary retention, constipation)
What are the three typical medications taken in anticholinergic poisoning?
TCAs
antihistamines
overactive bladder meds like oxybutynin
Describe the cholinergic toxidrome.
SLUDGE
Salivation Lacrimation Urination Diaphoresis Defecation Gastrointestinal upset excessive bradycardia or tachycardia (muscarinic or nicotinic)
What are the main sources of cholinergic poisoning?
organophosphates (pesticides)
nerve agents
What is the treatment for cholinergic poisoning?
atropine
2 PAM
decontaminate
Describe the sympathomimetic toxidrome.
(Fight or flight)
Tachycardia Hypertension Mydriasis Diaphoresis Hyperthermia Agitation
What are the usual sources for sympathomimetic poisoning?
OTC cold medicine cocaine amphetamines meth dietary suppl MDMA Ecstasy
What is the treatment for sympathomimetic poisoning?
sedation
hydration
treat any rhabdo or hyperthermia
Describe the opioid toxidrome.
apnea
hypoxia
unresponsiveness
flash pulmonary edema
What is the treatment for opioid poisoning?
naloxone
intubation if they need it
What should be included in the diagnostic testing for poisoning?
EKG (QRS intervals, R waves, rhythm, etc) Tox screen is mandatory Acetaminophen level ASA level Electrolytes Med levels if susp.
What are the three decontamination methods?
activated charcol
whole bowel irrigation (w/ PEG)
gastric lavage
What is the general time limit for activated charcol?
should be given within 1 hour of ingestion (but may work after that too)
