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PSA > Poisoning > Flashcards

Poisoning Flashcards

1
Q

Name 5 medications with delayed reaction

A

Aspirin, paracetamol, iron, TCAs, co-phenotrope

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2
Q

When should O2 be given at the highest conc possibl?

A

In carbon monoxide poisoning and irritant gases

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3
Q

What happens if BP drops to below 70?

A

Irreversible brain damage, renal tubular necrosis

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4
Q

Which 3 classes of drug are more likely to cause cardiac conduction defects?

A

TCAs, antipsychotics, antihistamines

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5
Q

Management of hyperthermia

A

Remove all unnecessary clothing, fan, sponge with tepid water

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6
Q

What might cause hyperthermia?

A

CNS stimulants
Serotonin syndrome
Children taking antimuscarinics

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7
Q

What might cause hypothermia?

A

After deeply unconscious for hours
eg OD barbiturates or phenothiazines
(eg secobarbital or prochlorperazine)

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8
Q

Management of methaemoglobinaemia?

A

Methylthioninium chloride if hypoxic despite O2 or conc >30%

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9
Q

When is activated charcoal useful?

A

To prevent absorption if drug taken very recently (up to 1hr post ingestion)
To enhance elimination of drugs such as carbamazepine, dapsone, phenobarbital, quinine, theophylline

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10
Q

When should activated charcoal be avoided?

A

Petroleum distillates, corrosive substances, alcohols, malathion, cyanides and metal salts (including iron and lithium)

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11
Q

When is haemodialysis used in poisoning?

A 
Ethylene glycol
Lithium
Methanol
Phenobarbital
Salicylates
Sodium valproate
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12
Q

What is done in salicylate poisoning?

A 
Activated charcoal if within 1hr and >125mg/kg ingested
Haemodialysis considered (if>700mg/litre)
Alkalinisation of urine (IV bicarbonate)
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13
Q

When is gastric lavage indicated?

A

Only in severe cases of poisoning where activated charcoal cannot be used
Iron and Lithium

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14
Q

What are the features of salicylate poisoning?

A 
Hyperventilation (respiratory alkalosis)
Followed by metabolic acidosis
Tinnitus
Deafness
Vasodilation
Sweating
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15
Q

When is salicylate poisoning severe?

A

> 500mg/L conc

Metabolic acidosis

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16
Q

When should activated charcoal be given in salicylate poisoning?

A

Within 1hr of ingesting >125mg/kg aspirin

17
Q

Features of opioid OD

A

Coma, resp depression, pin point pupils,

18
Q

Antidote to opioids?

A

Naloxone hydrochloride

IV infusion and monitoring

19
Q

Danger of paracetamol OD?

A

Severe hepatocellular necrosis
Renal tubular necrosis
Liver damage maximal 3-4days post ingestion
Encephalopathy, haemorrhage, hypoglycaemia, cerebral oedema, death

20
Q

Management of paracetamol poisoning

A

Hospital if >75mg/kg
Treat if >150mg/kg in less than 1hr
Acetyl cysteine protect liver if infused up to 24hrs post ingestion. Most effective for 8hrs post ingestion (augments glutathione levels)

21
Q

When do you measure a paracetamol level?

A

4 hrs post ingestion

Use a graph w/the treatment line

22
Q

Name 11 features of TCA OD

A 
Dry mouth
Coma & convulsions
Hypotension
Hypothermia
Hyperreflexia
Respiratory failure
Conduction defects & arrhythmias
Dilated pupils
Urinary retention
23
Q

Name 8 features of SSRI OD

A 
Agitation
Tremor
Nystagmus
Drowsiness
Sinus tachycardia
Convulsions
n&v
24
Q

What is serotonin syndrome?

A 
Neuropsychiatric effects
Neuromuscular hyperactivity
Autonomic instability
Hyperthermia
Rhabdomyolysis
Renal failure
Coagulopathies
25
Q

What is the antagonist to bezodiazepines?

A

Flumazenil

26
Q

In massive beta blocker OD what is needed?

A

Atropine to treat bradycardia
IV glucagon if still in cardiogenic shock
If still, IV isoprenaline or pacemaker

27
Q

Features of CCB OD

A

N+v+d
Agitation, confusion, coma
Metabolic acidosis and hyperglycaemia
Hypotension (cardiac depression)

28
Q

Management of CCB OD

A

Activated charcoal within 1 hr
Calcium chloride/gluconate
Atropine

29
Q

Management of iron OD

A

IV desferrioxamine mesilate (chelates iron)

30
Q

Management of lithium OD

A

Haemodialysis
Increase urine output (fluids)
Supportive care (electrolytes, convulsions ec)
Gastric lavage?

31
Q

Features of lithium OD

A

Apathy, restlessness
Ataxia, weakness, dysarthria, muscle twitching
Excess of 2mmol/L = poisoning

32
Q

Stimulant OD?

A 
Early stage (mania)-> lorazepam/diazepam
Late stage (exhaustion hyperthermia)=> tepid sponging, anticonvulsants, ventilation
33
Q

Effects of cocaine

A

Agitation, dilated pupils, tachycardia, hypertension, hallucinations, hyperthermia, hypertonia, and hyperreflexia; cardiac effects include chest pain, myocardial infarction, and arrhythmias.

34
Q

Serious SE of ecstasy

A

Delirium, coma, convulsions, ventricular arrhythmias, hyperthermia, rhabdomyolysis, acute renal failure, acute hepatitis, disseminated intravascular coagulation, adult respiratory distress syndrome, hyperreflexia, hypotension and intracerebral haemorrhage
Self induced water intoxication

35
Q

Management of theophylline OD

A 
Repeated activated charcoal
Ondansetron for vomiting
KCl for hypokalaemia
Lorazepam for convulsions
Diazepam for sedation
If not asthmatic: B-blocker
36
Q

Management of cyanide poisoning

A

O2
Dicobalt edetate if strong clinical suspicion of severe cyanide poisoning
Hydroxocobalamin for smoke inhalation victims

37
Q

Management of ethylene glycol or methanol OD

A

Fomepizole

Ethanol

38
Q

Management of carbon monoxide poisoning

A 
Clear airway
100% O2
NIV?
Cerebral oedema-> mannitol
? hyperbaric O2 chamber
39
Q

Management of organophosphate poisoning

A

Atropine

Pralidoxime chloride

PSA (21 decks)

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