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Poisoning Flashcards

1
Q

Severity of Cuastics injury depend upon:

A
  • agent type
  • concentration
  • Volume
  • PH
  • titratable acid\alkalline reserve (TAR)
  • Duration of contact
  • stomach contents
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2
Q

What is TAR?

A

Xenobiotic to neutrilize PH of a causatic to that of physiological tissue

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3
Q

What type of necrosis is associated with caustics toxicity?

A
  • alkaline: liquefaction necrosis

- acidic: coagulation necrosis

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4
Q

What are the phases of caustics toxicity?

A
  • acute inflammatory
  • Latent granulation
  • Chronic cicatrization
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5
Q

What are the late complications of Caustics?

A

Most common: stricture

Also esophageal carcinoma and pyloric stenosis

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6
Q

What is the long term effect of eosphageal stricture?

A

Formation of carcinoma

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7
Q

What is the role of induced emesis in caustic toxicity?

A

Contraindicated to the risk of aspiration

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8
Q

How to manage caustic toxicity?

A

1- airway and GI perforation maintenance
2- supportive care
3- no feeding\emesis\charcol\diluting
\neutralizing\steroid\antibiotic

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9
Q

Went to order endoscopy in causatic toxicity

A

Symptomatic older children
◦ Patients with altered mental status
◦ Patients with intentional ingestion
- large volume

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10
Q

What is the ABCs of toxicology

A 
1- A: airway\ antidot 
2- B: breathing 
3- C: circulation 
4- D: diasbility\dcontamination\dectroxe
5- E: elimination
6- F: find antidote 
7- G: get toxicology consult
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11
Q

What is the antidote of acetaminophen?

A

N-acetylcysteine

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12
Q

What to do if the patient O2 sat <90%

A
  • bag-valve-mask

- 100% O2

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13
Q

What to do if the patient O2 sat 90-95%

A

High flow O2

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14
Q

How to determine the level of conciousness?

A 
AVPU method 
Alert
Respond to verbal
Respond to pain 
Unresponsive
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15
Q

To assess disability, what to do?

A
  • AVPU
  • pupil (sizure, reactivity, movement)
  • reflexes
  • glucocheck
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16
Q

What are the 4 main agents to think about in case of disability?

A

1- dextrose for hypoglycemia
2- atropine for cholinergic
3- naloxone for opioid
4- oxygen for carbon monoxide

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17
Q

What indicates decontamination of skin?

A

poisoning with

  • corrosive
  • hydrocarbon
  • toxins absorbed in skin
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18
Q

How to decontamiante skin?

A

1- protective gear
2- remove contaminated clothes
3- flush area with copious running water\saline

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19
Q

What indicates decontamination of eye?

A

1- corrosive
2- hydrocarbon
3- chemical irritant

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20
Q

How to decontaminate eye?

A

1- flush with copious\tap water
2- anasthetic drops
3- remove contact lens
4- check conjunctivia and cornea

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21
Q

How to decontaminate inhalation by irritant gases and fume

A

Respiratory protection & supplemental O2

22
Q

What are the methods for GI decontamination?

A

1- charcoal
2- gastric lavage
3- whole bowel irrigation
4- surgery\endoscopy

23
Q

What is the role of activated charcol?

A

GI protection by absorption of ingested material and faster elimination

24
Q

What is the common side effect of activated charcol?

A

Nausea + aspiration

25
What are the contraindications of activate charcol?
``` 1- perforation 2- obstruction 3- need for endoscopy 4- caustic 5- coma\convulsion 6- abscense of bowel sound 7- toxin poorly absorbed by charcol ```
26
What is the golden hour of activated charcol?
First hour
27
Items that are not effectively decontaminated with activated charcol
Heavy metals, inorganic ions, corrosive, hydrocarbon, alcohol, essential oil
28
How to do whole bowel irrigation?
Administer polyethylene glycol “osmotically balanced” by nasogastric tube
29
What are the contraindication of whole body irrigation?
``` 1- extensive hematamesis 2- paralytic ileus 3- bowel obstruction\perforation 4- peritonitis 5- inability to place nasogastric tube ```
30
What are the side effect of whole body irrigation?
Metabolic acidosis & aspiration | Nausea, vomitting abdominal bloating
31
How to do gastric lavage
Aspiration of content in the stomache
32
What are the contraindications of gastric lavage?
Small children and corrostive\hydrocarbone
33
What are the side effects of gastric lavage?
Painful, time consuming, may induce bradycardia by vagal response
34
Asymptomatic patient presenting after ingestion of a substance are like that because
1- it’s non toxic 2- insufficient amount of poison 3- delayed absorption 4- the metabolite is toxic not the substance
35
What are the basic investigations to order in acute poisoning
``` 1- Blood (platelet\leukocyte\PT\PTT) 2- glucometer 3- ABG (anion gap Na-Cl+HCo= 12+-4) 4- electrolyte 5- Co-oximetery 6- ECG 7- urine and serum toxicology screen 8- LFT\RFT 9- imaging ```
36
``` 1- Hypertension & Tachycardia 2- Agitation, psychosis, delerium 3- mydriasis 4- Hyperthermia & diaphoresis 5- increased bowel sound ``` This is which toxidrome?
Sympathomimitcs
37
``` 1- Tachycardia & flushing 2- delerium & hallucination 3- mydriasis 4- Hyperthermia & dryness 5- decreased bowel sound ``` This is which toxidrome?
Anticholinergic
38
Differentiate between anticholinergic and sympathomimetics In: - sweating & heat - eye - HR
Heat, Eye and HR same; hyperthermia, myadrisis and tachycardia Except for diaphoresis in sympathomimitics
39
Name the anticholinergic agents
Atropine and | Anti: (depressnant - histamine - psychotic - parkinsoin)
40
``` Leaking & Bees. 1- defication 2- peeing (incontinence) 3- emesis 4- lacrimation 5- salivation ————————— 6- bradycardia 7- bronchosapsm 8- bubils are small ``` This is which toxidrome?
Cholinergic
41
Small pupils is seen in (meiosis)
1- opioids 2- cholinergics 3- sedatives 4- organophosphate
42
What are the opioids that you know and what is their antidote?
Methadone, morphine, heroin | Antidote: naloxone
43
What will you find in opioids toxicity?
Coma - miosis - Hypo (tension, reflexia, thermia, pnea)
44
Differentiate between opioid and sedatives?
- Both: respiratory\CNS\CVS depression - hyporeflexia - hypotension - Opioid: eye sign & hypothermia - sedative: ataxia, drowsy, slurred speach.
45
What are the sedatives that you know
Barbiturate, benzodiazpine and ethanol
46
Mention the following - High HR, Temp, pupil - Low sweat, bowel sound
Anticholinergic
47
Mention the following | - High HR, RR, Temp, pupil, sweat, bowel sound
Sympathomimetic
48
Name examples of sympathomimetic
Psudophedrine (decongestant) - theophylline - epinephrine - thyroid supplement - cocaine - caffeine - amphetamine
49
How to treat sympathomimitics
Benzodiazpine for agitaiton - antihypertensive for HTN (X beta blocker)
50
How to treat anticholinergic
1- hyperthermia: cooling 2- agitation: diazepam 3- urinary retention: cathater 4- activated charcol
51
What is the antidot for anticholinergic toxicity
Phystigmine

Pediatrics (41 decks)

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