Poisoning Flashcards
Severity of Cuastics injury depend upon:
- agent type
- concentration
- Volume
- PH
- titratable acid\alkalline reserve (TAR)
- Duration of contact
- stomach contents
What is TAR?
Xenobiotic to neutrilize PH of a causatic to that of physiological tissue
What type of necrosis is associated with caustics toxicity?
- alkaline: liquefaction necrosis
- acidic: coagulation necrosis
What are the phases of caustics toxicity?
- acute inflammatory
- Latent granulation
- Chronic cicatrization
What are the late complications of Caustics?
Most common: stricture
Also esophageal carcinoma and pyloric stenosis
What is the long term effect of eosphageal stricture?
Formation of carcinoma
What is the role of induced emesis in caustic toxicity?
Contraindicated to the risk of aspiration
How to manage caustic toxicity?
1- airway and GI perforation maintenance
2- supportive care
3- no feeding\emesis\charcol\diluting
\neutralizing\steroid\antibiotic
Went to order endoscopy in causatic toxicity
Symptomatic older children
◦ Patients with altered mental status
◦ Patients with intentional ingestion
- large volume
What is the ABCs of toxicology
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
What is the antidote of acetaminophen?
N-acetylcysteine
What to do if the patient O2 sat <90%
- bag-valve-mask
- 100% O2
What to do if the patient O2 sat 90-95%
High flow O2
How to determine the level of conciousness?
AVPU method Alert Respond to verbal Respond to pain Unresponsive
To assess disability, what to do?
- AVPU
- pupil (sizure, reactivity, movement)
- reflexes
- glucocheck
What are the 4 main agents to think about in case of disability?
1- dextrose for hypoglycemia
2- atropine for cholinergic
3- naloxone for opioid
4- oxygen for carbon monoxide
What indicates decontamination of skin?
poisoning with
- corrosive
- hydrocarbon
- toxins absorbed in skin
How to decontamiante skin?
1- protective gear
2- remove contaminated clothes
3- flush area with copious running water\saline
What indicates decontamination of eye?
1- corrosive
2- hydrocarbon
3- chemical irritant
How to decontaminate eye?
1- flush with copious\tap water
2- anasthetic drops
3- remove contact lens
4- check conjunctivia and cornea
How to decontaminate inhalation by irritant gases and fume
Respiratory protection & supplemental O2
What are the methods for GI decontamination?
1- charcoal
2- gastric lavage
3- whole bowel irrigation
4- surgery\endoscopy
What is the role of activated charcol?
GI protection by absorption of ingested material and faster elimination
What is the common side effect of activated charcol?
Nausea + aspiration
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
What is the golden hour of activated charcol?
First hour
Items that are not effectively decontaminated with activated charcol
Heavy metals, inorganic ions, corrosive, hydrocarbon, alcohol, essential oil
How to do whole bowel irrigation?
Administer polyethylene glycol “osmotically balanced” by nasogastric tube
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
What are the side effect of whole body irrigation?
Metabolic acidosis & aspiration
Nausea, vomitting abdominal bloating
How to do gastric lavage
Aspiration of content in the stomache
What are the contraindications of gastric lavage?
Small children and corrostive\hydrocarbone
What are the side effects of gastric lavage?
Painful, time consuming, may induce bradycardia by vagal response
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
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
1- Hypertension & Tachycardia 2- Agitation, psychosis, delerium 3- mydriasis 4- Hyperthermia & diaphoresis 5- increased bowel sound
This is which toxidrome?
Sympathomimitcs
1- Tachycardia & flushing 2- delerium & hallucination 3- mydriasis 4- Hyperthermia & dryness 5- decreased bowel sound
This is which toxidrome?
Anticholinergic
Differentiate between anticholinergic and sympathomimetics
In:
- sweating & heat
- eye
- HR
Heat, Eye and HR same; hyperthermia, myadrisis and tachycardia
Except for diaphoresis in sympathomimitics
Name the anticholinergic agents
Atropine and
Anti: (depressnant - histamine - psychotic - parkinsoin)
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
Small pupils is seen in (meiosis)
1- opioids
2- cholinergics
3- sedatives
4- organophosphate
What are the opioids that you know and what is their antidote?
Methadone, morphine, heroin
Antidote: naloxone
What will you find in opioids toxicity?
Coma - miosis - Hypo (tension, reflexia, thermia, pnea)
Differentiate between opioid and sedatives?
- Both: respiratory\CNS\CVS depression - hyporeflexia - hypotension
- Opioid: eye sign & hypothermia
- sedative: ataxia, drowsy, slurred speach.
What are the sedatives that you know
Barbiturate, benzodiazpine and ethanol
Mention the following
- High HR, Temp, pupil
- Low sweat, bowel sound
Anticholinergic
Mention the following
- High HR, RR, Temp, pupil, sweat, bowel sound
Sympathomimetic
Name examples of sympathomimetic
Psudophedrine (decongestant) - theophylline - epinephrine - thyroid supplement - cocaine - caffeine - amphetamine
How to treat sympathomimitics
Benzodiazpine for agitaiton - antihypertensive for HTN (X beta blocker)
How to treat anticholinergic
1- hyperthermia: cooling
2- agitation: diazepam
3- urinary retention: cathater
4- activated charcol
What is the antidot for anticholinergic toxicity
Phystigmine
