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Pediatrics > Poisoning > Flashcards

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
Q

What are the contraindications of activate charcol?

A 
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
Q

What is the golden hour of activated charcol?

A

First hour

27
Q

Items that are not effectively decontaminated with activated charcol

A

Heavy metals, inorganic ions, corrosive, hydrocarbon, alcohol, essential oil

28
Q

How to do whole bowel irrigation?

A

Administer polyethylene glycol “osmotically balanced” by nasogastric tube

29
Q

What are the contraindication of whole body irrigation?

A 
1- extensive hematamesis 
2- paralytic ileus 
3- bowel obstruction\perforation
4- peritonitis 
5- inability to place nasogastric tube
30
Q

What are the side effect of whole body irrigation?

A

Metabolic acidosis & aspiration

Nausea, vomitting abdominal bloating

31
Q

How to do gastric lavage

A

Aspiration of content in the stomache

32
Q

What are the contraindications of gastric lavage?

A

Small children and corrostive\hydrocarbone

33
Q

What are the side effects of gastric lavage?

A

Painful, time consuming, may induce bradycardia by vagal response

34
Q

Asymptomatic patient presenting after ingestion of a substance are like that because

A

1- it’s non toxic
2- insufficient amount of poison
3- delayed absorption
4- the metabolite is toxic not the substance

35
Q

What are the basic investigations to order in acute poisoning

A 
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
Q 
1- Hypertension & Tachycardia 
2- Agitation, psychosis, delerium
3- mydriasis 
4- Hyperthermia & diaphoresis 
5- increased bowel sound

This is which toxidrome?

A

Sympathomimitcs

37
Q 
1- Tachycardia & flushing 
2- delerium & hallucination 
3- mydriasis 
4- Hyperthermia & dryness 
5- decreased bowel sound

This is which toxidrome?

A

Anticholinergic

38
Q

Differentiate between anticholinergic and sympathomimetics

In:

  • sweating & heat
  • eye
  • HR
A

Heat, Eye and HR same; hyperthermia, myadrisis and tachycardia

Except for diaphoresis in sympathomimitics

39
Q

Name the anticholinergic agents

A

Atropine and

Anti: (depressnant - histamine - psychotic - parkinsoin)

40
Q 
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?

A

Cholinergic

41
Q

Small pupils is seen in (meiosis)

A

1- opioids
2- cholinergics
3- sedatives
4- organophosphate

42
Q

What are the opioids that you know and what is their antidote?

A

Methadone, morphine, heroin

Antidote: naloxone

43
Q

What will you find in opioids toxicity?

A

Coma - miosis - Hypo (tension, reflexia, thermia, pnea)

44
Q

Differentiate between opioid and sedatives?

A
  • Both: respiratory\CNS\CVS depression - hyporeflexia - hypotension
  • Opioid: eye sign & hypothermia
  • sedative: ataxia, drowsy, slurred speach.
45
Q

What are the sedatives that you know

A

Barbiturate, benzodiazpine and ethanol

46
Q

Mention the following

  • High HR, Temp, pupil
  • Low sweat, bowel sound
A

Anticholinergic

47
Q

Mention the following

- High HR, RR, Temp, pupil, sweat, bowel sound

A

Sympathomimetic

48
Q

Name examples of sympathomimetic

A

Psudophedrine (decongestant) - theophylline - epinephrine - thyroid supplement - cocaine - caffeine - amphetamine

49
Q

How to treat sympathomimitics

A

Benzodiazpine for agitaiton - antihypertensive for HTN (X beta blocker)

50
Q

How to treat anticholinergic

A

1- hyperthermia: cooling
2- agitation: diazepam
3- urinary retention: cathater
4- activated charcol

51
Q

What is the antidot for anticholinergic toxicity

A

Phystigmine

Pediatrics (41 decks)

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