POISONING AND OVERDOSE Flashcards
What is the max dose for Tylenol?
4G
Tina just ate 3 bottles of tylenol pills. What is her presentation for the first 24 hours?
N/V/sweat, malaise
Daniel is a suicidal teen in the ED. He overdosed on an unknown drug 72 hours ago and presents with acute hepatitis with aminotransferases>3000, rising PTT, RUQ pain, and acute kidney injury. What drug do you suspect?
acetaminophen
When can you use activated charcoal in acetaminophen poisoning?
if its been less than 4 hours since ingestion
How will you treat acetaminophen poisoning?
serum level track via nomogram, <4hrs activated charcoal, give N-acetylcystein
A man arrives at the ED with dilated pupils, HTN, is hyperthermic and tachycardic. What drug do you suspect and how will you treat it?
Amphetamines/stimulants/Cocaine
Benzo,
Nitroprusside for HTN
What drug should you not give for lowering blood pressure with someone on amphetamines?
Beta Blockers (unopposed alpha)
You arrive at the ED for shift and the attending tells you to go see the patient who has anticholinergic overdose. What are some examples of drugs that could cause this?
Antihistamines, TCAs….etc.
How do patients with anticholinergic overdose present?
Red (vasodil), dry (anhidrosis), hot (2nd to anhid), blind (mydriasis), mad (delirium), full (urinary retention), decreased BS, Tachycardia
What is the treatment for anticholinergic poisoning?
Physostigmine and benzo
A man who was seen and is now being treated for a heart attack he had last month comes in with bradycardia, hypotension, hypoglycemia and bronchospasms. His EKG shows a prolonged PR interval. When you ask his wife what she thinks is the cause she tells you that he tried to take extra pills he was prescribed because he missed a couple days. What do you suspect?
ßB and CC blockers
How do you treat BB/ CCB overdose?
TX arrhythmias per guidelines
consider activated charcoal
IV glucagon, Ca gluconate/chloride, epi, insulin +dextrose, lipid emulsion therapy
A child was rescued from a house fire and appears confused, is complaining of headache and just threw up. What do you suspect?
CO poisoning
high flow O2, Hyperbaric O2 if :CO>25%, LOC , low pH.
A fire fighter decided not to use his SCBA mask while assisting with putting out an industrial fire. He is now complaining of confusion, headache and abdominal pain. His skin has a cherry red color to it and his vitals are all elevated. You get and ABG on him and it shows a gap acidosis with increased LDH. What do you suspect?
Cyanide poisoning
TX:ABC, treat sx, Hydroxocobalamin if available, if not: sodium nitrite/thiosulfate.
What’s the general protocol for drunks?
fluids. If severe, ABCs, fluid and thiamine. Activated charcoal doesn’t work because ETOH is rapidly absorbed in GI.
Ben decides he’s had it with life and grabs a bottle of pills (Iron pills) from his mothers medicine cabinet. He eats them all. What is the early, intermediate and late prognosis?
Day 1: N/V/D abd pain, melena, hematemesis, lethargy. Met acidosis and shock.
Day 2: Coma, coagulopathy, juandice= hepatotoxicity.
2-4 weeks: Bowel Obst N/V, abd pain.
TX: Fluids, whole bowel irrigation if pills seen on x-ray, IV deferoxamine
Tommy, a four year old, just ate a handful of his dad’s lead fishing weights because he thought they looked like candy. What is the prognosis if left untreated? How is this treated?
Abd pain, aches, memory loss, conf., anemia, nephropathy, cognitive and behavioral impairments in kids.
DX Serum lead, x-ray in kids.
TX Kids: BLL >45 treat with chelation.
Adults:
>50 + symptoms or anything over 80 gets chelation.
What toxicity presents with nausea, vomiting, diarrhea, alopecia, horizontle white lines in the nails and a rapidly ascending peripheral neuropathy?
Arsenic poisoning. TX w/ chelation
Timmy just drank the contents of a an old thermometer. What are his symptoms
Mercury poisoning. Tremor, inflamed gums, deafness and acrodynia (body rash with swelling of hands and feet, desquamination and a pink coloration). TX w/ chelation
Billy bob was trying to suck some gas from a car tank and accidentally inhaled and ingested some. What are possible symptoms and what is the treatment?
CNS depression
seizure
arrhythmia
pneumonitis and dyspnea
TX: if small amount no decon, if large amount and within 60 minutes gastric lavage; otherwise its supportive.
What is a complication of inhaling leaded gas?
Methemoglobinemia
Deborah just overdosed on her bipolar medication. She has had N/V/D is sluggish and ataxic. What is this toxicity and what is a complication
Lithium
Diabetes Insipidus
Pt brought to ED w/ respiratory depression, hypothermia, pinpoint pupils, and decreased bowel sounds. What is the toxicity?
Opiates
TX if SP02s not opiate overdose. Also treat hypoT w/ fluid.
Pt comes in to ED salivating, their eyes are running, they have increased urinary frequency, and increased bowel motility and have thrown up several times. What is this and how is it treated?
Organophosphate poisoning
Atropine+Pralidoxime+Benzo.
Pt comes in to ED in restraints. It took 10 cops to restrain him and he’s showing elevated vital signs, nystagmus and altered mental status. What is this and how is it treated?
Phencyclidine (PCP)
Restraints and Benzos
A patient is on 1st gen/typical antipsychotics. He tried to make up for a missed day of medications by doubling his dose. What symptoms do you expect?
: (i.e. chlorpromazine) parkinson’s like movements, rigidity, tremors, dystonia (twistint/writhing), akathisia (can’t sit still), tardive dyskinesia. TX supportive
A patient is on 2st gen/atypical antipsychotics. He tried to make up for a missed day of medications by doubling his dose. What symptoms do you expect?
(i.e. clozapine) lethargy, mydriasis, tachycardia, orthostatic, confusion, see anticholinerigic tox. TX supportive
Jimmy decides to eat some mushrooms for old times’ sake while at a reunion. Unfortunately the shrooms were bad ones. What are common symptoms and how should be be treated?
: GI/Renal/CNS (hallucination, depression), etc. call poison control to determine type. ABC, fluids, activated charcoal.
Sarah decides this is going to be the last headache she ever has and eats an entire bottle of aspirin. How will she present? How will you treat this?
tachypnea, tinnitus, N/V, met acidosis w/ resp alk., hyperthermia pulm edema
DX plasma salicylate level
TX O2, activated charcoal, glucose (cerebral glucose lowered by ASA), bicarb (to alkalinize), dialysis.
Taking too many benzos can cause respiratory depression: True or false?
False:
CNS depression with normal vitals
TX supportive, avoid flumazenil to reverse.
What time frame can activated charcoal usually be used in? What is the max dose
if ingestion w/in 4 hours. 1g/kg no more than 50 g.
sympathomimetic syndrome
CNS (agitation, delirium), tachyC, hypoT, sweats, Mydriasis, Hot.
sympatholytic syndrome
decreased bowel sounds, bradycardia, miosis, hypotension.
cholinergic syndrome
SLUDGE. Bradycardia, Hypotension, Miosis, alt MS.
anticholinergic syndrome
Red (vasodil), dry (anhidrosis), hot (2nd to anhid), blind (mydriasis), mad (delirium), full (urinary retention), decreased BS, Tachycardia.
serotonin syndrome
clonus, agitation, diaphoresis, ocular clonus, hyperreflexia, fever
Where is syrup of ipecac best used?
prehospital setting w/ protected airway and within 60 minutes of ingestion. Effectiveness is variable and not a great option
What is gastric lavage and when is it used?
NG tube placed and stomach flushed. Only used if airway can be protected, toxic levels of drug ingested or sustained release and w/ in 60 minutes of ingestion
What is the preferred form of decontamination?
Activated Charcoal
When is activated charcoal contraindicated?
Don’t use with hydrocarbon/caustic ingestions/heavy metals.
What is whole bowel irrigation?
When is it used?
When shouldn’t you use it?
- polyethylene glycol given to induce liquid stool and then GI tract mechanically flushed to get rid of pills, drug packs, etc.
- Good for sustained release tablets, drug packets, heavy metals like lead.
- Don’t use with bowel obstruction or hemorrhage.
When is dialysis indicated?
uremia, acidemia, elect. imbalances, SLIME: salicylic acid, lithium, isopropanol, magnesium-containing laxatives, and ethylene glycol.
When is chelation therapy indicated?
iron, lead and other heavy metal toxicity.
What are the two main types of snake venom toxicity?
Hemotoxin
Neurotoxin
What is the basic plan for treating snake bites?
TX reduce spread of venom: calm/rest, remove jewelry, splint, TX ABC, antivenom (if confirmed bite + collapse, convulsions, weakness, paralysis, respiratory failure, shock, or bleeding), if not, then supportive. Tetanus.
How long do bee stings usually hurt for?
3 hours. Consider cold compress and or prednisone
Bob just got bit by a black widow. What can you tell him of his prognosis?
: muscle pain-72 hrs, spasm, paresthesia, HA, N/V, localized diaphoresis, inc.HR, HTN.
Blanched circular patch w/ red perimeter and bite marks. TX clean, painkiller, muscle relaxant/benzo, tetanus, cold pack.
What parts of the US are brown recluses located in?
: south, west, midwest
How do brown recluse spider bites progress?
Red plaque, bite marks. Usually self-limited, can become necrotic and heal by 2nd intent.
Are there many poisonous scorpions in the US?
No. One has a neurotoxin. It is in the southwest. Otherwise bites are painful: clean, give pain killer and tetanus.
-if patient has muscle fasciculations, hypersalivation, cranial nerve dysfunction, roving eye movements then ABC benzos, antivenom.
What is the general protocol for marine envenomations?
TX hot water immersion, painkiller and tetanus.
How do dog bites differ from cat bites?
dogs crush and rip
cats puncture
What bacteria are common with dog/cat bites?
. Pasteurella multicoda, Capnocytophaga, and anaerobes + human skin stuff like staph/strep
How do you treat dog/cat bites?
Wound care, x-ray for deep infections, blood clultures. 2nd closure. ABX: Augmentin or doxy/moxi/cefurixime + clina/metro
How do you treat human bites compared to dog and cat bites?
same
A patient comes into your clinic after spending a week camping in the woods. He has a maculo-papular rash which appears to be converting to petechia. It started at his hands and feet and is moving towards his core. He is also febrile and complaining of myalgias. What is this?
Rickettsia/ Rocky Mountain Spotted Fever
A patient comes into your clinic after spending a week camping in the woods. He has a targetoid lesion on his waist. He is also febrile and complaining of myalgias. What is this?
Lyme disease
Whats the general plan for treating tick bites?
ID tick (deer tick for lyme, dog and wood tick for rickettsia). Remove tick. *most don't transmit disease until attached for >48 hours. TX if SX last 72 hrs and in endemic area: Doxy.
