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Poisoning and Overdose Flashcards

1
Q

What type of poisoning is the leading cause of death?

A

CO poisoning

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2
Q

What toxicity is the most common overdose?

A

Acetaminophen toxicity is the most common pharmaceutical agent causing fatalities

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3
Q

When should drug OD and poisoning be considered?

A

Diagnosis of drug OD or poisoning must be considered in ANY patient who presents w/ coma, seizure, acute hepatic or acute renal failure or acute bone marrow failure

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4
Q

What systems should be focused on in the PE?

A 
1. Vitals & neurologic status
A. Agitation, tremors, convulsions, coma
2. Pupil size
3. Skin
A. Warm, dry skin
B. Anticholinergics
C. “Blind as a bat”, “hot as Hades”, “red as a beet”, “dry as a bone” & “mad as a hatter”
D. Salivation & urination: Organophosphates
4. Abdomen
A. Bowel activity
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5
Q

What treatments do all symptomatic OD pts need?

A
  1. Protection of airway
  2. IV access (2 lg bore)
  3. Supplemental oxygen to maintain SO2 > 95%
  4. Telemetry
  5. Continuous observation
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6
Q

What treatments do OD pts need if an altered mental status is present?

A
  1. D 50 1 ampule over 3-4 min
  2. Oxygen
  3. Naloxone/Narcan 2 mg IV push q 1-2 min up to 10-20 mg (pinpoint pupils)
    A. Duration of action 2-3 hrs
  4. Flumazenil/Romazicon 0.2 mg IV push q 30 sec x 2 doses, then 0.5 mg IV q min prn up to 6 doses (max 5 mg total) (nystagmus)
  5. Thiamine 100 mg IV or IM if alcoholism suspected
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7
Q

What other treatments may be considered in OD pts?

A
  1. Anti-seizure med

2. Decontamination

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8
Q

How is the airway supported in a pt with an altered mental status?

A 
1. Establish airway
A. No gag reflex /LOC-INTUBATE
B. Supplemental O2 at 12L/min non-rebreather
C. Monitor pulse oximetry continuously
D. ABG’s
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9
Q

What type of OD increases the risk for pulmonary edema?

A

Salicylate OD

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10
Q

What IV meds may be given for an altered mental status pt?

A
  1. IV Access, large bore (18+ g or CVP)
    A. Crystalloid (NS or LR)
    B. Dopamine 5-15 ug/kg/min to maintain bp
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11
Q

How are seizures managed in an OD pt?

A
  1. Diazepam 0.1-0.2 mg/kg OR Lorazepam 0.05 mg/kg IVP, repeat in few min. x 1 prn
  2. If seizures continue, give Phenobarbital 20 mg/kg IV over 20 min
  3. Phenytoin ineffective for most poison induced seizures
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12
Q

How is gastric decontamination achieved in OD pts?

A
  1. NG tube & activated charcoal 1 g/kg in 1st hr

2. Gastric lavage

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13
Q

How is pulmonary decontamination achieved in OD pts?

A
  1. Fresh air/O2 via mask

2. Watch for delayed edema

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14
Q

How is ocular decontamination achieved in OD pts?

A

Irrigate w/ H2O or saline ONLY, STAT referral to Ophthalmology

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15
Q

How is dermatological decontamination achieved in OD pts?

A
  1. Remove clothes, avoid direct exposure

2. Wash

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16
Q

What methods are used to prevent absorption of toxins?

A
  1. Activated charcoal
  2. Gastric lavage
  3. Urinary alkalinization
  4. Hemodialysis
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17
Q

What is the mechanism of activated charcoal?

A
  1. Suspension in water with or without cathartic

2. Inhibits absorption of some toxins

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18
Q

What is the mechanism of gastric lavage?

A
  1. Gastric lavage w/ saline or tap water

A. Gastric irrigation or “pumping stomach”

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19
Q

What is the mechanism of urinary alkalinization?

A

Enhances elimination of some drugs

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20
Q

What dx studies are useful in a suspected OD/poisoning pt?

A
  1. CBC, CMP, serum osmolality, PT/PTT, ABG’s, carboxyhemoglobin, Urine tox screen, BAC, UA, serum drug levels
  2. CXR
    A. R/O ARDS
    B. Pulmonary Edema
  3. EKG (serial if TCA’s)
  4. CT Brain w/o contrast if stuporous or comatose
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21
Q

What drug OD may cause hyperthermia?

A
  1. Amphetamine
  2. Anticholinergic
  3. Cocaine
  4. ETOH/Sedative Withdrawal
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22
Q

What drug OD may cause hypothermia?

A
  1. Ethanol
  2. Hypoglycemia
  3. Opioid
  4. Phenothiazine
    A. Compazine
    B. Thorazine
  5. Sedative/Hypnotic
23
Q

What drug OD can cause miosis?

A
  1. Cholinergic
  2. Opioid
  3. Sedative/hypnotic
24
Q

What drug OD can cause mydriasis?

A
  1. Anoxia
  2. Anticholinergic
  3. Sympathomimetic
25
Q

What drug OD can cause tachycardia?

A
  1. Amphetamines
  2. Anticholinergic
  3. Ethanol
  4. Nicotine
  5. Organophosphates
  6. ASA
26
Q

What drug OD can cause bradycardia?

A
  1. B-Blocker
  2. Ca Channel Blockers
  3. Opioid
  4. Head Trauma
  5. Sedative/Hypnotics
27
Q

What drug OD can Cause HTN?

A
  1. Amphetamine
  2. Cocaine
  3. Ergotamine
  4. Head Trauma
  5. MAOIs
  6. PCP
28
Q

What drug OD can cause hypotension?

A
  1. B-Blockers
  2. Amanita Mushrooms
  3. Ca Channel Blockers
  4. Opioid
  5. TCA’s
  6. Sedative /Hypnotics
29
Q

What drug OD can cause hyperventilation?

A
  1. ASA
  2. Sympathetic NS stimulants
  3. Alcohol withdrawal
30
Q

What drug OD can cause hypoventilation?

A
  1. Opioid
  2. Ethanol
  3. Organophosphates
  4. Sedative/ hypnotics
31
Q

What are the goals of drug OD/poisoning therapy?

A
  1. Support vital signs
  2. Prevention of further absorption
  3. Enhancement of elimination
  4. Administration of specific antidotes
  5. Prevention of re-exposure
  6. Tx is usually initiated before toxicology results & labs are known
32
Q

What is the antidote for APAP OD?

A

Acetylcysteine (Mucomyst)

33
Q

What is the antidote for anticholinergic OD?

A

Physostigmine

34
Q

What is the antidote for organophosphate OD?

35
Q

What is the antidote for TCA OD?

A

Sodium bicarb

36
Q

What is the antidote for benzodiazepines?

A

Flumazenil (Romazicon)

37
Q

What is the antidote for CO OD?

A

100% O2

Hyperbaric chamber

38
Q

What is the antidote for methanol OD?

A

Fomepizole

Ethanol

39
Q

What is the antidote for narcotics OD?

A

Naloxone (Narcan)

40
Q

What is the antidote for amphetamine OD?

A

None, supportive care only

41
Q

What can ingestion of acids and alkalis lead to?

A

Tissue necrosis

42
Q

What are the sxs of acid/alkali ingestion?

A

Mouth & throat pain, dysphagia, drooling, substernal or abd pain

43
Q

How is ingestion of acid/alkalis treated?

A
  1. Includes diluting agent w/ water, milk or NS
  2. Endoscopy is recommended
    A. Assess degree of damage
44
Q

What are the sxs of inhalant OD?

A

Pt may have hallucinations & become abusive & combative

45
Q

How is inhalant OD treated?

A
  1. ABC’s
  2. Supplemental oxygen, IV access, cardiac monitoring
  3. Protect airway
  4. Treat bronchospasm
    A. (Inhaled albuterol)
46
Q

What is the antidote for Methylene chloride?

A

100% oxygen

47
Q

What is the antidote for alkyl nitrites?

A

Methylene blue

48
Q

What is the antidote for carbon tetrachloride?

A

N-acetylcysteine (Mucomyst)

49
Q

What are the sxs of anticholinergic OD?

A
  1. ↑ Temp
  2. ↑ HR
  3. ↑ BP
  4. Dilated pupils
  5. Lungs clear
  6. Absent BS
  7. Skin: Hot & Dry
50
Q

What are the sxs of cholinergic OD?

A
  1. Normal Temp
  2. ↓ HR
  3. ↓ BP
  4. ↓ Resp
  5. Pupils constrict
  6. Lungs wet
  7. Hyperactive BS
  8. Skin Wet
51
Q

What are the sxs of sympathomimetic OD?

A
  1. ↑ Temp
  2. ↑ HR
  3. ↑ BP
  4. ↑ Resp
  5. Dilated pupils
  6. Lungs clear
  7. Normal BS
  8. Skin: Hot & Wet
52
Q

What are the sxs of opiate OD?

A
  1. ↓ Temp
  2. ↓ HR
  3. ↓ BP
  4. ↓ Resp
  5. Pinpoint pupils
  6. Lungs clear (If wet-ARDS)
  7. ↓ Bowel Sounds
  8. Skin: Cold & Dry
53
Q

What are the sxs of sedatives/hypnotic OD?

A
  1. ↓ Temp
  2. ↓ HR
  3. ↓ BP
  4. ↓ Resp
  5. Nystagmus
  6. Lungs clear
  7. Normal BS
  8. Skin: Dry

Gen Med: Emergency Med (13 decks)

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