Poisoning and Overdose Flashcards
What type of poisoning is the leading cause of death?
CO poisoning
What toxicity is the most common overdose?
Acetaminophen toxicity is the most common pharmaceutical agent causing fatalities
When should drug OD and poisoning be considered?
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
What systems should be focused on in the PE?
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
What treatments do all symptomatic OD pts need?
- Protection of airway
- IV access (2 lg bore)
- Supplemental oxygen to maintain SO2 > 95%
- Telemetry
- Continuous observation
What treatments do OD pts need if an altered mental status is present?
- D 50 1 ampule over 3-4 min
- Oxygen
- Naloxone/Narcan 2 mg IV push q 1-2 min up to 10-20 mg (pinpoint pupils)
A. Duration of action 2-3 hrs - 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)
- Thiamine 100 mg IV or IM if alcoholism suspected
What other treatments may be considered in OD pts?
- Anti-seizure med
2. Decontamination
How is the airway supported in a pt with an altered mental status?
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
What type of OD increases the risk for pulmonary edema?
Salicylate OD
What IV meds may be given for an altered mental status pt?
- IV Access, large bore (18+ g or CVP)
A. Crystalloid (NS or LR)
B. Dopamine 5-15 ug/kg/min to maintain bp
How are seizures managed in an OD pt?
- Diazepam 0.1-0.2 mg/kg OR Lorazepam 0.05 mg/kg IVP, repeat in few min. x 1 prn
- If seizures continue, give Phenobarbital 20 mg/kg IV over 20 min
- Phenytoin ineffective for most poison induced seizures
How is gastric decontamination achieved in OD pts?
- NG tube & activated charcoal 1 g/kg in 1st hr
2. Gastric lavage
How is pulmonary decontamination achieved in OD pts?
- Fresh air/O2 via mask
2. Watch for delayed edema
How is ocular decontamination achieved in OD pts?
Irrigate w/ H2O or saline ONLY, STAT referral to Ophthalmology
How is dermatological decontamination achieved in OD pts?
- Remove clothes, avoid direct exposure
2. Wash
What methods are used to prevent absorption of toxins?
- Activated charcoal
- Gastric lavage
- Urinary alkalinization
- Hemodialysis
What is the mechanism of activated charcoal?
- Suspension in water with or without cathartic
2. Inhibits absorption of some toxins
What is the mechanism of gastric lavage?
- Gastric lavage w/ saline or tap water
A. Gastric irrigation or “pumping stomach”
What is the mechanism of urinary alkalinization?
Enhances elimination of some drugs
What dx studies are useful in a suspected OD/poisoning pt?
- CBC, CMP, serum osmolality, PT/PTT, ABG’s, carboxyhemoglobin, Urine tox screen, BAC, UA, serum drug levels
- CXR
A. R/O ARDS
B. Pulmonary Edema - EKG (serial if TCA’s)
- CT Brain w/o contrast if stuporous or comatose
What drug OD may cause hyperthermia?
- Amphetamine
- Anticholinergic
- Cocaine
- ETOH/Sedative Withdrawal
What drug OD may cause hypothermia?
- Ethanol
- Hypoglycemia
- Opioid
- Phenothiazine
A. Compazine
B. Thorazine - Sedative/Hypnotic
What drug OD can cause miosis?
- Cholinergic
- Opioid
- Sedative/hypnotic
What drug OD can cause mydriasis?
- Anoxia
- Anticholinergic
- Sympathomimetic
