Poisoning: Recognition and Management

Question 1

Low GCS and respiratory depression

Answer 1

Benzos or ethanol

Mx: flumazenil

Question 2

Severe bradycardia or hypotension

Answer 2

Beta-blockers

Mx: Atropine

Question 3

Almond smell

Anxiety and confusion followed by arrhythmia, fits and coma

Answer 3

Cyanide

Mx: Dicobalt edentate

Question 4

Headache, dizziness, nausea, metabolic acidosis

Answer 4

CO

Mx: Hyperbaric oxygen

Question 5

Low GCS, yellow-green visual haloes, arrhytmias

Answer 5

Digoxin

Mx: Anti-digoxin Abs

Question 6

Raised anion gap metabolic acidosis, drank antifreeze

Answer 6

Ethylene Glycol

Mx: ethanol (competitive inhibition of breakdown), haemodialysis

Question 7

Heparin

Answer 7

Protamine

Question 8

Nausea, vomiting, abdominal pain (Iron)

Answer 8

Desferrioxamine

Question 9

Ataxia, coarse tremor, confusion, polyuria and renal failure

Answer 9

Lithium

Mx: Saline

Question 10

Methanol (Raised anion gap metabolic acidosis with visual disturbance)

Answer 10

Mx: ethanol and haemodialysis

Question 11

Pin point pupils, low GCS and respiratory depression

Answer 11

Opiates

Mx: Naloxone

Question 12

Organophosphates e.g. malathion

Answer 12

Mx: Atropine + Pralidoxime

Question 13

Raised QTc (–> torsade de pointes), metabolic acidosis and anticholinergic effects

Answer 13

Tricyclics e.g. Amitriptyline

Mx: Activated charcoal (within 60 minutes), NaHCO3 IV

Question 14

Warfarin

Answer 14

Vitamin K IV

Prothrombin complex or FFP