Poisonings Flashcards
What are the 3 things to do with an unresponsive patient?
Hypoxia: Place on 100% O2 nonrebreather (also useful prior to intubation)
Hypoglycemia: obtain a point of care fingerstick blood glucose
Opioids: administer Narcan 0.4 to 2mg IV to reverse opiates
Anticholinergic Symptoms
Mad as a hatter (Altered mental status) Blind as a bat (mydriasis) Hot as Hades Red as a beat Dry as a bone
Anticholinergic Common Drugs
TCA’s Tricyclic antidepressants
Antihistamines
Overactive bladder medication
Cholinergic Symptoms (SLUDGE)
Salivation Lacrimation Urination Diaphoresis and defecation Gastrointestinal upset Excessive bradycardia or tachycardia (muscarinic or nicotinic)
Cholinergic Causes
Organophosphate Poisoning and Nerve Agents
Cholinergic Treatment
Atropine, pralidoxime, decontaminate
Sympathomimetic Poisoning
Tachycardia Hypertension Mydriasis Diaphoresis Hyperthermia Agitation
Sympathomimetic Drugs
over-the-counter cold agents (containing ephedrine), illegal street drugs (eg, cocaine, amphetamines, methamphetamine), dietary supplements (ephedra), and illicit designer drugs (eg, 3,4-methylenedioxy methamphetamine (MDMA, “ecstasy”)
Sympathomimetic Treatment
sedation, hydration, and treatment of complications such as rhabdomyalysis and hyperthermia.
Opioid Overdose
Apnea
Hypoxia
Unresponsiveness
Flash pulmonary edema (rare)
Opioid overdose treatment
Naloxone and possibly Intubation. Naloxone will wear off before the opiate so continue to monitor.
How does activated charcoal work?
Bind to toxins and prevent absorption
When do you have to give charcoal by?
Work best Within one hour of ingestion. Can still give later though. Don’t give if somnolent (aspiration). Doesn’t work well with alcohol, hydrocarbons or metals (iron).
Acetaminophen overdose
May be asymptomatic initially. 4 stages: (1 and 2) nausea, vomiting, Lethal dose is 150 mg/kg,
Acetaminophen antidote
n-acetylcysteine
Aspirin overdose
ill appearing, breathing fast, vomiting, confused, and sometimes febrile.
Aspirin overdose pathology
uncoupling of oxidative phosphorylation. This causes a profound anoin gap metabolic acidosis.
Aspirin overdose treatment
Sodium bicarb and dialysis
TCA overdose pathology
direct alpha-adrenergic blockade, inhibition of norepinephrine and serotonin reuptake, and blockade of fast sodium channels in myocardial cells.
TCA overdose treatment
In the setting of QRS widening, Sodium bicarbonate should be administered. Seizures are treated with benzodiazepines
What are the three toxic alcohols?
isopropanol, methanol, and ethylene glycol.
Diagnostic tests for ethylene glycol ingestion
Anti-freeze. Woods lamp to urine –> see fluorescence. Calcium oxalate crystals. Anion gap metabolic acidosis.
Methanol overdose
metabolized to formaldehyde.
Treatment of methanol and ethylene glycol
blockade production of ADH. Fomepizole.
