Poisonings, Accidents, Child abuse

Question 1

Iron poisoning

• features
• dx findings
• tx

Answer 1

Initially:

• ab pain
• vomiting
• diarrhea
• hypotensive shock
• metabolic acidosis

Later:

• hepatic necrosis (days)
• pyloric stenosis (later)

Dx findings:

• AG metabolic acidosis
• radiopaque pills on Xray!

Tx

• whole bowel irrigation
• deferoxamine**
• supportive
• syrup of ipecac if no evidence gastroenteritis

Question 2

Tx acetaminophen poisoning

Answer 2

Activated charcoal

N acetylcysteine (best 8-16h of ingestion)

Question 3

When do you gastric lavage EtOH OD?

Answer 3

< 2 h

Question 4

3 phases of salicylate ingestion

Answer 4

1

• respiratory alkalosis from direct stim of respiratory center
• K and bicarb excreted
• can look like diabetic ketoacidosis

2
- paradoxical aciduria as alkalosis continues

3

• metabolic acidosis 2/2 lactic acidosis
• dehydration
• hypokalemia

Question 5

Tx caustics poisoning

Answer 5

Flush a lot with water

DO NOT GI lavage or emesis or charcoal

Question 6

Organophosphate (anticholinesterase) poisoning - sx

Answer 6

Muscarinic

• salivation
• lacrimation
• urination
• defecation
• emesis

Nicotinic

• cramps
• fasiculations
• twitching
• weakness
• areflexia
• paralysis of voluntary muscles
• • > occurs after Muscarinic effects; not seen in mild poisoning

CNS
- anxiety
- ataxia
- HA
- convulsions
0 coma

Question 7

Dx organophosphate poisioning

Answer 7

decreased RBC cholinesterase

Clinical is best

Question 8

Tx organophosphate (anticholinesterase) poisoning

Answer 8

If ingested:
GI lavage
Activated charcoal

If skin:
wash with water

+ atropine
+ pralidoxime (for nicotinic sx)

Question 9

Tx antihistamine poisoning

Answer 9

Activated charcoal

Whole bowel irrigation if sustained release antihistamine given

Risk death from seizures if no tx

Question 10

Main systems affected by TCA poisoning

Answer 10

CNS

Heart

Question 11

Tx TCA posioning

Answer 11

Activated charcoal to –| more absorption

Na bicarb to prevent dysrhythmias
Tx dysrhythmias not responding with lidocaine

Question 12

Tx anticholinergic OD

Answer 12

Physostigmine sulfate

Question 13

Tx CO poisoning

Answer 13

O2

Question 14

Tx cyanide poisoning

Answer 14

Amyl nitrite

then sodium nitrite

then sodium thiosulfate

Question 15

Tx ethylene glycol poisoning

Answer 15

EtOH

Question 16

Tx heavy metal poisoning in general

Answer 16

Chelators

EDTA

Dimercaprol

Penicillamine

2,3-dimercaptosuccinic acid

Question 17

Tx INH poisoning

Answer 17

Pyridoxine

Question 18

Tx methanol poisoning

Answer 18

EtOH

Question 19

Tx methemoglobinemia

Answer 19

Methylene blue

Question 20

Tx opioid OD

Answer 20

Naloxone

Question 21

Tx warfarin poisoning

Answer 21

Vit K

FFP

Question 22

Drowning freshwater vs saltwater

Answer 22

Freshwater
- may have lung damage 22 hypotonic fluid washing out surfactant

Saltwater
- more prone pulmonary edema

Question 23

Degree burns

Answer 23

1 - epidermis

2 - epidermis + dermis

3 - full thickness

Question 24

Fluid resusscitation in burns

Answer 24

Ringer’s lactate

Question 25

Hymenal opening size

Answer 25

< 5 mm in < 5yo < 9 mm in < 9 yo Not diagnostic though

Question 26

If person is sexually assaulted, specimens should be collected to test for?

Answer 26

``` Acid phsophatase G/C Syphilis Hep B HIV ```

Question 27

Why do you get lead lines?

Answer 27

Usually at wrists and ankles (calcification because lead inhibits osteoclast activity)

Question 28

Clinical manifestations of foreign body aspiration

Answer 28

Signs + Sx - hx choking - coughing - cyanosis - sudden onset resp distress - AMS PE - focal monophonic wheezing on affected side - diminished aeration on affected side Xray - HYPERinflation or atelectasis of affected side - foreign body