poisons Flashcards by J Pint

emergency management of coma

A-airway
B- Breathing
C- circulation
D- Drugs
-Dextrose for low bs
- naloxone for opioids
- flumazenil (unless coingested anticonvulsant, high dose benzouser, or has seizure DO)

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Emergency treatment of Hypotension

in general give 1-2L ns
monitor CVP
dopamin or norepi if not responding to nS
determine cause treat specific cases

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over dose trycyclic antidepressant

sodium bicarb

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overdose betablocker

glucagon

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calcium channel blocker overdose

calcium chloride

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Bupropion and Verapamil overdoses can be treated with

lipid emulsion

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Treatment of emergent hypertensionf diastolic greater than 105-110mmHg and no prior history

Lorasepam for anxiety
phentolamine or nitroprusside hypertension
esmolol or labetalol for tachycardia
-no betablockers alone

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emergent treatment of arrhythmias ( general, tricyclic, digoxin, Torsades, chlorinated)

amiodarone

if tricyclic then sodium bicarb
if digoxin then digi-bind
if Torsades de point Mg
propranolol

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Emergency treatment of seizures

lorazepam or diazepam

-phenobarbitol if refractory

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Emergent treatement of hYperthermia (general, muscle rigidity, neruomalignant syndrome, serotonin syndrome)

clothes off, water on body,fanning

Muscle rigidity =neromuscular blocker (intubation, ventilation, EEG) followed by dantrolene
Neromalignant syndrome = bromocriptine
Serotonin syndrome= Cyproheptitdine or chlorpromazine

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antidote for antichlinergics

physostigmine

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antidote for anticholinesterases (organophosphate pesticide)

atropine and pralidoxime

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antidote for benzodiazepines

flumazenil

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antidote for carbon monoxide

O2 hyperbaric

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antidote for cyanide

sodium nitrate
or hydroxycobalamine (b12)

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antidote for isoniazid

pyridoxine (b6)

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antidote for methylene or ethylene glycol

ethanol or fomepizole

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antidote for sulfonylurea or hypoglycemic drug

glucose or octreotide

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When is gastric lavage contraindicated

stuporus or comatose patients; only use if endotracheal tube is in place

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Gastric lavage technique

drop the lubricated tube
aspirated stomach contents
wash stomach with tepped water until clear

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Contraindications of activated charcoal

comatose or convulsin patients unless airway is inplace and gastric tube is available in place

do not give to ppl with ileus or intestinal obstruction
do not give for corosives

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Sorbitol Catharsis should be monitored for

hypotension and dehydration intestinal cramping and vomiting, also third spacing

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Whole Bowel irrgation (polyehtlene glycol electrolyte) can be used for

massive iron ingestion or lithium, or sustained release tablets

Poisoning labs to order

serum osmolality and osmol gap, electrolytes and anion gap, glucose, creatinine, blood urea nitrogen, creatine kinase, urinalysis, and EKG

Osmol gap increases in presence of

alcohol and ketoacidosis

Anion Gap elevation in presence of

accumulation of lactic acid including carbon monoxide, cyanide, ethylene glycol, medicinal iron, INH, methanol, metformin, ibu, and salicylates

treatment of acid ingestion

``` glass of water place tube remove stomach contents symptomatic endoscopy ct possible surgery ```

Treatment of alkalies

``` glass of water small tube to remove agent symptomatic enodscopy ct ```

Treatment of amphetamine

treat seizures> benzo (phenobarbital) lower body temp give fluids treat hypertention > nitroprusside

treatment of anticoagulant

``` stop medication acute overdose give charcoal get PT/INR - pt increase in 12-24(36-48 peak) - --> newer anticoags have no peak pt but with normal inr will be considered safe with no toxicity ```

Treatment of warfarin overdose

``` Donot treat prophylactically with VitK (wait for pt/inr) get labs pt/inr give fresh frozen plasma prothrombin complex concentrate activated factor VII ```

Treatment of chronic warfarin user overdose

fresh frozen plasma and vit k

Treatement of superwarfarin user

monitor over several weeks using vitK at large doses

Direct acting anticoagulants like dabigatran treated with

idarucizumab

treatment of anticonvulsants overdose

activated charcole and gastric wash

patient using valproic acid comes in with hypernatremia, metabolic acidosis, hypocalcemia, elevated amino transferase and serum ammonia you suspect and order

valproic acid toxicity order bowel irrigation referral for dialysis if severe

treatement for antipsychotic medication

activated charcol | fluid and vasopressors for hypotension

Treatment for arsenic poison

perform gastric lavage and give fluids

patient comes in feeling bad urine screen finds high levels of arsenic what is next

ask paitent if they have eatten seafood

treatment of atropine and anticholinergics

activated charcoal | external cooling for high temperatures

treatment for calcium channel blocker

charcoal and bowel irrigation

treatment of carbonmonoxid

100% o2 with high flow reservor face mask

treament of clonidine overdose

charcoal, airway fluids dopamine or atropine for bradycardi

treatment of cyanid poisoning

``` charcoal cyanide kit sodium nitrite or sodium thiosulfate or Hydroxocobalamin (may casue red skin) ```

treatment of digitalis poisoning

digifab (immune specific antibodies) | digibind (based on calculation)

Treament of ethanol

charcoal

Flumazenil may cause seizures in patients with

seizure disorder, benzoaddiction, using tricyclic, or other anticonvulsant overdose

treatment of iron poisoning

fluids whole bowel irrigation Deferoximine (chelation) ( for short time or ARDS)

Treatment of isoniazid poisoning

active charcoal B6 (pyridoxine) benzo is seizures

Treatment of lead poisoning

ABD radiograph whole bowel irrigation endoscopy or surgery (maybe) edetate calcium dysodium

Treatment of lithium poisoning

gastric lavage or whole bowel irrigation lithium levels fluids hemodialysis (maybe)

treatment of Lsd and hallucinogin

physostigmine benzo or haldol for psychosis betablockers for dysrhythmias

treatment of Methanol and Ethylene glycol

``` nasogastric aspiration hemodialysis folic acid, thiamine, and pyridoxine may enhance breakdown Fomepizole (ethylene glycol) ethanol block metabolism ```

treatment of pesticide toxicity

nasogastric aspiration then give activiated charcoal wash skin Atropin (muscarini stimultion reverse) Pralidoxime (oranophosphate binding reversal)

Treatment for salicilate toxicity

``` gastric lavage charcoal glucose Sodium bicarb (metabolic acidosis) Hemodialysis ( server acidosis) Specific alkalinization of urine ```

Treatment of theophyllin or caffeine poison

``` charcoal Whole bowel irrigation Hemodialysis benzodiazepine for seizure beta blocker (low dose for hypotension and tachycardia) ```

Treatment of trycyclic antidepressants

``` charcoal and gastric lavage sodium bicarb (help sodium channels) ```