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test 2 > poisons > Flashcards

poisons Flashcards

1
Q

emergency management of coma

A 
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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2
Q

Emergency treatment of Hypotension

A

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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3
Q

over dose trycyclic antidepressant

A

sodium bicarb

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4
Q

overdose betablocker

A

glucagon

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5
Q

calcium channel blocker overdose

A

calcium chloride

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6
Q

Bupropion and Verapamil overdoses can be treated with

A

lipid emulsion

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7
Q

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

A

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

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8
Q

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

A

amiodarone

  • if tricyclic then sodium bicarb
  • if digoxin then digi-bind
  • if Torsades de point Mg
  • propranolol
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9
Q

Emergency treatment of seizures

A

lorazepam or diazepam

-phenobarbitol if refractory

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10
Q

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

A

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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11
Q

antidote for antichlinergics

A

physostigmine

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12
Q

antidote for anticholinesterases (organophosphate pesticide)

A

atropine and pralidoxime

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13
Q

antidote for benzodiazepines

A

flumazenil

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14
Q

antidote for carbon monoxide

A

O2 hyperbaric

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15
Q

antidote for cyanide

A 
sodium nitrate
or hydroxycobalamine (b12)
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16
Q

antidote for isoniazid

A

pyridoxine (b6)

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17
Q

antidote for methylene or ethylene glycol

A

ethanol or fomepizole

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18
Q

antidote for sulfonylurea or hypoglycemic drug

A

glucose or octreotide

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19
Q

When is gastric lavage contraindicated

A

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

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20
Q

Gastric lavage technique

A

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

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21
Q

Contraindications of activated charcoal

A

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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22
Q

Sorbitol Catharsis should be monitored for

A

hypotension and dehydration intestinal cramping and vomiting, also third spacing

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23
Q

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

A

massive iron ingestion or lithium, or sustained release tablets

24
Q

Poisoning labs to order

A

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

25
Q

Osmol gap increases in presence of

A

alcohol and ketoacidosis

26
Q

Anion Gap elevation in presence of

A

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

27
Q

treatment of acid ingestion

A 
glass of water
place tube remove stomach contents
symptomatic
endoscopy 
ct
possible surgery
28
Q

Treatment of alkalies

A 
glass of water
small tube to remove agent
symptomatic
enodscopy
ct
29
Q

Treatment of amphetamine

A

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

30
Q

treatment of anticoagulant

A 
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
31
Q

Treatment of warfarin overdose

A 
Donot treat prophylactically with VitK (wait for pt/inr)
get labs pt/inr
give fresh frozen plasma
prothrombin complex concentrate
activated factor VII
32
Q

Treatment of chronic warfarin user overdose

A

fresh frozen plasma and vit k

33
Q

Treatement of superwarfarin user

A

monitor over several weeks using vitK at large doses

34
Q

Direct acting anticoagulants like dabigatran treated with

A

idarucizumab

35
Q

treatment of anticonvulsants overdose

A

activated charcole and gastric wash

36
Q

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

A

valproic acid toxicity
order bowel irrigation
referral for dialysis if severe

37
Q

treatement for antipsychotic medication

A

activated charcol

fluid and vasopressors for hypotension

38
Q

Treatment for arsenic poison

A

perform gastric lavage and give fluids

39
Q

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

A

ask paitent if they have eatten seafood

40
Q

treatment of atropine and anticholinergics

A

activated charcoal

external cooling for high temperatures

41
Q

treatment for calcium channel blocker

A

charcoal and bowel irrigation

42
Q

treatment of carbonmonoxid

A

100% o2 with high flow reservor face mask

43
Q

treament of clonidine overdose

A

charcoal,
airway
fluids
dopamine or atropine for bradycardi

44
Q

treatment of cyanid poisoning

A 
charcoal
cyanide kit
sodium nitrite
or 
sodium thiosulfate
or 
Hydroxocobalamin (may casue red skin)
45
Q

treatment of digitalis poisoning

A

digifab (immune specific antibodies)

digibind (based on calculation)

46
Q

Treament of ethanol

A

charcoal

47
Q

Flumazenil may cause seizures in patients with

A

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

48
Q

treatment of iron poisoning

A

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

49
Q

Treatment of isoniazid poisoning

A

active charcoal
B6 (pyridoxine)
benzo is seizures

50
Q

Treatment of lead poisoning

A

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

51
Q

Treatment of lithium poisoning

A

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

52
Q

treatment of Lsd and hallucinogin

A

physostigmine
benzo or haldol for psychosis
betablockers for dysrhythmias

53
Q

treatment of Methanol and Ethylene glycol

A 
nasogastric aspiration
hemodialysis 
folic acid, thiamine, and pyridoxine may enhance breakdown
Fomepizole (ethylene glycol)
ethanol block metabolism
54
Q

treatment of pesticide toxicity

A

nasogastric aspiration
then give activiated charcoal
wash skin

Atropin (muscarini stimultion reverse)
Pralidoxime (oranophosphate binding reversal)

55
Q

Treatment for salicilate toxicity

A 
gastric lavage
charcoal
glucose
Sodium bicarb (metabolic acidosis)
Hemodialysis ( server acidosis) 
Specific
alkalinization of urine
56
Q

Treatment of theophyllin or caffeine poison

A 
charcoal
Whole bowel irrigation
Hemodialysis
benzodiazepine for seizure
beta blocker (low dose for hypotension and tachycardia)
57
Q

Treatment of trycyclic antidepressants

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

test 2 (13 decks)

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