Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Tox Exam 1 > Principles of Acute Poisonings > Flashcards

Principles of Acute Poisonings Flashcards

1
Q

6 Step Treatment Plan

A
  1. Emergency Stabilization
  2. Complete Patient evaluation
  3. Appropriate treatment to reduce absorption
  4. Appropriate measures to improve elimination of the toxin
  5. Consideration of use of specific antidote
  6. Continue care and disposition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define Emergency Stabilization

A

Immediate assessment of vital function is essential

ABCDEF!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Vital signs can potentially tell you what?

A

If immediate action is necessary, clues as to the type of agent involved, prompt additional testing to asses organ function and/or provide monitoring parameters to follow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ABCDEF means what?

A 
Airway
Breathing
Circulation (pulse and BP)
DONT (dextrose, oxygen, naloxone, thiamine)
Exposure (eye and skin contamination)
Fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Airway What are you looking for?

A

Obstruction results from mucosal swelling, secretion, tongue, foreign bodies and trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Airway Treatment

A 
Chin lift
Clear airway
Nasopharyngeal or oropharyngeal airways
Intubation
Cricothyroidotomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

3 things that make you breath?

A

Hypercapnia (CO2 rising)
Hypoxia (O2 dropping)
Metabolic acidosis (body wants get rid of CO2 - acid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Breathing Treatment

A

Supplemental Oxygen

Oxygen toxicity - intubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What Cause Bradycardia?

A

CNS depressants - alcohol
Cholinergic agents
Sympatholytic (BB)
CCBs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What causes tachycardia?

A

CNS stimulants
Agents that cause hypoxia eary
CNS depressant withdrawal - alcohol
Sympathomimetic agents (meth)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What causes hypertension?

A 
CNS stimulants
Sypathomimetics (meth)
Anticholinergics
Vasoconstrictors
CNS depressant withdrawal
Thyroid supplements
Nicotine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What causes hypotension?

A 
CNS depressants - alcohol
Diuretics 
Vasodilators
Sympatholytics (BB)
Cholinergic agents
CCBs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hypotension Treatment

A 
Large bore peripheral venous line
Crystalloid fluid challenge
Monitor cardiac function
ECG
CVP
Dopamine
NE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

DON’T Agents are?

A

Dextrose 50%, 50 mL IV bolus
Oxygen
Naloxone 2 mg IV (pinpoint pupils)
Thiamine 100 mg IM/IV (alcohol withdrawal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Eye contamination treatment?

A

Flush eyes with water at room temperature for at least 30 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Skin contamination treatment?

A

Avoid secondary exposure by wearing protective gear
Remove all clothing, jewelry, shoes
Wash the patient with soap and tepid water TWICE regardless of how much time as elapsed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Fever is important why?

A

They are not dead until they are warm and dead - measure core temperature specifically in hypothermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Complete Patient Evaluation includes:

A

Detailed history, PE and labs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What should a detailed history include?

A
  • History of ingestion or exposure (any co-ingestion, what agent, route of administration, amount taken, time since ingestion, why, chronicity)
  • Corroborative history and physical evidence
  • Onset and progression of symptoms
  • Other exposed peoples symptoms
  • First aid administration
  • Neurologic symptoms (seizure, confusion, slurred speech)
  • Cardiopulmonary (syncope, cough, SOB)
  • GI (N/V, diarrhea, etc)
  • Age
  • Weight and height
  • Personal medical history (AMPS)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does AMPS mean

A

Allergies with reaction
Medications
Past medical and psychiatric history (CARDIAC, RENAL, HEPATIC disease)
Situation prior to event

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What should you look at for Physical Exam ?

A 
Look at the PATIENT
Look at the SKIN
Smell the pt's BREATH
Listen to the LUNGS
Listen to the HEART
ABDOMINAL examination
EXTREMITIES/neurologic exam
COMA assessment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What do you look at for coma assessment?

A

Level of consciousness (AEIOU TIPS)
Respiration (don’t want shallow and deep)
Pupils
Motor function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What does AEIOU TIPS mean?

A

Alcohol, Epilepsy, Insulin (hypoglycemia), Overdose, Uremia & hypoNa/hyperCa
Trauma/Tumor, Infection, Pain/Psychiatric, Stroke/Syncope and other CV abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Glasgow Coma Scale

A

15 is normal

3 is unresponsive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Digitalis Toxidrome

A 
Visual disturbances
Confusion
Abnormal EKG
Sinus bradycardia/AV block
N/V
Relative hyperK
Arrhytmias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Methanol Toxidrome

A 
Alcoholic pts
CNS depression
N/V
Snowy or blurred vision
Blindness
High anion gap metabolic acidosis
Hyperventilation 
PANCREATITIS (pickles the pancrease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Anticholinergic Toxidrome

A 
Hot as a Hare
Blind as a Bat
Dry as a Bone
Red as a beet
Mad as a hatter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Anion Gap Means

A

Elevated: metabolic acidosis that is caused by unmeasured organic acids
Normal: metabolic acidosis implies acid gain or bicarbonate loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Anion Gap Formula

A

Na - (Cl+CO2)

Normal: 10-14 (12)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

High Anion Gap Causes

A 
AT MUD PILES
Alcohol
Toluene
Methanol
Uremia
Diabetic Ketoacidosis
Paraldehyde
Iron, Isoniazide
Lactic acidosis
Ethylene glycole
Salicylate, Strychnine
31
Q

Normal Anion Gap Causes

A 
USED CAR
Ureteroenterostomy
Starvation
Emesis
Diuretics, Diarrhea
Carbonic anhydrase inhibitor
Acid
Renal tubular acidosis
32
Q

Serum Osomality Gap Causes

A 
ME DIE
Methanol
Ethanol
Diuretics
Isopropyl alcohol
Ehtylene glycol
33
Q

Criteria for Toxicology Screening

A
  1. Unknown etiology
  2. Confirm a specific toxin where treatment is altered
  3. Unexpected toxic symptoms based on the history of present illness
34
Q

Amphetamines Detection Interval

A

1-2 days

2-4 days

35
Q

Barbiturates Detection Interval

A

2-4 days

36
Q

Benzos Detection Interval

A

1-30 days

37
Q

Cannabinoids Detection Interval

A

1-3 days

>1 month (THCA in hair 1 year)

38
Q

Drugs in which treatment is guided by blood concentrations

A 
Acetaminophen
Carboxyhemglobin
Digoxin
Ethanol
Ethylene glycol
Iron
Lithium
Methanol
Salicylate
Theophylline
39
Q

Axioms for Lab Evaluation

A

Negative does not mean no toxin present, only that none on the list are present
Serum levels are more important to forensic pathologist
Serum levels do not correlate with psychiatric motivation or prognosis

40
Q

Properties of Activated Charcoal

A

Very effective but efficacy depends on delayed absorption or secretion (ER formulation) and charcoal to drug ration (low is not preferred)

41
Q

***Agents which charcoal DOES NOT bind

A 
CHAMP
Caustic (strong acids/alkalais)
Hydrocarbons (highly volaile like petroleum)
Alcohols
Metals
Pesticides
42
Q

Activated Charcoal CI

A

GI perforation is likely
Increase risk of severity of aspiration
Airway protective reflexes are absent

43
Q

Activated Charcoal Precautions

A 
Thorough mixing
Aspiration pneumonitis
Syrup of ipecac
Corrosive agents
Constipation and charcoal briquettes
44
Q

***Activated Charcoal Dosing

A

10X amount of ingested drug or 1g/kg of body weight

45
Q

AACT/EAPCCT Position on AC

A

Effectiveness decreases with time (greatest benefit is within 1 hour)
Do not routinely use
Unless a patient has an intact or protected airway, the administration of charcoal is CI

46
Q

Multiple Dose Activated Charcoal Technique

A

Inital dose orally or via orogastric or nasogastric tube (1g/kg)
Repeat doses orally or orogastric or nasogastric tube (0.5g/kg Q4-6H for 12-24 hours)

47
Q

Cathartics Options

A

Saline (osmosis of fluids)

Sorbital (increased colonic osmosis)

48
Q

Cathartic Precautions

A

Very young or very old due to electrolyte and fluid depletion
Mg should be avoided in renal problems
Avoid sodium in HTN, renal/hepatic/heart failure
Avoid cathartic use in corrosive ingestion, diarrhea, electrolyte problems
Caution in absence of bowel sounds

49
Q

AACT/EAPCCT Position on Cathartics

A

Do not do routinely

Limited to single dose

50
Q

Define Whole Bowel Irrigation

A

Rapid administration of large volumes of fluid through nasogastric tube quickly causing diarrhea- continue until the rectal effluent resembles the infusate

51
Q

WBI Indication

A

Sustained-Release Drugs
Not absorbed by AC
Remove foreign substance from the body

52
Q

WBI CI

A

Airway protective reflexes are absent
GI tract not intact
Persistent vomiting
Cocaine packet leakage

53
Q

AACT/EAPCCT Position on WBI

A

Not routinely used
Consider for sustained-release or enteric coated drugs, IRON, Illicit drug packets
Single dose of AC prior is okay! But not during WBI

54
Q

Overdose with Sustained Release Preparation leads to

A 
Prolong period between ingestion and toxic manifestation
Prolong toxic and resolution phase
Aggressive gastric lavage
Repeated AC and cathartic administration
Consider WBI
55
Q

Urinary acidification use

A

weak bases liked 24D

56
Q

Urinary alkalinization use

A

Weak acids like salicylates

57
Q

AACT/EAPCCT Position on Urinary Alkalinization

A

Increases elimination of 24D
First line in patients with moderately severe salicylate poisoning
Consider in 24D and mecoprop poisoning

58
Q

Dialysis MOA

A

Semi-permeable membrane that only allows things to cross into the water layer that are soluble
Blood is going in one direction and waste in the other

59
Q

Hemoperfusion MOA

A

Has a cartridge filled with charcoal so it pushes the blood across and the toxins stay in the charcoal filter
- Also have immuno-affinity systems which have antibodies against the toxins and does not allow the antibody out of the system to cause a immune reactions

60
Q

Hemodialysis Toxin Characteristics

A

MW less than 5000 Da
Water soluble
Not bound to plasma proteins

61
Q

Hemoperfusion Toxin Characteristics

A

Absorption by AC

Binding by plasma proteins does not preclude

62
Q

Hemofiltration Toxin Characteristics

A

MW less than 40,000 Da

63
Q

IV Fat Emulsion MOA

A
  1. Lipid sink or sponge - soaks up lipid-soluble toxins and removes it from the site of toxicity
  2. Modulation of intracellular metabolism- may block or inhibit enzymes
  3. Activation of Ca Channels
64
Q

IV Fat Emulsion Dosing

A

LD: 20% IFE, 1.5 mL/kg
MD: 20% IFE, 0.25 mL/kg/min or 15 mL/kg/h to run for 30-60 minutes

65
Q

IV Fat Emulsions AE

A

Pulomonary fat embolie syndrome

66
Q

IV Fat Emulsions CI

A

Egg/soybean allergy
Disorder of fat metabolism
Liver disease
MI

67
Q

Continuing Care Supportive measures

A 
HTN
Hypothermia
Hyperthermia
Fluid and Electrolyte Balance
Acid-Base Balance
68
Q

Supportive Measure - what do you do?

A

Give sodium bicarb to patients who are acidotic
Never discharge anybody until their mental status and vital signs are normal for 24 hours and may want to wait longer for extended release
Anyone who tries to commit suicide must undergo a psychiatric eval

69
Q

QPR Suicide Prevention

A

Question the person about suicide
Persuade the person to get help
Refer the person for help

70
Q

Patient Education for Accidental Ingestions

A

Store medicine, cleaners, paints and pesticides in their original packages in locked cabinets out of sight and reach of kids
Install a safety latch
Use safety caps
Refer to medicines by their proper name
Ensure proper dosage
Never place poisonous products in food or drink containers
Have smoke and carbon monoxide detectors

71
Q

What if swallowed poison?

A

DO NOT make your child vomit

Do not use syrup of ipecac

72
Q

What if skin poison?

A

Remove clothes and rinse skin with lukewarm water

73
Q

What if eye poison?

A

Flush the ye with eyelid open

Clin Tox Exam 1 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions