Principles of Acute Poisonings Flashcards

Question

Digitalis Toxidrome

Answer 1

``` Visual disturbances Confusion Abnormal EKG Sinus bradycardia/AV block N/V Relative hyperK Arrhytmias ```

Answer 2

``` Alcoholic pts CNS depression N/V Snowy or blurred vision Blindness High anion gap metabolic acidosis Hyperventilation PANCREATITIS (pickles the pancrease ```

Answer 3

``` Hot as a Hare Blind as a Bat Dry as a Bone Red as a beet Mad as a hatter ```

Answer 4

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

Answer 5

Na - (Cl+CO2) | Normal: 10-14 (12)

Answer 6

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

Answer 7

``` USED CAR Ureteroenterostomy Starvation Emesis Diuretics, Diarrhea Carbonic anhydrase inhibitor Acid Renal tubular acidosis ```

Answer 8

``` ME DIE Methanol Ethanol Diuretics Isopropyl alcohol Ehtylene glycol ```

Answer 9

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

Answer 10

1-2 days | 2-4 days

Answer 11

1-3 days | >1 month (THCA in hair 1 year)

Answer 12

``` Acetaminophen Carboxyhemglobin Digoxin Ethanol Ethylene glycol Iron Lithium Methanol Salicylate Theophylline ```

Answer 13

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

Answer 14

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

Answer 15

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

Answer 16

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

Answer 17

``` Thorough mixing Aspiration pneumonitis Syrup of ipecac Corrosive agents Constipation and charcoal briquettes ```

Answer 18

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

Answer 19

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

Answer 20

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)

Answer 21

Saline (osmosis of fluids) | Sorbital (increased colonic osmosis)

Answer 22

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

Answer 23

Do not do routinely | Limited to single dose

Answer 24

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

Answer 25

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

Answer 26

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

Answer 27

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

Answer 28

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

Answer 29

weak bases liked 24D

Answer 30

Weak acids like salicylates

Answer 31

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

Answer 32

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

Answer 33

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

Answer 34

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

Answer 35

Absorption by AC | Binding by plasma proteins does not preclude

Answer 36

MW less than 40,000 Da

Answer 37

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

Answer 38

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

Answer 39

Pulomonary fat embolie syndrome

Answer 40

Egg/soybean allergy Disorder of fat metabolism Liver disease MI

Answer 41

``` HTN Hypothermia Hyperthermia Fluid and Electrolyte Balance Acid-Base Balance ```

Answer 42

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

Answer 43

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

Answer 44

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

Answer 45

DO NOT make your child vomit | Do not use syrup of ipecac

Answer 46

Remove clothes and rinse skin with lukewarm water

Answer 47

Flush the ye with eyelid open