S15C170 - General mgmt of poisoined patients Flashcards
Classic ‘coma’ cocktail:
- oxygen
- naloxone
- glucose
- thiamine (does not have to proceed glucose)
Naloxone infusion amount:
-2/3 of the dose of naloxone that fully aroused the patient in the initial bolus, infused over an hour
ABCDEF of tox
ABC
Decontamination
Elimination (urinary alkalinzation, diruesis, HD)
Find the Antidote
Decontamination
-from skin (remove clothing), wash with water
-from eyes - irrigation
-GI - remove from stomach via mouth (ipecac, orogastric lavage)
bind toxin in gut
increase transit time of toxin (cathartics, WBI)
Antidotes: cyanide
- amyl nitrite
- soidium nitrite
- sodium thiosulfate
- hydroxycobalamin
Antidotes: CCB / BB
- calcium chloride
- glucagon
- lipid emulsion
- ECMO
Antidotes: iron
deferoxamine
Antidotes: methotrexate
-folic acid / leucovorin
Antidotes: methanol, ethylene glycol
-fomepizole
Antidotes: benzos
-flumazenil
Antidotes: cyanide / nitroprusside
-hydroxocobalamin
Antidotes: nintrite, benzocaine, sulfonamides (oxidizing chemicals)
-methylene blue
Antidotes: oral hypoglycemics
-octreotide
Antidotes: anticholinergics
-physostigmine
Antidotes: cholinergics
-pralidoxime
Antidotes: heparin
-protamine
Antidotes: isoniazid
-pyridoxine
Antidotes: sodium channel blockers
-sodium bicarbonate
Antidotes: wet beri-beri, wernicke’s
-thiamine
Antidotes: anticoagulants/rodenticides
-vit K
Activated charcoal
- most benefit if given w/in 1h of ingestion
- 1g/kg first dose then 0.5g/kg after
- contraindicated if esophagus/bowel perforation
- don’t give for: iron, lithium, lead, hydrocarbons, toxic alcohols
- MDAC (multidose charcoal) for long 1/2 life drugs, bezoars, theophylline, carbamazepine, phenobarbital, quinine, dapsone
Toxidrome: cns depression, miosis, resp depression
- opioids
- naloxone, airway
Toxidrome: psychomotor agitation, mydriasis, diaphoresis, tachycardia, HTN, hyperthermia
- sympathomimetics, cocaine, amphetamine
- other serious complications: MI, seizure, rhabdo, death
- cooling, sedation, benzos
Toxidrome: salivation, lacrimation, diaphoresis, n/v, urination, defecation, bronchorrea
- cholinergic (organophosphates, insecticides)
- DUMBELS
- nicotinic effects: fasciculations and weakness
- other: bradycardia, miosis/mydrisais, Sz, resp failure, paralysis, bronchorrhea
- airway, atropine, pralidoxime
Toxidrome: AMS, mydriasis, dry flushed skin, urinary retention, decreased bowel sounds, hyperthermia, dry mm
- anticholinergics (red as a beet, mad as a hatter, hot as a pepper…)
- scopolamine, atropine
- seizures, dysrhythmias, rhabdo
- physostigmine, benzos, cooling
Toxidrome: AMS, resp alkalosis, metabolic acidosis, tinnitus, hyperpnea, tachycardia, diaphoresis, n/v
- ASA, oil of wintergreen = salicylates
- low grade fever, ketonuria
- MDAC, alkalinization of urine, KCl, hemodialysis
Toxidrome: depressed LOC, slurred speech, ataxia
- sedatives - barbs, benzos
- stupor/coma, depressed RR, apnea, bradycardia
- airway mgmt
Toxidrome: AMS, diaphoresis, tachycardia, HTN
- hypoglycemics - sulfonylureas, insulin
- paralysis, slurred speech, Sz,
- glucose, octreotide
Toxidrome: hallucinations, dysphoria, anxiety
- hallucinogenics: mescaline, LSD
- hyperthermia, mydriasis, nausea, sympathomimetic Sx
- supportive care
Toxidrome: AMS, increased muscle tone, hyperreflexia, hyperthermia
- serotonin syndrome: SSRI, MAOI, TCA, meperidine
- death from hyperthermia
- cooling, sedation with benzos, supportive, ? cyproheptadine
Toxidrome: dystonia, torticollis, tremor, muscle rigidity
- EPS - haldol, risperidone, olanzapine
- choreoathetosis, hyperreflexia, Sz
- benzos, diphenhydramine, benztropine
When to use whole bowel irrigation:
- sustained or delayed release formulations
- agents that form bezoar
- iron/heavy metals
- paint chips with lead
- lithium
- body stuffers/packers
Hemodialysis (HD) for:
SMELT
- ASA, methanol, ethylene glycol, lithium, theophylline
- carbamazepine
- amanita mushrooms
