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Tintinalli Section 15 - Toxicology > S15C170 - General mgmt of poisoined patients > Flashcards

S15C170 - General mgmt of poisoined patients Flashcards

1
Q

Classic ‘coma’ cocktail:

A
  • oxygen
  • naloxone
  • glucose
  • thiamine (does not have to proceed glucose)
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2
Q

Naloxone infusion amount:

A

-2/3 of the dose of naloxone that fully aroused the patient in the initial bolus, infused over an hour

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3
Q

ABCDEF of tox

A

ABC
Decontamination
Elimination (urinary alkalinzation, diruesis, HD)
Find the Antidote

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4
Q

Decontamination

A

-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)

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5
Q

Antidotes: cyanide

A
  • amyl nitrite
  • soidium nitrite
  • sodium thiosulfate
  • hydroxycobalamin
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6
Q

Antidotes: CCB / BB

A
  • calcium chloride
  • glucagon
  • lipid emulsion
  • ECMO
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7
Q

Antidotes: iron

A

deferoxamine

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8
Q

Antidotes: methotrexate

A

-folic acid / leucovorin

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9
Q

Antidotes: methanol, ethylene glycol

A

-fomepizole

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10
Q

Antidotes: benzos

A

-flumazenil

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11
Q

Antidotes: cyanide / nitroprusside

A

-hydroxocobalamin

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12
Q

Antidotes: nintrite, benzocaine, sulfonamides (oxidizing chemicals)

A

-methylene blue

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13
Q

Antidotes: oral hypoglycemics

A

-octreotide

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14
Q

Antidotes: anticholinergics

A

-physostigmine

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15
Q

Antidotes: cholinergics

A

-pralidoxime

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16
Q

Antidotes: heparin

A

-protamine

17
Q

Antidotes: isoniazid

A

-pyridoxine

18
Q

Antidotes: sodium channel blockers

A

-sodium bicarbonate

19
Q

Antidotes: wet beri-beri, wernicke’s

A

-thiamine

20
Q

Antidotes: anticoagulants/rodenticides

A

-vit K

21
Q

Activated charcoal

A
  • 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
22
Q

Toxidrome: cns depression, miosis, resp depression

A
  • opioids

- naloxone, airway

23
Q

Toxidrome: psychomotor agitation, mydriasis, diaphoresis, tachycardia, HTN, hyperthermia

A
  • sympathomimetics, cocaine, amphetamine
  • other serious complications: MI, seizure, rhabdo, death
  • cooling, sedation, benzos
24
Q

Toxidrome: salivation, lacrimation, diaphoresis, n/v, urination, defecation, bronchorrea

A
  • cholinergic (organophosphates, insecticides)
  • DUMBELS
  • nicotinic effects: fasciculations and weakness
  • other: bradycardia, miosis/mydrisais, Sz, resp failure, paralysis, bronchorrhea
  • airway, atropine, pralidoxime
25
Q

Toxidrome: AMS, mydriasis, dry flushed skin, urinary retention, decreased bowel sounds, hyperthermia, dry mm

A
  • anticholinergics (red as a beet, mad as a hatter, hot as a pepper…)
  • scopolamine, atropine
  • seizures, dysrhythmias, rhabdo
  • physostigmine, benzos, cooling
26
Q

Toxidrome: AMS, resp alkalosis, metabolic acidosis, tinnitus, hyperpnea, tachycardia, diaphoresis, n/v

A
  • ASA, oil of wintergreen = salicylates
  • low grade fever, ketonuria
  • MDAC, alkalinization of urine, KCl, hemodialysis
27
Q

Toxidrome: depressed LOC, slurred speech, ataxia

A
  • sedatives - barbs, benzos
  • stupor/coma, depressed RR, apnea, bradycardia
  • airway mgmt
28
Q

Toxidrome: AMS, diaphoresis, tachycardia, HTN

A
  • hypoglycemics - sulfonylureas, insulin
  • paralysis, slurred speech, Sz,
  • glucose, octreotide
29
Q

Toxidrome: hallucinations, dysphoria, anxiety

A
  • hallucinogenics: mescaline, LSD
  • hyperthermia, mydriasis, nausea, sympathomimetic Sx
  • supportive care
30
Q

Toxidrome: AMS, increased muscle tone, hyperreflexia, hyperthermia

A
  • serotonin syndrome: SSRI, MAOI, TCA, meperidine
  • death from hyperthermia
  • cooling, sedation with benzos, supportive, ? cyproheptadine
31
Q

Toxidrome: dystonia, torticollis, tremor, muscle rigidity

A
  • EPS - haldol, risperidone, olanzapine
  • choreoathetosis, hyperreflexia, Sz
  • benzos, diphenhydramine, benztropine
32
Q

When to use whole bowel irrigation:

A
  • sustained or delayed release formulations
  • agents that form bezoar
  • iron/heavy metals
  • paint chips with lead
  • lithium
  • body stuffers/packers
33
Q

Hemodialysis (HD) for:

A

SMELT

  • ASA, methanol, ethylene glycol, lithium, theophylline
  • carbamazepine
  • amanita mushrooms

Tintinalli Section 15 - Toxicology (30 decks)

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