Specifics "C"

Question 1

Carbamazapine

Answer 1

• Na Ch, NA reuptake, anticholinergic M & N, NMDA
• 20-50mg /kg
• CNS, CVS ( VT,VF QRS,BP) , anticholinergic
• arryhtmias with NaHCO3
• E- Elimination - MDAC and HD
• monitor levels if coma
• Paeds - clear if >1hr levels negative

Question 2

Chloroquine

Answer 2

• Na , Ca and K Channels
• Catastrophic deterioration
• BP, QRS, Long Q, Low K, CNS
• 10-30mg/kg Toxic, > 5g is fatal
• RESUS - NaHCO3 and hyperventilation for arrythmia, early adrenaline inf, K correction to low normal levels, high dose diazepam (0.5mg/kg)
• Elimination - lipid emulsion, ECMO

Question 3

Colchicine

Answer 3

• inhibit mitosis - GIT and BM
• toxic >0.5mg/kg
• Severe gastro +/- shock —–> MOD and death (LATE)
• GIT symp ——->after days BM supression, rabdo, renal, ARDS,arrythmia and death
• Place for AC but ? MDAC
• ICU and supportive care

Question 4

Carbon Monoxide

Answer 4

• Acute toxic and delayed Neuro-psych effects
• Effects O2 carrying and endothelial inujury
• CNS - Headache, MMSE, ataxia
• CVS - tacy, HTN, hypotension, AMI
• RS - NPO , Metabolic ( Rabdo,LA, BSL, DIC)
• Corelation of COHb% to symptoms
  
  • >=20% symptomatic
• 100% NBO - for 8h
• HBO if high risk / preggy
  
  • LOC, Coma, low GCS, Cerebellar
  • MA, MI, age >55

Question 5

Coccaine

Answer 5

• Sympathomimetic and Na+ channel block
• > 1g lethal
• Sympathomimetic toxidrome- CNS, CVS, peripheral
• Complications ;
  
  • ACS, disection, ICH, cerebral oedema, Rhabdo, AKI
  • APO, PTX, Pnmediastinum
• ECG - ACS, Na Ch block VT, QTp, Brugada
• Special Rx ;
  
  • VT - NaHCO3 , Defib, Lignocaine 1.5mg/kg
  • SVT - BDZ and then Verapamil / adenosine /DCCV
  • ACS- STD except BB, !thrombolytics, PCA
  • HTN - IV Phentolamine 1mg, GTN, SNP
  • Seizure/delerium - IV diazepam 5mg
  • Hyperthermia
    
    • >38.5 - IVF, monitor, BDZ
    • > 39.5- Rapid Ext cooling, RSI and paralysis

Question 6

CCB - Diltiazem , Verapamil, ( amlodipine )

Answer 6

• > 10 tablets (XR) Toxic
• Co- ingestions, other cardiac issues very important
• Mainly Cardiac , LA and hyperglyceamia
• CNS indicates co-ingestion (unless shock)
• Resus
  
  • IV calcium ( temporizing )
  • HIET - earliest when refractory hypotension
  • Catecholamines -complimentry
  • Other - V pacing, CP bypass, ECHMO, IABP
• Decontamination
  
  • AC ( all intubated , <1or4h )
  • WBI ( after AC, tox dose, <4h, no tox signs)