Themed Evening- Managing Poisoned Patients Flashcards
Which drug of abuse would cause small pupils?
Opiates
Which drug of abuse would cause large pupils?
Sympathomimetics and anticholinergic
Stimulants
What might conjunctival haemorrhage indicate?
Protracted/prolonged vomiting
Would jaundice be seen with a paracetamol overdose?
Not initially, jaundice is a late sign due to the liver dysfunction. Therefore jaundice is a late presentation.
What investigations would be done for a poisoned patient?
ABCDE approach used
Oxygen saturations
ABG
ECG
Temperature
Bloods- FBC, U&Es, LFTs Clotting
Blood glucose
Creatine kinase- indicator of cell breakdown and rhabdomyolysis
Specific drug assay- Blood bottle (EDTA) and urine (plain white top tube)
Imaging- consider ingested objects with body stuffers/body packers that can be released within the GI tract
What is the difference between a body stuffer and a body packer?
A body packer smuggles drugs within themselves
A body stuffer stuffs the drugs inside themselves when being searched/raided- these are often poorly packed to are prone to bursting leading to OD
What blood bottle is used for drug assays?
EDTA bottle
What bottle is used for urine toxicology analysis?
White/plain
Coma, meiosis and reduce respiratory rate can be seen with?
Opiates
Agitation, delirium, mydriasis, hyperthermia, tachycardia, arrhythmias may be seen with?
Amphetamines, cocaine, ecstasy
Nausea, vomiting, tinnitus, deafness, sweating, hyperventilation, metabolic acidosis may be seen with?
Aspirin/salicylates
Coma. hypertonia, mydriasis, tachycardia may be seen with?
Anticholinergics,
TCAs
Coma, convulsions and cardiac arrhythmias may been seem with?
TCAs
These are the three Cs of severe TCA overdose
Describe the difference between single dose activated charcoal and multiple dose activated charcoal
Single dose activated charcoal is a 500ml drink that contains charcoal which binds to the drug within the lumen
Multiple dose activated charcoal creates a concentration gradient that draws drugs out of capillaries
When would single dose activated charcoal be used?
For patients presenting within one hour of overdose
What drugs does charcoal not work for?
Alcohols, glycols, acids/alkalis, iron or lithium
What is whole bowel irrigation?
Given Klean prep which flushes out and clears the gut
2 litres per hour is given orrally
Used for body packers
When would urine alkalisation be carried out?
Aspirin overdose
When would extracorpeal elimination be carried out? What is it?
This is haemodialysis/haemofiltration
Useful for renal failure as patients have reduced clearance
Enhances elimination of ethanol. ethylene glycol, methanol, salicylates and lithium
What are chelating agents?
Bind to the drug
Used for heavy metal poisoning e.g. Sodium calcium edetate for lead poisoning
Iron chelators are used for iron toxicity with repeated transfusion
What must be given in paracetamol overdose?
Acetylcysteine
What must be given in opiate over dose?
Naloxone
What must be given for benzodiazepine overdose?
Flumazenil
What is rhabdomyolysis?
Breakdown of muscle tissue
Can occur with overdose due to prolonged period of lying still which causes muscle hypoxia
Blood tests can reveal elevated CCK, myoglobin and potassium
Myoglobin also causes coca-cola urine
