Themed Evening- Managing Poisoned Patients

Question 1

Which drug of abuse would cause small pupils?

Answer 1

Opiates

Question 2

Which drug of abuse would cause large pupils?

Answer 2

Sympathomimetics and anticholinergic

Stimulants

Question 3

What might conjunctival haemorrhage indicate?

Answer 3

Protracted/prolonged vomiting

Question 4

Would jaundice be seen with a paracetamol overdose?

Answer 4

Not initially, jaundice is a late sign due to the liver dysfunction. Therefore jaundice is a late presentation.

Question 5

What investigations would be done for a poisoned patient?

Answer 5

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

Question 6

What is the difference between a body stuffer and a body packer?

Answer 6

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

Question 7

What blood bottle is used for drug assays?

Answer 7

EDTA bottle

Question 8

What bottle is used for urine toxicology analysis?

Answer 8

White/plain

Question 9

Coma, meiosis and reduce respiratory rate can be seen with?

Answer 9

Opiates

Question 10

Agitation, delirium, mydriasis, hyperthermia, tachycardia, arrhythmias may be seen with?

Answer 10

Amphetamines, cocaine, ecstasy

Question 11

Nausea, vomiting, tinnitus, deafness, sweating, hyperventilation, metabolic acidosis may be seen with?

Answer 11

Aspirin/salicylates

Question 12

Coma. hypertonia, mydriasis, tachycardia may be seen with?

Answer 12

Anticholinergics,

TCAs

Question 13

Coma, convulsions and cardiac arrhythmias may been seem with?

Answer 13

TCAs

These are the three Cs of severe TCA overdose

Question 14

Describe the difference between single dose activated charcoal and multiple dose activated charcoal

Answer 14

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

Question 15

When would single dose activated charcoal be used?

Answer 15

For patients presenting within one hour of overdose

Question 16

What drugs does charcoal not work for?

Answer 16

Alcohols, glycols, acids/alkalis, iron or lithium

Question 17

What is whole bowel irrigation?

Answer 17

Given Klean prep which flushes out and clears the gut
2 litres per hour is given orrally
Used for body packers

Question 18

When would urine alkalisation be carried out?

Answer 18

Aspirin overdose

Question 19

When would extracorpeal elimination be carried out? What is it?

Answer 19

This is haemodialysis/haemofiltration
Useful for renal failure as patients have reduced clearance
Enhances elimination of ethanol. ethylene glycol, methanol, salicylates and lithium

Question 20

What are chelating agents?

Answer 20

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

Question 21

What must be given in paracetamol overdose?

Answer 21

Acetylcysteine

Question 22

What must be given in opiate over dose?

Answer 22

Naloxone

Question 23

What must be given for benzodiazepine overdose?

Answer 23

Flumazenil

Question 24

What is rhabdomyolysis?

Answer 24

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