Thera 2 Toxicology Flashcards
To asses a pt that comes to the hospital because of a overdose:
Step 1
A
B
C
D
E
A= Airway
B=Breathing
C=Circulation–> BP, HR
D=Disability –> Also D-stick that is bedside blood glucose measurment. You need to check the blood glucose because if low blood glucose can increase the risk of seizure and also if the pt is agitated than it will be harder for them to breath
E=Exposure
To asses a pt that comes to the hospital because of a overdose:
Step 2
A
M
P
L
E
A=Allergies
M=Medications
P=Past medical history
L= Last meal
E=Events leading up to presentation
Step 3 perform a physical exam
Vital signs: HR, BP, RR, O2 saturation
Pupil size
Mental status
Skin–> Flushy? Dry? Sweaty?
Bowel sounds: Decrease? Increased?
Describe the anticholinergic toxidrome
Hot as a hade–> Warm to touch
Mad as a hatter–> Confusion, hallucinations
Dry as a bone–> Xerostomia
Blind as a Bat–> Mydriasis pupil dilated
Full as a flask–> Increase urine retention
Red as a beet–> Flush skin
Drugs like:
Diphenhydramine (Benadryl)
Muscarinic antagonist
TCA
Jimson weed
Describe the cholinergic toxidrome
DUMBBELS
D–>Diarrhea
U–>Urination
M–>Miosis (pupil constricted)
B–>Bronchorrhea (fluid accumulation in lungs
B–>Bronchospasm
E–> Emesis–> Vomiting
L–>Lacrimation
S–>Salivation
Drugs like
cholinesterase inhibitors-> Edrophonium, ambenonium, neostigme, pyridostigme, physostigme
-Nerve agents
-Organic phosphates
Describe the Opioid toxidrome
CNS depression
Respiratory depression–> Decrease breathing
Miosis
Bradycardia
Hypothermia
Describe the sedative-hypnotic toxydrome
-CNS depression
-Respiratory depression
-Small or mild size pupils
-Bradycardia
Drugs that cause it
Benzos
Barbs
ETOH
Describe the sympathomimetic toxydrome
-Agitation
-Mydriasis (Dilated pupils)
-Hyperthermia
-Hypertension
-Tachycardia
-Diaphoresis –> Excessive sweating
-Normal to increased bowel sounds
Drugs that can cause it:
Cocaine and amphetamines
A wide QRS what does it indicate and what can you give to the patient
Indicates Na+ blockade
Can give Na+ bicarbonate
What are the GI decontamination for Gastric emptying
IPEPAC–> Enhances vomiting
Gastric lavage–> Pull contents of stomach
What are the GI decontamination Activated charcol
Binds to the chemical and prevent being absorbed
Antidote of opiods
Naloxone (Narcan)
Antidote of acetaminophen
N-acetylcysteine
Antidote of Salicylates
Sodium bicarbonate
Acetaminophen stage 1 clinical presentation
1-24hrs
N/Vm diarrhea, pallor , diasphoresis
See high levels of APAP
Acetaminophen clinical presentation Stage 2
24-72hrs
Hepatic injury
high AST, ALT, INR
liver pain
increase beeling
Acetaminophen clinical presentation stage 3
72-96 hrs liver failure
pH <7.3
PT >100
Cr>3.4
Considere liver transplant
If the levels of acetaminophen are undetectable but have elevated ALT and AST what should you do?
Need to treat it with N-acetylcysteine
If the levels of acetaminophen are >10mcg/ml but normal AST and ALT what should you do?
Need to treat it with N-acetylcysteine
If the levels of acetaminophen are undetectable and the AST and ALT are normal what should you do?
No treatment
Explain the Salicylate toxicity mechanism
Increase BP –>PGE2 and PGI2 are inhibited
Increase breathing tachypnea–> Accumulation of acetylsalicylic acid in the blood
Oxidative phosphorylation
Nausea and vomiting–> Trigger chemotriger zone in brain
Salicylate toxicity presentation
Ear–> Tinnitus if left untreated deafness
Acute renal failure
Skin–> Diaphoresis abnormal sweating
CNS–> Altered mental status Seizure, coma
Pulmonary–> Rapid breathing, pulmonary edema
Cardio–> Tachycardia
GI–> Nausea/Vomiting
-Fever
Salicylate toxic Lab findings
> 30mg/dl
Acute toxicity of Salicylate:
> 90-100mg/dl
Chronic toxicity of Salicylate:
> 60mg/dl
