Tox 1 Flashcards
who do you ask for hx?
EMS
Family
Pt (pt not reliable)
imp. historial details
timing
drugs/substance
acute v chronic
WHY (accidental, environment, depression, etc)
primary survey
ABCD(decontamination)
airway and IV access, cardiac monitor and EKG
secondary survey
seek more history
repeat exam
consult toxicology and poison control
COMA cocktail
DONT
D-50 (get a glucose)
Oxygen
Narcan
Thiamine (500 mg IV)
decontamination strategies
Protect yourself
Eye: NS irrigation
Skin: Soap and water
drugs with an increased risk to cause hypoglycemia
insulin DM drugs (I.e. sulfonuryeas) Alcohol Salicylates acetaminophen
clinical features of sympathomimetic OD
Mydriasis (DILATED Pupils)
HTN, Hyperthermia
Diaphoresis
Agitated and excitable
sympathomimetic toxicology tx
IV hydration
benzos
cooling
intubation
DO NOT RESTRAIN for long time
opiates v opioids
opiATE: made from the poppy seed (heroin, opium, codeine, morphine)
opiOID: synthetic (oxygen, fentanyl, Percocet)
symptoms of opioid toxicity
respiratory depression
CNS depression
mitosis (pinpoint pupil)
anticholinergics toxicity sx
mydriasis tachycardia hyperthermia urinary retention ventricular dysrhythmia (Prolonged QRS, VTach)
anticholinergics toxicity tx
IVF and Benzo first line
Physostigmine if severe
TCA OD tx
sodium bicarb (dysrhythmia)
fluid bolus, benzos (seizure/agitation)
physostigmine = CHF risk, seizures, heard block
TCA drugs names
amitriptyline (elvail)
Imipramine (Tofranil)
TCA
Clinical Features:
Combative, Seizure, HoTN, Dysrhythmia
TCA Patho:
direct myocardial depression, inhibition of norepinephrine uptake
TCA ECG:
QRS prolongation,
tachycardia,
aVR
Cholinergic OD Symptoms
Vomiting
Fasciculation
DUMBELS
DUMBELS
Diarrhea,diaphoresis Urination Miosis Bronchorrhea,bronchospasm, bradycardia Emesis Lacrimation Salivation
Cholinergic Treatment
Skin decontamination
Atropine
2-PAM (pralidime)
clinical features of sedatives.hypnotic OD
normal vital signs + CNS depression
Sedative/hypnotic OD tx
supportive (Airway, IV hydration, cardiac monitor)
Acetaminophen metabolization
liver
depletion of gluthione = accumulation
Acetaminophen stages of toxicity
24hrs: nausea, vomiting, malaise
24-48 hrs: asymptomatic, liver enzyme elevation
48-96 hrs: hepatic failure, encephalopathy, coagulopathy
7-8 days: recovery
what scale monitors Acetaminophen toxicity?
rhumack Matthews
taken at arrival and 4hrs later
Acetaminophen toxicity tx
NAC (PO) if toxic rhumack or evidence of renal failure
within 8 hrs (ineffective after 24 hrs)
beta blocker toxicity present when?
MC within 1-4 hrs of ingestion
primary organ system affected by beta blocker toxicity
cardiovascular system
hallmark of severe beta blocker toxicity
bradycardia
shock
cause of bradycardia in beta blocker toxicity
sinus node suppression or conduction abnormality
beta blocker toxicity affects which systems
Cardio
CNS
pulmonary system
neuro manifestation of beta blocker toxicity
depressed mental status
coma
seizure
psychosis
CV manifestations of beta blocker toxicity
HoTn Bradycardia conduction delay/blocks ventricular dysrhythmia asystole decreased contractility
electrolyte manifestation of beta blocker toxicity
hypoglycemia
hyperkalmia
beta blocker toxicity w/u
renal function 12-lead EKG glucose stick acid base status oxygenation
beta blocker toxicity tx list (8)
Glucagon Adrenergic receptor agonist high dose insulin therapy atropine calcium Calcium Salts Sodium Bicarbonate Cardiac Pacing
glucagon beta blocker toxicity
first line
for bradycardia and HoTN
effects occur 1-2 min
ADR: n/v
adrenergic receptor agonist beta blocker toxicity
Norepinephrine, epinephrine, dopamine
esp. NE and E due to chronotropic
high dose insulin tx beta blocker toxicity
inotrope
facilitates myocardial glucose usage = energy supply during stress
stimulated contraction
ADRs of high dose insulin tx in beta blocker toxicity
hypoglycemia and lower K
dextrose infusion and supplemental K ( <2.8 mEq)
atropine beta blocker toxicity
muscarinic blocker
not effective in management of BB Brady and HoTN but not harmful
calcium beta blocker toxicity
inotrope
reverse myocardial depression
not often used, but option for refractory cases
calcium salts beta blocker toxicity
Ca gluconate = peripheral administration
Ca chloride = central line (sclerosis risk)
sodium bicarbonate beta blocker toxicity
severe acidosis
wide QRS interval dysrhythmia
given if QRS > 120-140
