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SU-18 ER > Tox 1 > Flashcards

Tox 1 Flashcards

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1
Q

who do you ask for hx?

A

EMS
Family
Pt (pt not reliable)

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2
Q

imp. historial details

A

timing
drugs/substance
acute v chronic
WHY (accidental, environment, depression, etc)

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3
Q

primary survey

A

ABCD(decontamination)

airway and IV access, cardiac monitor and EKG

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4
Q

secondary survey

A

seek more history
repeat exam
consult toxicology and poison control

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5
Q

COMA cocktail

A

DONT

D-50 (get a glucose)
Oxygen
Narcan
Thiamine (500 mg IV)

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6
Q

decontamination strategies

A

Protect yourself
Eye: NS irrigation
Skin: Soap and water

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7
Q

drugs with an increased risk to cause hypoglycemia

A 
insulin
DM drugs (I.e. sulfonuryeas) 
Alcohol
Salicylates 
acetaminophen
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8
Q

clinical features of sympathomimetic OD

A

Mydriasis (DILATED Pupils)
HTN, Hyperthermia
Diaphoresis
Agitated and excitable

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9
Q

sympathomimetic toxicology tx

A

IV hydration
benzos
cooling
intubation

DO NOT RESTRAIN for long time

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10
Q

opiates v opioids

A

opiATE: made from the poppy seed (heroin, opium, codeine, morphine)

opiOID: synthetic (oxygen, fentanyl, Percocet)

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11
Q

symptoms of opioid toxicity

A

respiratory depression
CNS depression
mitosis (pinpoint pupil)

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12
Q

anticholinergics toxicity sx

A 
mydriasis 
tachycardia 
hyperthermia 
urinary retention 
ventricular dysrhythmia (Prolonged QRS, VTach)
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13
Q

anticholinergics toxicity tx

A

IVF and Benzo first line

Physostigmine if severe

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14
Q

TCA OD tx

A

sodium bicarb (dysrhythmia)

fluid bolus, benzos (seizure/agitation)

physostigmine = CHF risk, seizures, heard block

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15
Q

TCA drugs names

A

amitriptyline (elvail)

Imipramine (Tofranil)

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16
Q

TCA

Clinical Features:

A

Combative, Seizure, HoTN, Dysrhythmia

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17
Q

TCA Patho:

A

direct myocardial depression, inhibition of norepinephrine uptake

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18
Q

TCA ECG:

A

QRS prolongation,
tachycardia,
aVR

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19
Q

Cholinergic OD Symptoms

A

Vomiting
Fasciculation

DUMBELS

20
Q

DUMBELS

A 
Diarrhea,diaphoresis
Urination 
Miosis
Bronchorrhea,bronchospasm, bradycardia
Emesis
Lacrimation 
Salivation
21
Q

Cholinergic Treatment

A

Skin decontamination
Atropine
2-PAM (pralidime)

22
Q

clinical features of sedatives.hypnotic OD

A

normal vital signs + CNS depression

23
Q

Sedative/hypnotic OD tx

A

supportive (Airway, IV hydration, cardiac monitor)

24
Q

Acetaminophen metabolization

A

liver

depletion of gluthione = accumulation

25
Q

Acetaminophen stages of toxicity

A

24hrs: nausea, vomiting, malaise

24-48 hrs: asymptomatic, liver enzyme elevation

48-96 hrs: hepatic failure, encephalopathy, coagulopathy

7-8 days: recovery

26
Q

what scale monitors Acetaminophen toxicity?

A

rhumack Matthews

taken at arrival and 4hrs later

27
Q

Acetaminophen toxicity tx

A

NAC (PO) if toxic rhumack or evidence of renal failure

within 8 hrs (ineffective after 24 hrs)

28
Q

beta blocker toxicity present when?

A

MC within 1-4 hrs of ingestion

29
Q

primary organ system affected by beta blocker toxicity

A

cardiovascular system

30
Q

hallmark of severe beta blocker toxicity

A

bradycardia

shock

31
Q

cause of bradycardia in beta blocker toxicity

A

sinus node suppression or conduction abnormality

32
Q

beta blocker toxicity affects which systems

A

Cardio
CNS
pulmonary system

33
Q

neuro manifestation of beta blocker toxicity

A

depressed mental status
coma
seizure
psychosis

34
Q

CV manifestations of beta blocker toxicity

A 
HoTn
Bradycardia 
conduction delay/blocks
ventricular dysrhythmia 
asystole
decreased contractility
35
Q

electrolyte manifestation of beta blocker toxicity

A

hypoglycemia

hyperkalmia

36
Q

beta blocker toxicity w/u

A 
renal function 
12-lead EKG
glucose stick 
acid base status 
oxygenation
37
Q

beta blocker toxicity tx list (8)

A 
Glucagon
Adrenergic receptor agonist 
high dose insulin therapy 
atropine 
calcium 
Calcium Salts
Sodium Bicarbonate
Cardiac Pacing
38
Q

glucagon beta blocker toxicity

A

first line

for bradycardia and HoTN

effects occur 1-2 min

ADR: n/v

39
Q

adrenergic receptor agonist beta blocker toxicity

A

Norepinephrine, epinephrine, dopamine

esp. NE and E due to chronotropic

40
Q

high dose insulin tx beta blocker toxicity

A

inotrope

facilitates myocardial glucose usage = energy supply during stress

stimulated contraction

41
Q

ADRs of high dose insulin tx in beta blocker toxicity

A

hypoglycemia and lower K

dextrose infusion and supplemental K ( <2.8 mEq)

42
Q

atropine beta blocker toxicity

A

muscarinic blocker

not effective in management of BB Brady and HoTN but not harmful

43
Q

calcium beta blocker toxicity

A

inotrope

reverse myocardial depression

not often used, but option for refractory cases

44
Q

calcium salts beta blocker toxicity

A

Ca gluconate = peripheral administration

Ca chloride = central line (sclerosis risk)

45
Q

sodium bicarbonate beta blocker toxicity

A

severe acidosis
wide QRS interval dysrhythmia

given if QRS > 120-140

SU-18 ER (11 decks)

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