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tox Flashcards

1
Q

what toxins can vs can’t cross placenta

A

cadmium can’t

lead, mercury, PCBs, insecticides all can

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2
Q

what shouldn’t you use activated charcoal for

A 
CALM
cyanide
alcohol/alkaline/kerosene
lithium
heavy metals

also antidotes, except for NAC

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3
Q

activated charcoal dosing

A

0.5-1 g/kg

adult range: 25-100 g

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4
Q

how much acetaminophen = overdose

A

140 mg/kg

if known to have ingested more than this, can give NAC right away

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5
Q

when to take acetaminophen level

A

4-10 hrs post ingestion

most important predictor of outcome

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6
Q

wintergreen odor

A

salicylates

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7
Q

can salicylate toxicity cause fever

A

yes

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8
Q

management of ibuprofen ingestion

A

supportive

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9
Q

cutoffs for BAC in ethanol toxicity

A
  1. 1% = mild
  2. 2% = moderate (slurred speech, ataxia)
  3. 3% = severe (stupor, confusion)
  4. 4% - coma, resp depression
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10
Q

what to monitor for in ethanol toxicity

A

hypoglycemia
electrolyte abnormalities
other toxidromes

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11
Q

metabolic acidosis, abdominal pain, high AG, vision issues

A

methanol ingestion

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12
Q

management of methanol ingestion

A

ethanol?
4-MP?
sodium bicarb

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13
Q

drunk with no odor of alcohol and large anion gap

A

ethylene glycol toxicity

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14
Q

calcium oxalate crystals in urine 2/2 ingestion

A

ethylene glycol

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15
Q

muscarinic effects

A

salivation, lacrimation, diarrhea, wheezing, bradycardia

give atropine

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16
Q

nicotinic effects

A

neuromuscular - weakness, paralysis, fasciculations

give pralidoxime

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17
Q

management of TCA toxicity

A

activated charcoal
EKG monitoring
sodium bicarb if widening QRS

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18
Q

TCA and allergy testing

A

interfere with histamine response - results not valid

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19
Q

GI irritation, choking, resp symptoms, infiltrates on CXR

A

hydrocarbon (gasoline, kerosene, lighter fluid) ingestion

can cause ARDS

20
Q

mgmt of hydrocarbon ingestion

A

obs for 6 hrs if asymptomatic

resp support if symptomatic

21
Q

sudden flu like symptoms, afebrile, other family members affected

A

carbon monoxide poisoning

22
Q

CO poisoning management

A

100% oxygen (O2 sat reading inaccurate)

carboxyhemoglobin levels

23
Q

smell of almonds, flu like symptoms and respiratory distress without responding to O2

A

cyanide poisoning

24
Q

management of cyanide poisoning

A

hydroxocobalamin

sodium thiosulfate, nitrate

25
Q

coughing, crying, drooling, chest pain, trouble swallowing

A

caustic substance ingestion

DO NOT DO GASTRIC LAVAGE

26
Q

what part of GI tract do alkali substances injure

A

esophagus

27
Q

what part of GI tract do acidic substances injure

A

stomach

28
Q

mechanism of alkali toxicity

A

direct contact with skin and mucosa cuasing necrosis

29
Q

min lead level to cause cognitive deficit

A

10 mcg/dL

30
Q

what to do for lead 5-14 mcg/dL

A

report and confirm in 3 months, screen for iron, development

31
Q

what to do for lead 15-44 mcg/dL

A

report and confirm in 4 weeks, consider XR for pt with pica

32
Q

what to do for lead 45-70

A

confirm in 48 hours, chelation with succimer as outpt, admit if GI or CNS sx

33
Q

what to do for lead 70+

A

confirm immediately, admit, dimercaprol and edetate calcium disodium

34
Q

how much iron is toxic ingestion

A

40 mg/kg elemental iron

35
Q

multisystem effects of iron ingestino

A

metabolic acidosis
coagulopathy
cardiovascular collapse

36
Q

when to check iron level

A

4 hrs post ingestion

37
Q

indications for iron chelation

A

severe symptoms
AG acidosis
iron > 500 mcg/dL
many pills seen on AXR

38
Q

activated charcoal for iron?

A

not indicated (poor absorption)

39
Q

when is deferoxamine therapy done?

A

urine no longer pink

40
Q

early teeth eruption, dark pigmentation of skin, acneiform rash, low birthweight

A

prenatal PCB exposure

Pigmentation Cutting teeth Birthweight low

41
Q

vesicles starting in face and extremities in same stage of dvlpmt, leaves scars

A

small pox

42
Q

pruritic papule –> central black painless eschar

A

cutaneous anthrax

43
Q

coin in esophagus on CXR

A

face forward on PA film

44
Q

coin in trachea on CXR

A

face forward on lateral film

45
Q

how long for coin to pass through GI tract

A

4-6 days

46
Q

coin in prox esophagus –>

A

endoscopy

47
Q

coin in mid-lower esphagus –>

A

observe if asymptomatic

boards prep (34 decks)

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