TOX - ENVIRONMENTAL - SUBSTANCE ABUSE Flashcards
All patients must be warmed to a minimum of what degree?
86F (30C)
What is the final pathology of a submersion injury?
Hypoxia due to submersion
What is the main symptom of heat exhaustion? Heat stroke?
Heat exhaustion = sweating profusely
Heat stroke = hot and dry
What is the treatment for both heat exhaustion and heat stroke? (4)
-Rapid cooling
-Avoid shivering
-IVF/electrolytes
-Check for rhabdo/DIC
Radiation injury is related to what 3 things?
Time, distance, shielding
What might be the first sign of petroleum distallates overdose (aka gasoline)?
cough
“Nerve agents” - acetylcholinesterase inhibitor that causes too much ACTH buildup. Neuromuscular junction cannot “reset” for next impulse. Leads to paralysis of the diaphragm. AKA acetylcholinergic crisis. Found in insecticides and WMD. Treat with atropine.
Organophosphates
S&S of organophosphates OD
MUDDLES:
-miosis (constriction of pupil)
-urination
-diaphoresis
-defecation
-lacrimation
-excitation (seizures)
-salavation
Constriction of pupil?
Dilation of pupil?
Miosis
Mydriasis
What toxidromes cause miosis (2)?
What cause mydriasis (1)?
Miosis = opiates & organophosphates
Mydriasis = stimulants
How long after tylenol ingestion should we get a level?
4 hours
What is a (often terminal) finding of carbon monoxide poisioning?
Cherry red skin and mucous membranes
What are some sources of CO poisioning? What patient education needs to be done?
Anything that burns and gas appliances
Have CO detectors
What may cause “bitter almond” breath?
Cyanide Toxicity
What are 3 routes for cyanide toxicity?
inhale, oral, IV (nipride)
What is charcol contraindicated in?
Iron toxicity
What is tinnitus a symptom of?
ASA toxicity
What have both anticholinergic and alpha-adrenergic properties?
(alpha cells are on blood vessels, so they vasoconstrict and increase the HR)
TCAs (elevil, amitryptline)
What is a common anticholinergic? What are 4 symptoms?
Atropine
Can’t see, can’t pee, can’t spit, can’t shit
3 Cs of TCA OD
Cardiac (dysrhythmias)
Convulsions (seizures)
Coma (decreased LOC)
Alcohol can cause what to happen to the eyes?
Nystagmus
This causes increase in catecholamine release from CNS. Symptoms of increased HR/palpitations/CP coming from brain, not heart
Cocaine
How do we treat symptoms r/t cocaine OD?
Benzos (not nitro or BB!)
Leads to autonomic instability and causes HTN, tachycardia, disphoresis
Delirum Tremens
This is r/t alcohol abuse and can lead to Korsakoff psychosis.
Werenicke’s encephalopathy
What should we give to alcoholics/werenicke’s encephalopathy patients before giving glucose to protect the brain?
Thiamine
What are some toxic symptoms of lithium? How do we treat?
-ataxia
-nystagmus
-renal impairment (renally excreted)
-seizures
Treat with IVF
Why do we use digoxin? What can dig toxicity cause (3)?
A-fib
-decreased HR
-heart blocks
-“yellow halos”
Antidote to coumadin
vitamin K
Antidote to dilantin
supportive (heart rhythm changes)
Antidote to CCB
calcium chloride/gluconate
Antidote to ethylene glycol/methanol
10% ethanol
Antidote to BB/CCB
glucagon
Antidote to oral sulfonylureas (metformin/glucophage)
octreotide/sandostatin
(this blocks pancreas and causes it to slow down insulin production)
Antidote to heparin
protamine sulfate
Antidote to tylenol
mucomyst (PO)/acetylcysteine
Antidote to benzos
Romazicon/Flumazeril
Antidote to carbon monoxide
high flow oxygen
Antidote to cyanide
Cyanide kit:
Amyl nitrate (inhaled)
Sodium nitrate (IV)
Sodium thiosulfate (IV)
Antidote to iron
deFEroxamine (this may cause pink/red urine)
Antidote to salicylates
HCO3
Antidote to TCAs
HCO3
