Tox I Flashcards
What are the most commonly ingested products in children?
Plants
Cleaning products
Cough/cold preps
perfumes
What is the difference between children, adolescent/adult and elderly toxic ingestions?
Children - single, known, promptly
A/A - multiple, intentional, unknown, delayed regocnition
Elderly - med overuse
What are the 3 things that you should identify when approaching a patient who has ingested something toxic?
Substance
Amount
Route of ingestion
5 things to check on physical exam
- VS
- Coma grade/level of consciousness
- Neurological findings
- Cardiac dysrhythmias
- Odors
What is a toxidrome?
constellation of S/S referable to a single drug overdose
What labs should you order?
ELectrolytes Anion Gap ABG Serum osmolality EKG Toxic screen - common available drugs Coags LFTs UA Serum myoglobin KUB
What are the 5 treatment principals?
- Provide supportive care
- Prevent absorption
- Enhance elimination
- Interrupt or alter metabolism (Anti-freeze)
- Provide specific antidotes
What is the old tox drug cocktail?
- Thiamine 100mg (IV) – Vit B - alcoholics that are vitamin deficient can develop Wernicke’s encephalopathy
- D5W – 50ml (IV) In case they are hypoglycemic
- Naloxone – 2-8mg IV narcotic antidote
- Flumazenil – 0.2mg IV Benzo antidote
How does Ipecac work? What is the key to deciding whether or not Ipecac is appropriate?
Local gastric irritant and stimulator of the CTZ
Key - When the ingestion occured - Whether the toxin is before or after the pyloric valve
What is the time limit when using Ipecac?
Beyond 4-6 hours of time 0 is ineffective unless the toxin itself delays the absorption time
Children younger than ______ are not given Ipecac.
6 months
What are the 5 relative contraindications to giving Ipecac?
- Seizure-inducing drugs – seizing + vomiting = aspiration, asphyxiation
- Rapid coma inducing drugs – same thing
- Pregnancy process of vomiting causes bradycardia (ACh), which decreases blood flow to the fetus
- Hydrocarbons (gasoline, oils) - #1 risk is that they can cause aspiration, so do not bring them back up closer to chest
- Severe bradycardia – patient will pass out
What are the 3 absolute contraindications to using Ipecac
- Children
- Corrosive
- Seizing/coma
What is gastric lavage?
Passage of a large bore orogastric tube and the administration/aspiration of small volumes of liquid (200-300cc of warm water or saline) for removal of gastric contents.
“Stomach pumping”
Avoid using ______ in children when performing gastric lavage for risk of _________. Only use _____.
avoid water for risk of hyponatremia
only use saline
Follow up gastric lavage with _______.
activated charcoal
Only use gastric lavage in cases where the ingestion occured ____________ prior.
1 hour
Name a absolute contraindication of gastric lavage.
Name a relative contraindication.
Name the 2 most common AEs.
absolute NO - unprotected airway
relative NO - hydrocarbons and corrosive
AEs - aspiration PNA and bradycardia
Activated charcoal is emerging as the _____ decontamination produced. It is available _____. It is okay/not to give it when substance is post-pyloric
Sole
OTC
okay
You need to do WHAT before giving someone activated charcoal (AC). Why?
Check for bowel sounds. If patient has ileus, it can lead to toxic megacolon
How does AC work? What is the most common AE?
Absorbs toxic substances and prevents their absorption in the GI tract.
Constipation
What is AC not effective for? MUST KNOW.
Heavy metals - irons, lithium, minerals
Alchohols - ethanol, methanol
Hydrocarbons - cyanide, organic solvents
Which should you use first…ipecac or charcaol?
Ipecac because charcoal will absorb ipecac.
When is whole bowel irrigation used?
- In the massive ingestions of of toxic substances in patients presenting late (>4h post-exposure)
- ingestion of SR drug products
- ingestion of drug packets by body stuffers
- ingestion of small foreign bodies (disk batteries)
- ingestion of substances not removed by activated charcoal.
