Toxic emergencies Flashcards
who do you contact if there has been a poisoning event?
poison control center- national networks (good to provide this phone number to parents)
routes of exposure?
ingestion, inhalation, skin surface irritation, injection (animal bites/stings, IV drugs)
what should you NOT do with a toxic exposure?
give q cathartic or inducing vomiting and diarrhea. (often found that these do no work or can cause more harm–i.e. aspiration)
what are some acceptable general tx options?
Gastric lavage and activated charcoal may be utilized.
Enhance elimination of the toxin by use of hydration and poison or drug antidotes when possible.
antidote for acetomenophen?
N-Acetylcysteine
antidote for cyanide?
amyl nitrate, then sodium nitrate, then sodium thiosulfate
antidote for lead?
edetate calcium disodium or dimercaptosuccinic acid (DMSA)
antidote for atropine?
physostigmine
antidote for benzodiazepines?
flumazenil
How do you treat suicidal patients?
Document, do they have a plan, are there meds/guns in the house…etc. Involve law enforcement, medical direction, know local procedures for protective custody. (legal obligation)
What other substance do you ask about during an assessment of ingested toxin?
Alcohol involvement.
What do you avoid ingesting with unknown toxic exposure?
food– may cause vomiting
what vitamin deficiency is seen in alcoholics?
Thiamine (B1) , often added to IV fluids in this population.
which two substances may have fatal withdrawal sequelae?
alcohol and benzodiazepines
signs and symptoms of carbon-monoxide?
HA, N/V, confusion or altered mental status, tachypnea [dec O2 carrying capacity]
signs and symptoms of Anticholinergic toxicity
dry skin/mucous membranes, thirst, dysphagia, dilated pupils, tachycardia, rash, confusion,/delirium
signs and symptoms of organophosphate toxicity (acetylcholinasterase inhibitors)
SLUDGE
salivation, lacrimation, urination, defecation, GI distress, Emesis
antidote for organophosphates?
atropine
Signs and symptoms of narcotic toxicity?
CNS depression, **pinpoint pupils, slow respiration, hypotension
signs and symptoms of metal fume fever?
chills, fever, N/V, ms pain, throat dryness, HA, fatigue
Signs and symptoms of cyanide poisoning?
a burning sensation in the mouth and throat, headache, confusion, combativeness, hypertension and tachycardia
what is dangerous about cyanide?
rapidly acting toxin (can be ingested, inhaled and absorbed through the skin)
what is the number one side effect of hypertensive drugs?
hypotension! overshooting with meds.
what is the number one side-effect of cardiac drugs?
dysrhythmias
Signs and symptoms of caustic substances (chemical or thermal burns)?
Hoarseness, stridor, or shortness of breath
Shock from bleeding, vomiting.
pain in the lips, tongue, throat, drooling, difficulty swallowing
Signs and symptoms of salicylate toxicity? (salicylism) -w/ASA
tachypnea, abdominal pain, vomiting, tinnitus, pulmonary edema, ARDS hyperthermia, confusion, lethargy, coma, dysrhythmias, cardiac failure and respiratory arrest.
we urinate more and hyperventilate with asa overdose (body trying to decrease acid)
What causes Reye’s syndrome?
Giving aspirin to children aspirin for a viral fever.
What is often a cause for liver failure?
acetominophen/tylenol overdose
what molecule is the most hepato-toxic molecule (from break down of acetominophine)?
NAPQI: N-acetyl-p-benzoquinone-imine.
why is mixing tylenol and alcohol dangerous?
more rapid breakdown of tylenol to NAPQI and depletion of glutithione stores –> toxicity.
At what stage does peak acteominophen toxicity occur?
STAGE 3: 72 to 96 hours: AST may exceed 20k.
When is NAC the most effective as an antidote for tylenol?
asap or within 8 hours.
given IV
why is NAC an antidote for acetominophen?
NAC is a precursor of glutathione and increases glutathione availability to bind to NAPQI (toxic breakdown moledule of acetominophin)
Signs and symptoms of overdose of an NSAIDs?
abdominal pain, nausea, vomiting, drowsiness, headache, tinnitus, dyspnea, wheezing, pulmonary edema, swelling of extremities, rash and itching.
samters triad?
consists of asthma, recurrent sinus disease with nasal polyps, and a sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs).
what warning do all antidepressants have?
black box warning: increased suicidal ideation especially in adolescents.
What is notable about tricyclic anti-depressants?
have a narrow therapeutic index.
TCA toxicity signs and symptoms?
have an anti-histamine like effects: Dry mouth, blurred vision, urinary retention, constipation
(have been used to prevent bed wetting in children- not a great drug choice obviously)
what is notable bronchodilator used for asthma and COPD has a narrow therapeutic index?
theophylline (theodur)
Serotonin syndrome? **
agitation, anxiety, confusion, insomnia, headache, coma, salivation, diarrhea, abdominal cramps, cutaneous piloerection, flushed skin, hyperthermia, rigidity, shivering, incoordinationand myoclonic jerks.
what should people taking MAOi’s avoid?
foods with tyramine- dried fruits, aged cheeses…etc
what 2 conditions can be induced by lithium?
hypothyroidism or diabetes insipidus (nephrogenic) - often irreversible
when is activated charcoal not indicated?
with iron, lead, mercury (or metal) overdose
what are the signs and symptoms of iron overdose?
vomiting (possible hematemesis), diarrhea, abdominal pain, shock, liver failure, bowel scarring and obstruction, metabolic acidosis.
