Toxicologic Emergencies Lecture Powerpoint Flashcards
Toxidromes
Signs and symptoms associated with a specific class of poisoning in a patient (anticholinergic, cholinergic, sympathomimeetic, sedative, serotonergic)
Coma coctail
Used for patient with altered consciousness and includes
- dextrose (hypoglycemia)
- thiamine
- naloxone
Toxidrome approach
- pupil size
- temp
- bowel sounds
- heart rate
- blood pressure
- respiratory rate
- skin findings
Common anticholinergic toxidromes (5)
- antihistamines (diphenyhdramine, hydroxyzine)
- antispasmotics (dicyclomine, oxybutynin)
- atropine
- TCAs (amitriptyline)
- Jimson weed
Anticholinergic toxidrome findings
- hyperthermic, tachycardia, hypertensive
- CNS agitation and delirium
- mydriasis**
- skin dry, warm flushed**
- diminished bowel sounds, urinary retention
Common cholinergic toxidromes (3)
- organophosphates and insectisides
- cholinesterase inhibitors
- nerve agents
Cholinergic toxidrome findings
- bradycardia, high or low BP, high or low breathing
- CNS agitation and confusion
- pinpoint pupils, lacrimation
- diaphoresis***
- salivation, vomiting, diarrhea, incontinence***
Common sympathomimetic toxidromes (5)
- cocaine
- PCP
- amphetamines
- LSD
- bath salts
Sympathomimetic toxidrome findings
- Hyperthermia, tachycardia, hypertension
- CNS enhanced alertness, delirium, seizure, coma
- Mydriatic pupils
- diaphoretic, hot skin
- normal or active bowel sounds
Common opioid toxidromes (6)
- opium
- morphine
- heroin
- hydrocodone (vicodin)
- oxycodone
- fentanyl
Opioid toxidrome findings
- hypothermia, bradycardia, normal or low BP, bradypnea
- CNS lethargy and coma
- pupil miosis
- skin cool, pale, moist, evidence of needle injections
- hypoactive bowel sounds, constipation***
- hyporeflexia on neurologic exam
Common sedative hypnotic toxidromes (4)
- alcohol
- benzos
- barbituates
- sleeping aids
Sedative hypnotic toxidromes findings
- hypothermia, normal or bradycardia
- CNS drowsy, lethargy, coma
- pupils miotic
- decreased or no bowel sounds
- dry
Sympatholytic toxidrome findings
- bradycardia, hypotension, bradypnea
- CNS normal to lethargic
- pupils mid size
Common serotonin syndrome toxidromes (3)
- MAOIs
- SSRIs
- NSRIs
Serotonin syndrome toxidrome findings
- hyperthermia, tachycardia, hypertension
- CNS confusion, agitation, lethargy
- pupils mydriatic
- diaphoretic flushed skin
- hyperreflexia, tremors, clonus
Common sympatholytic toxidromes (3)
- B blockers
- a blockers
- a2 adrenergic agonists
Acetaminophen toxicity antidote
N acetylcysteine
Anticholinergic agents toxicity antidote
Physostigmine
Benzodiazepine toxicity antidote
Flumazenil
Carbon monoxide toxicity antidote
Oxygen
B or Ca2+ channel blockers toxicity antidote
IV fluids, calcium, glucagon, insulin
Cocaine or other sympathomimetics toxicity antidotes
Benzodiazepines
Ethylene glycol (antifreeze) toxicity antidotes
-fomepizole, ethanol, hemodialysis
Hydrofluoric acid toxicity antidotes
-Calcium gluconate
Acetone in ethanol, alcohol, chloroform, and salicyates have a characteristic ___ odor.
Cyanide has a characteristics ___ odor.
Arsenic, organophosphates, phosophorus have a ___ odor.
Organophoshates have a ___ odor.
Hydrogen sulfide has a ___ odor.
Methyl salicylate has a ___ odor.
Phosgene has a ___ odor
Fruity Bitter almonds Garlic kerosene Rotten eggs Wintergreen Freshly mown hay
Opioid toxicity antidote
Naloxone
Salicylates toxicity antidote
Alkalinization, hemodialysis
Warfarin toxiticy antidote
Fresh plasma, vit K
When does a patient need enhanced elimination of a toxidrome
-In cases of severe intoxication with deteriorating conditon despite maximal supportive care, or in cases where lethal blood level is known, or those with severe underlying medical conditions
Max dose of acetaminophen in adults and children, when do peak serum levels occur?
- 4g/day or 3g/day if daily alcohol
- 80mg/kg/day
-4 hours after overdose (get a 4 hour acetaminophen level!)
Carbon monoxide poisoning symptoms (4)
- nonspecific
- vague, flu like symptoms without fever or lymphadenopathy, cherry red coloration
- multiple patients from the same household
- source presence such as smoke, car exhaust, malfunctioning in heating symptoms
Carbon monoxide poisoning diagnosis (2)
- pulse ox CANNOT screen
- COHb levels 0-5% in nonsmoker and up to 10% in smokers
Fluorescein added to antifreeze allows the urine to….
….fluoresce under woods lamp
Urinary alkalinization
Administration of IV sodium bicarb to produce alkaline urine that can then improve elimination of salicylates
Cholinesterase inhibitors and organophosphate toxicity antidote
Atropine
Cyanide toxicity antidote
Hydroxocobalamin (deriv of B12)
Oral contraceptives can increase risk of what pathology?
Pulmonary embolism
