Toxicologic Emergencies Lecture Powerpoint Flashcards

1
Q

Toxidromes

A

Signs and symptoms associated with a specific class of poisoning in a patient (anticholinergic, cholinergic, sympathomimeetic, sedative, serotonergic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Coma coctail

A

Used for patient with altered consciousness and includes

  • dextrose (hypoglycemia)
  • thiamine
  • naloxone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Toxidrome approach

A
  • pupil size
  • temp
  • bowel sounds
  • heart rate
  • blood pressure
  • respiratory rate
  • skin findings
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Common anticholinergic toxidromes (5)

A
  • antihistamines (diphenyhdramine, hydroxyzine)
  • antispasmotics (dicyclomine, oxybutynin)
  • atropine
  • TCAs (amitriptyline)
  • Jimson weed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Anticholinergic toxidrome findings

A
  • hyperthermic, tachycardia, hypertensive
  • CNS agitation and delirium
  • mydriasis**
  • skin dry, warm flushed**
  • diminished bowel sounds, urinary retention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Common cholinergic toxidromes (3)

A
  • organophosphates and insectisides
  • cholinesterase inhibitors
  • nerve agents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Cholinergic toxidrome findings

A
  • bradycardia, high or low BP, high or low breathing
  • CNS agitation and confusion
  • pinpoint pupils, lacrimation
  • diaphoresis***
  • salivation, vomiting, diarrhea, incontinence***
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Common sympathomimetic toxidromes (5)

A
  • cocaine
  • PCP
  • amphetamines
  • LSD
  • bath salts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Sympathomimetic toxidrome findings

A
  • Hyperthermia, tachycardia, hypertension
  • CNS enhanced alertness, delirium, seizure, coma
  • Mydriatic pupils
  • diaphoretic, hot skin
  • normal or active bowel sounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Common opioid toxidromes (6)

A
  • opium
  • morphine
  • heroin
  • hydrocodone (vicodin)
  • oxycodone
  • fentanyl
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Opioid toxidrome findings

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Common sedative hypnotic toxidromes (4)

A
  • alcohol
  • benzos
  • barbituates
  • sleeping aids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Sedative hypnotic toxidromes findings

A
  • hypothermia, normal or bradycardia
  • CNS drowsy, lethargy, coma
  • pupils miotic
  • decreased or no bowel sounds
  • dry
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Sympatholytic toxidrome findings

A
  • bradycardia, hypotension, bradypnea
  • CNS normal to lethargic
  • pupils mid size
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Common serotonin syndrome toxidromes (3)

A
  • MAOIs
  • SSRIs
  • NSRIs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Serotonin syndrome toxidrome findings

A
  • hyperthermia, tachycardia, hypertension
  • CNS confusion, agitation, lethargy
  • pupils mydriatic
  • diaphoretic flushed skin
  • hyperreflexia, tremors, clonus
17
Q

Common sympatholytic toxidromes (3)

A
  • B blockers
  • a blockers
  • a2 adrenergic agonists
18
Q

Acetaminophen toxicity antidote

A

N acetylcysteine

19
Q

Anticholinergic agents toxicity antidote

A

Physostigmine

20
Q

Benzodiazepine toxicity antidote

A

Flumazenil

21
Q

Carbon monoxide toxicity antidote

22
Q

B or Ca2+ channel blockers toxicity antidote

A

IV fluids, calcium, glucagon, insulin

23
Q

Cocaine or other sympathomimetics toxicity antidotes

A

Benzodiazepines

24
Q

Ethylene glycol (antifreeze) toxicity antidotes

A

-fomepizole, ethanol, hemodialysis

25
Hydrofluoric acid toxicity antidotes
-Calcium gluconate
26
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 ```
27
Opioid toxicity antidote
Naloxone
28
Salicylates toxicity antidote
Alkalinization, hemodialysis
29
Warfarin toxiticy antidote
Fresh plasma, vit K
30
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
31
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!)
32
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
33
Carbon monoxide poisoning diagnosis (2)
- pulse ox CANNOT screen | - COHb levels 0-5% in nonsmoker and up to 10% in smokers
34
Fluorescein added to antifreeze allows the urine to....
....fluoresce under woods lamp
35
Urinary alkalinization
Administration of IV sodium bicarb to produce alkaline urine that can then improve elimination of salicylates
36
Cholinesterase inhibitors and organophosphate toxicity antidote
Atropine
37
Cyanide toxicity antidote
Hydroxocobalamin (deriv of B12)
38
Oral contraceptives can increase risk of what pathology?
Pulmonary embolism