Toxicologic Emergencies Lecture Powerpoint

Question 1

Toxidromes

Answer 1

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

Question 2

Coma coctail

Answer 2

Used for patient with altered consciousness and includes

• dextrose (hypoglycemia)
• thiamine
• naloxone

Question 3

Toxidrome approach

Answer 3

• pupil size
• temp
• bowel sounds
• heart rate
• blood pressure
• respiratory rate
• skin findings

Question 4

Common anticholinergic toxidromes (5)

Answer 4

• antihistamines (diphenyhdramine, hydroxyzine)
• antispasmotics (dicyclomine, oxybutynin)
• atropine
• TCAs (amitriptyline)
• Jimson weed

Question 5

Anticholinergic toxidrome findings

Answer 5

• hyperthermic, tachycardia, hypertensive
• CNS agitation and delirium
• mydriasis**
• skin dry, warm flushed**
• diminished bowel sounds, urinary retention

Question 6

Common cholinergic toxidromes (3)

Answer 6

• organophosphates and insectisides
• cholinesterase inhibitors
• nerve agents

Question 7

Cholinergic toxidrome findings

Answer 7

• bradycardia, high or low BP, high or low breathing
• CNS agitation and confusion
• pinpoint pupils, lacrimation
• diaphoresis***
• salivation, vomiting, diarrhea, incontinence***

Question 8

Common sympathomimetic toxidromes (5)

Answer 8

• cocaine
• PCP
• amphetamines
• LSD
• bath salts

Question 9

Sympathomimetic toxidrome findings

Answer 9

• Hyperthermia, tachycardia, hypertension
• CNS enhanced alertness, delirium, seizure, coma
• Mydriatic pupils
• diaphoretic, hot skin
• normal or active bowel sounds

Question 10

Common opioid toxidromes (6)

Answer 10

• opium
• morphine
• heroin
• hydrocodone (vicodin)
• oxycodone
• fentanyl

Question 11

Opioid toxidrome findings

Answer 11

• 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

Question 12

Common sedative hypnotic toxidromes (4)

Answer 12

• alcohol
• benzos
• barbituates
• sleeping aids

Question 13

Sedative hypnotic toxidromes findings

Answer 13

• hypothermia, normal or bradycardia
• CNS drowsy, lethargy, coma
• pupils miotic
• decreased or no bowel sounds
• dry

Question 14

Sympatholytic toxidrome findings

Answer 14

• bradycardia, hypotension, bradypnea
• CNS normal to lethargic
• pupils mid size

Question 15

Common serotonin syndrome toxidromes (3)

Answer 15

• MAOIs
• SSRIs
• NSRIs

Question 16

Serotonin syndrome toxidrome findings

Answer 16

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

Question 17

Common sympatholytic toxidromes (3)

Answer 17

• B blockers
• a blockers
• a2 adrenergic agonists

Question 18

Acetaminophen toxicity antidote

Answer 18

N acetylcysteine

Question 19

Anticholinergic agents toxicity antidote

Answer 19

Physostigmine

Question 20

Benzodiazepine toxicity antidote

Answer 20

Flumazenil

Question 21

Carbon monoxide toxicity antidote

Answer 21

Oxygen

Question 22

B or Ca2+ channel blockers toxicity antidote

Answer 22

IV fluids, calcium, glucagon, insulin

Question 23

Cocaine or other sympathomimetics toxicity antidotes

Answer 23

Benzodiazepines

Question 24

Ethylene glycol (antifreeze) toxicity antidotes

Answer 24

-fomepizole, ethanol, hemodialysis

Question 25

Hydrofluoric acid toxicity antidotes

Answer 25

-Calcium gluconate

Question 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

Answer 26

``` Fruity Bitter almonds Garlic kerosene Rotten eggs Wintergreen Freshly mown hay ```

Question 27

Opioid toxicity antidote

Answer 27

Naloxone

Question 28

Salicylates toxicity antidote

Answer 28

Alkalinization, hemodialysis

Question 29

Warfarin toxiticy antidote

Answer 29

Fresh plasma, vit K

Question 30

When does a patient need enhanced elimination of a toxidrome

Answer 30

-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

Question 31

Max dose of acetaminophen in adults and children, when do peak serum levels occur?

Answer 31

- 4g/day or 3g/day if daily alcohol - 80mg/kg/day -4 hours after overdose (get a 4 hour acetaminophen level!)

Question 32

Carbon monoxide poisoning symptoms (4)

Answer 32

- 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

Question 33

Carbon monoxide poisoning diagnosis (2)

Answer 33

- pulse ox CANNOT screen | - COHb levels 0-5% in nonsmoker and up to 10% in smokers

Question 34

Fluorescein added to antifreeze allows the urine to....

Answer 34

....fluoresce under woods lamp

Question 35

Urinary alkalinization

Answer 35

Administration of IV sodium bicarb to produce alkaline urine that can then improve elimination of salicylates

Question 36

Cholinesterase inhibitors and organophosphate toxicity antidote

Answer 36

Atropine

Question 37

Cyanide toxicity antidote

Answer 37

Hydroxocobalamin (deriv of B12)

Question 38

Oral contraceptives can increase risk of what pathology?

Answer 38

Pulmonary embolism