Toxicology Flashcards
What does ABCDE stand for?
Airways. Breathing. Circulation. Disability. Exposure.
State 3 things to check out for with airways.
1) Is the airway protected? 2) What’s the GCS? 3) Are there any clues for poison - smell (alcohol), colour, tablet residue, burns.
State 2 things to look for in breathing.
1) Are they breathing? 2) The rate - opiates 3) Pattern - Kussmaul’s sign (deep laboured breathing pattern) 4) Added sounds - Paraquat (plant killer) lead to lung damage
State 2 things to look out for in circulation.
1) Pulse 2) BP 3) IV access 4) Pacemaker 5) Intravenous drug abuser
State 2 things to look out for in disability.
1) Small pupils - opiates, organophosphates, cholinergics 2) Large pupils - alcohol, anti-cholinergics, amphetamines, beta-blockers
When is activated charcoal used?
To treat drug overdose/poisoning - GI decontamination.
How does activated charcoal work?
By trapping chemicals and preventing their absorption.
When can’t activated charcoal be used?
When KLEN-PREP is used (this is a bowel cleansing agent which flushes everything out the intestines).
State 3 common drugs.
Paracetamol. Opiates. Tricyclic depressants. Salicylates. Cocaine.
State a risk of paracetamol.
Severe liver damage (ALT > 1000 iu/litre) - 6g fatal.
State 2 features of a paracetamol overdose.
Loin pain. Haematuria. Proteinuria. Nausea/vomiting.
State a treatment of a paracetamol overdose.
If within 4 hours - Activated charcoal and Measure the INR (clotting time), U&E, liver function test e.g. ALT.
If less than 8 hours - start IV acetylcysteine.
Give an example of an opiate.
Heroin. Methadone.
State a symptom of a paracetamol beyond 2-3 days.
Hepatic necrosis. Right subcostal pain. Coma. Severe metabolic acidosis.
State a feature of an opiate overdose.
Drowsy/unconscious patient. Dysfunctional breathing and respiratory rate.
State a treatment of an opiate overdose.
Intravenous naloxone.
State a treatment of an opiate overdose.
Naloxone (intravenously) if respiratory depression - competitive antagonist.
Give another name for tricyclics.
Antidepressants e.g. amititripyline, amoxapine.
State a peripheral effect of a tricyclic overdose.
Sinus tachycardia. Hot dry skin. Dry mouth. Urinary retention. Hypothermia.
State a central effect of a tricyclic overdose.
Dilated pupils. Ataxia (group of disorders that affect balance). Nystagmus (eyes make repetitive uncontrolled movements). Coma. Seizure. Respiratory depression.
State a feature of a tricyclic overdose on an ECG.
Prolonged PR and QRS interval. Increased QT. Ventricular dysrhythmias.
State the management of a tricyclic overdose.
1) Flumazenil (treat effects of a benzodiazepine overdose)
2) Check airway and maintain ventilation (NaHCO3 if acidotic)
3) Consider naloxone to reverse respiratory stress
State a management of dysrhythmias.
Correct hypoxia/acidosis (aim for pH of 7.45-7.50). Na loading. ECG monitoring is required (QRS interval guide to cardiac toxicity).
State a feature of an aspirin overdose.
Hyperventilation. Sweating. Tremor. Nausea/vomiting.
State a metabolic feature of an aspiring overdose.
Hypo/hyper-glycaemia. Hypokalaemia. Respiratory alkalosis. Metabolic acidosis.
State a management of an aspirin overdose.
ABCDE. Salicylate (paracetamol) level at 4hrs (> 700 lethal).
State a treatment for an aspirin overdose.
Rehydrate. Monitor glucose. Correct acidosis. K+ levels.
State a treatment for an aspirin overdose if levels >500mg/L.
Alkalize urine - increase poison elimination by administering intravenous NaHCO3.
State a treatment for an aspirin overdose if levels >700mg/L.
Consider haemodialysis - way of replacing some of the functions of the kidney (may lead to renal failure/pulmonary oedema).
State an effect of cocaine on the ECG.
QRS widening. QT prolongation.
State a clinical feature of a cocaine overdose.
Feeling of euphoria followed by irritability. Hyperadrenergic state (agitation, anxiety, dilated pupils, hyperthermia, cardiac arrhythmias).
State a treatment for a cocaine overdose.
ABCDE. Benzodiazepine - for agitation. Alpha/beta-blocker e.g. labetolol for hypertension/myocardial toxicity. Malignant hypertension e.g. nitroprusside. For MI e.g. GTN (vasodilator), benzodiazepine.
State an agent that results in hypoglycaemia in overdose.
Insulin. Sulphonylureas.
State symptoms of insulin and sulphonylureas.
Agitation. Sweating. Confusion. Hypotension. Drowsiness. Coma.
State a treatment of insulin/sulphonylureas overdose.
Prolonged infusions of hypertonic dextrose (may increase insulin production). Octreotide to inhibit release of insulin from pancreas.
