Toxicology Flashcards
Most poisonings involve children under what age?
6
Most poisoning death occur in what age range?
40-49
What poisonings will cause a patient to smell like rotten eggs?
Hydrogen sulfide, mercaptans, disulfiram
What poisonings will cause a patient to smell like garlic?
DMSO, organophosphates, phosphorous, arsenic, arsine gas, thallium
What poisoning will cause a patient to smell like wintergreen?
methylcalicylate
Poisoning with what will cause the patient to smell like peanuts.
Rodenticides
Poisoning with what will cause a patient to smell like mothballs?
camphor
A patient will smell like disinfectants if they OD on what?
phenol
creosote
A patient will smell like acrid (aldehyde like) if they have what type poisoning.
Carbon monoxide
A patient will smell acrid (pear like) with what type poisoning?
Paraldehyde, chloral hydrate
What type lab is an assessment of poison concentration in tissues and is useful for antidotes?
Quantitative labs
What type lab tests for the presence of a toxin and is expressed as present or absent?
Qualitative
For radiopaque compounds what should you do to assess toxicity?
Get a radiograph
What does gastrointestinal decontamination reduce?
Poisons bioavailability
Does GI decontamination have an improvement in morbidity or mortality?
No
What are some contraindications of GI decontamination.
Rapid onset of seizures
Rapid onset of CNS depression
Alkaline corrosives (acid controversial)
loss of gag reflex
Where is emesis usually used with toxicity?
Rurall settings where there will be a dealy of >1 hour before the patient gets to an ER
How long is the onset for syrup of Ipecac
15-20 minutes
What does a lavage do?
Orogastric retrieval of substance
Where do you stop a lavage?
When there are clear returns
When can you lavage a patient w/ CNS depression
If intubated and cuffed with endotracheal tray
Should you lavage patient with underlying pathology of esophagus or stomach?
Nope
What type compounds will activated charcoal not bind?
low molecular weight charged compounds
highly concentrated solutions
What are some compounds activated charcoal won’t bind.
Cyanide bromide potassium ethanol methanol iron lithium alkaline corrosives mineral acids gasoline kerosenes, alcohols
What should you use whole bowel irrigation on
Substances not absorbed to AC Very large ingestions Significant GI hemorrhage Obstruction Unprotected airway hemodynamic instability
What solution is used for whole bowel irrigation
Golytely
What is the endpoint of whole bowel irrigation
Clearing of rectal effluent
What are ways to enhance eliminiation
Multiple dose activated charcoal ion trapping hemodialysis forced diuresis exchanged transfusions
What does multiple dose activated charcoal interrupt
Enetro-enteric and entero-hepatic recirculation of poison or poison metabolite
What are 3 OD indications for multiple dose activated charcoal.
Theophylline
Carbamazepine
Phenobarbital OD
What are some ADRs of multiple dose activated charcoal.
Pulmonary aspiration, constipation, fluid and electrolyte imbalance
What does ion trapping do?
change pH of urine to ionize poison preventing reabsorption
For salicylate and phenobarbital (weak acids) what should you administer for ion trapping.
Sodium bicarb to achieve a urine pH > 7
What is dimercaprol (BAL) used as a chelator for
AS
Hg
Pb
Cd
What is penicillamine used as a chelator for
Cu
Pb
Hg
As
What are 2 toxicities of dimercaprol (BAL)
HTN
tachycardia
What is EDTA (edetate calcium disodium) used as a chelator for
Lead
what is a toxicity of EDTA
Nephrotoxicity
What is deferoxamine used as a chelator for
Fe
What are some ADRs of deferoxamine
Hypotension
anaphlyactoid rxn
ARDS
What antivenin is used for a rattlesnake bite
Crotalidae antivenin
What is used for a black widow bite
lactrodectus antivenin
What is used to treat eastern and texas coral snake bites
Elapidae antivenin
What is used to treat botulism types A, B, and E
trivalent botulinum
What is used to treat digoxin immune Fab
Digoxin and Digitoxin
What is used to treat acetaminopehn poisoning.
N-acetylcysteine
How does N-acetylcysteine work
Prevents NAPQI from binding at hepatocyte
What do you use to treat opioid poisoning
Naloxone
What is naloxone
Opioid receptor antagonist
What is used to treat benzodiazepine OD
Flumazenil
What is flumazenil
Benzodiazepine receptor antagonist
What is used to treat organophosphate and pesticides poioning
Atropine
What is atropine
Muscarinic receptor antagonist
What is used to treat methanol and ethylene glycol poisoning
Fomepizole
What does fomepizole block
Metabolite formation
