Toxicology Flashcards
Stimulant Toxidrome? Examples of drugs?
Coke, meth, etc. Symptoms: dilated pupils, tachycardia, tachypneic, htn or hypotensive, paranoia, seizures, progressing to cardiac arrest.
Narcotic Toxidrome and examples of drugs?
Opiods: Pinpoint pupils, respiratory depression, drowsiness, stupor, coma
Sympathomimetic Toxidrome and Drugs?
Phenylephrine/Pseudophedrine: HTN, tachycardia, dilated pupils, agitation, seizures, hyperthermia.
Sedative/Hypnotic Toxidrome and drugs?
Midaz, Phenobarbital etc. Drowsy, Ataxia, Slurred speech, confusion, resp depression, CNS depression, hypotension.
Cholinergic Toxidrome and drugs?
Sarin gas, VX gas, etc: Increased salivation, lacrimation, GI distress, diarrhea, resp depression, apnea, seziures, coma.
Anti-Cholinergic Toxidrome and drugs?
Atropine, anti-psychs, anti-histamines: dry, flushed skin, hyperthermia, dilated pupils, blurred vision, tachycardia, mild hallucinations, delirium.
What type of necrosis does acids cause? Where does it cause damage?
Coagulation necrosis, an eschar forms limiting further damage. It effects the stomach more than the esophagus.
What type of necrosis do alkalis cause? Where does it do the most damage?
Liquifaction necrosis, no eschar formation and damage continues till alkali is neutralized or diluted. It effects the esophagus more than the stomach however ingestion of large quantities effects both.
S/S of Caustic Ingestion?
Early: Drooling and dysphagia.
Late: Pain, vomiting, sometimes bleeding to the mouth, nose, throat, chest, or abdomen. Airway burns with associated coughing, tachypnea, and stridor.
S/S of esophageal perforation?
Perforation leads to mediastinitis which can cause severe cp, tachycardic, fever, tachypnea and shock.
What can gastric perforation lead to?
Peritonitis
What are txs and tx to avoid in caustic ingestion?
Avoid: Inducing vomiting, gastric emptying, don’t neutralize caustics. No OG or NG tube.
Txs: Early intubation if signs of impending airway compromise, decon, fluid resuscitation (due to third spacing), anti-emetic.
What determines type of damage caused?
Type of substance used, how long it is in contact with the skin, liquid vs solid, amount ingested, alkali vs acid.
Important part of hx taking in caustic ingestion?
Amount? Intentional? Substance used? Any other substances?
Physical findings of caustic ingestion?
Chemical burns on mucosa of oral cavity, edema, erythema, peeling skin, tachycardia, tachypnea, abdominal tenderness, hematemesis, bloody stool. Splashes on other body parts –> dribble burns on stomach, chest, and face.
Symptoms of alkali ingestion?
drooling, pain, N/V, abdo pain, burning sensation in the upper GI, Sob –> leading to edematous airway, aspiration, and inhalation of toxic fumes.
Evaluation of caustic ingestion?
Assess airway.. drooling, stridor, vomiting = early intubation. evaluate for shock –> fluid resus, consider other ingestions.
What can happen when caustic agents mix with other contents in the stomach?
Chlorine gas
What is cholinergic toxicity caused by?
substances that mimic, enhance, or stimulate acetylcholine
What can cause cholinergic toxicity?
Insecticides, nerve agents, meds, mushrooms.
Patho of Cholinergic Toxicity?
Toxicity leads to excessive parasympathetic stimulation
What are the 3 cholinergic receptors?
Muscarinic, nicotinic, CNS
Pneumonic for Cholinergic Toxicity
SLUDGE
Salivation
Lacrimation
Urinary Freq
Diaphoresis/Diarrhea
GI cramping and pain
Emesis
What do symptoms depend on in Cholinergic Toxicity
Which receptor is activated
Muscarinic receptor symptoms in cholinergic toxicity?
Increased secretions, salivation, tearing/sweating, bronchoconstriction, chest tightness, wheezing, bradycardia, vomiting, gi problems, abdo tight, diarrhea, and cramps
CNS receptor symptoms in cholinergic toxicity?
H/A, insomnia, giddiness, confusion, drowsy. SEVERE –> slurred speech, seizures, coma, respiratory depression.
Cholinergic Toxicity TX?
ABCDE’s
Decon, vasc access, manage seizures.
Treat dysrhythmia if seen
Mag for VT in suspected QtC prolongation from toxin.
Atropine goals in cholinergic tox?
Decrease secretions, correction of bradycardia and hypotension. Atropine can cross the blood brain barrier to reach the CNS and decrease AcH from it.
Atropine dose in cholinergic toxicity?
1-2 mg IM/IV q 5-60 mins till symptoms resolve. Double the dose q 5 mins till effect seen.
MOA of anti-cholinergic tox?
Antagonizes acetylcholine
Causes of anti-cholinergic tox
Anti-depressants, anti-histamines, anti-parkinsons, anti-psychs, mydriatics.
Whats important to note about ingestion of anti-cholinergics?
Can be synergistic with different meds when ingested.
Patho of Anti-Cholinergics?
Block binding of acetylcholine on muscarinic receptors.
S/S and Anti-Cholinergic tox?
Flushing, dry, mydriasis, AMS, fever, urinary retention, decreased bowel sounds, delirium, confusion, seizures.
Whats important to note about a diphendyramine OD?
It can lead to WCT and a prolonged QT
Complications of Anti Chol tox?
Resp failure, CVS collapse, seizures, rhabdomyolysis, coma, death.
TX of Anti Chol Tox?
ABCDE’s
fluid resus if needed
cool if hyperthermic
dysrhythmia mgmt as needed (WCT –> sodium bicarb)
agitation -> midaz
Acetaminophen OD Antidote?
NAC or N-acetylcysteine
ASA or Salicylates Antidote?
Sodium Bicarb
Cholinergic or Organophosphates antidote?
Anticholinergics - Atropine
Opiods antidote?
Naloxone
