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.
