toxicology Flashcards
APAP OD tx
NAC - if APAP >150 at 4 hours (rumack-matthew nomogram), suspected ingestion >150mg/kg, evidence of liver injury. must give within 8 hours
activated charcoal - if <2h
king’s college criteria
for liver transplant referral
pH<7.3
INR >6.5
Cr >3.4
Grade III or IV encephalopathy
salicylates OD tx
activated charcoal if <2h
IVF - LR/NS until 1-1.5ml/kg/h UOP.
if salicylate level >40, give NaHCO3 in D5W
HD if >100mg/dL or refract acidosis, volume overload
manage hypoglycemia
opioid OD mgmt
head CR, CXR (aspiration)
bowel irrigation if drug packets (golytely)
HD
methylnaltrexone for constipation (if no obstruction)
naloxone (narcan) - goal spontaneous respirations/ventilation
0.2-0.4mg IV
benzo OD mgmt
flumazenil
NOT in seizure disorder
ABCS
ETOH OD mgmt
IVF
thiamine
gastric lavage if <1h
monitor for DTs
observe until EtOH<100
isopropyl - charcoal if <1h, HD for hypotension (will not have HAGMA)
methanol - lavage if <30 min, folinic acid, HD if severe
ANTIZOL: ETHANOL ANTIDOTE
ethylene glycol intox CM
CNS depression
met acidosis
renal failure
ethylene glycol OD mgmt
charcoal/lavage if <30 min
correct acidosis w bicarb
antizol
pyridine, thiamine
HD for severe
BB OD mgmt
if <2h, lavage/charcoal
bradycardia - atropine, glucagon, pacing, IABP, HD
hypotension - fluids, trendelenburg, epi/lego
QT prolong - bicarb
hypoglycemia - D50, monitor for seizures
CCB OD mgmt
if < 2h, lavage/charcoal
bradycardia - calcium chloride/calcium gluconate, glucagon
hypotension - fluids, levo
manage hyperglycemia
insulin/glc for inotropic effects
ECMO
CO poisoning symptoms
early - HA, dizziness, nausea
mid - confusion, dyspena
high - hypotension, coma, seizures
CO poisoning mgmt
check carboxyhgb
puse ox not helpful
ABG - normal/high PaO2
100% O2
hyperbaric if LOC, carboxyhgb >25%, metabolic acidosis, age >50, cerebellar exam findings
