Toxicology Flashcards
A thorough physical examination is essential but in what specifically do you want to concentrate on?
Mental status, pupil size and reactivity, skin temperature in the presence or absence of sweat, muscular tone, gastrointestinal motility, and mucous membrane moisture.
What information on history do you want to obtain?
Type of medication, amount, timing, and route of exposures, as well as the number of persons involved.
True or false: in the emergency setting toxicologic screening tests of blood and/or urine contribute significantly to the evaluation, management, or outcome for most patients.
False.
However, acetaminophen and aspirin are common and treatable coingestants and should be screened for.
What is the acceptable coma cocktail?
Naloxone (0.2-2mg iv), glucose (50cc d50w iv), thiamine (100mg iv), oxygen.
In general, how should hypotension be managed?
First with fluid resuscitation, then consider vasopressors. Also consider using ACLS protocols, or specific treatment for a specific toxin.
In general what is the first-line therapy for seizures?
Benzodiazepines.
What should you do with ocular exposures?
Copious irrigation using iso tonic crystalloid. Ocular anesthetic can facilitate the decontamination.
What are the three general methods of G.I. decontamination?
Removing toxins from the gut, binding toxins in the stomach, and enhancing transit through the intestines.
When would you use Ipecac syrup?
Syrup of ipecac is no longer routinely recommended.
What is the timeframe and the contraindication for OG lavage?
Orogastric lavage is reserved for potentially lethal poisonings. It is generally given within one hour of ingestion. Contraindications include an unprotected airway, caustic or hydrocarbon ingestion, or ingestion of pills that are known to be too large to fit through the side ports of OG tube.
When would you use activated charcoal? What is the dose? And when should it not be used?
Activated Charcoal is the agent most commonly used to decontaminate the G.I. tract. It will be fine to most organic and some inorganic substances. Benefit greater when administered soon after drug ingestion. Awake and cooperative patients can drink the activated charcoal, alternatively it can be instilled through an NG tube. Dose is 1 g per kilogram or in a 10 to 1 AC to drug ratio, which ever is larger.
It should not be used if the infested substance is known not to buying to charcoal, for caustic or volatile substances, if the airway is not protected, or if the patient is actively vomiting.
When can you use osmotic cathartics and what are the Contra indications?
Maybe given with the first dose of activated charcoal, although evidence is lacking. Contraindications include H less than five years old, caustic ingestion’s, bowel obstructions, renal failure, and poisonings by substances known to cause significant diarrhea.
When would you consider whole bowel irrigation?
It may enhance elimination of sustained a released products, heavy metals, jug carried by body stuffers or Packers, or agents known to form bezoar.
Give Peg via an NG tube (1.5-2L/h in adults, 0.5 L/h in children <6 y.o.) until rectal effluent is clear
What are the clinical findings for anticholinergics?
They include mydriasis, hypo active or absent bowel sounds, tachycardia, flushed skin, disorientation, urinary retention, hyperthermia, dry skin and mucous membranes, dysarthria, confusion, Agitation, and auditory or visual hallucinations.
Mnemonic: dry as a bone, red as a beat, hot as a hare, blind as a bat, mad as a Hatter, and stuffed as a pipe.
What is the most common ECG findings in anticholinergic?
Sinus tachycardia. Wide complex tachy dysrhythmias and QT interval prolongation can also be seen.
