Toxicology Flashcards by Henry Kwan

What is the most important thing to remember in regards to removing stingers?

Remove the stinger as soon as possible

Use a card to scrap the stinger out, do not use tweezers as this may squeeze or venom into the wound

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Define venom

Toxin produced by snakes, spiders and some marine life

Delivered through fangs

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What are the only 2 venomous spiders native to Ohio?

Brown recluse

Black widow

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Most bites are ____ ______ until well after the fact.

Not Noticed

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What are the 3 venomous snakes native to Ohio and 1 that may be found in Ohio?

The Eastern Massauge

Timber Rattle Snake

Northern Copperhead

Water Moccasins are not native but can be found in streams in Ohio

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What is the major concern with related to snake bites?

Development of tissue necrosis and sepsis

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Baby snakes are more dangerous when they bite compared to adult snakes, why?

Baby snakes have not learned to control how much venom they output in their bites

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What is treatment for a snake bite?

Treat for shock, O2, keep warm

Locate wound and cleanse with soap or alcohol

Remove stinger

Remove constricting jewelry

Immobilize if on an extremity

Transport, medical direction

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Define substance abuse

Use of pharmacological substances for purposes other than medically defined reasons

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What are 5 identifiers for nonvenomous snakes

Head usually oval, but may be somewhat traingular

Pupils round

No pits-only- nostrils

Divided scales on the underside of the trail

Although many snakes vibrate their tail when upset, nonvenomous snakes never have rattles

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Define addiction

Compulsive and overwhelming dependence on a drug; an addiction may be physiologic dependence, a psychological dependence, or both.

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Define tolerance

The need to progressively increase the dose of a drug to reproduce the effect originally achieved by smaller doses.

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Define withdrawl

Referring to alcohol or drug withdrawal in which the patient’s body reacts severely when deprived of the abused substance.

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How many Americans have tried an illicit drug at least once?

28 Million People

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How many Americans use illicit drugs regularly?

14.5 Million People

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Define toxicology

Study of the detection, chemistry, pharmacological actions, and antidotes of toxic substances.

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Define toxins

Any poisonous chemical secreted by bacteria or released following destruction of the bacteria; any chemical (drug, poison, or other) that causes adverse effects on an organism that is exposed to it.

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What are the four routes for a toxin to enter the body?

Ingestion

Inhalation

Injection

Absorption

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What is the most common route of entry for toxic exposure?

Ingestion

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What medication is derived from the deadly night shade plant?

Atropine

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With toxic ingestion, burns may occur where?

Lips, tongue, throat and esophagus

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What is the phone number for Central Columbus Poison Control?

1-800-222-1222

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Can inhalation be a route for rapid absorption?

Yes, due to absorption through the alveolar-capillary membrane in the lungs

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Define organophosphates

Phosphorus-containing organic chemicals

Often used as pesticides

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Define Decontamination

The process of minimizing toxicity by reducing the amount of toxin absorbed into the body. Reduce the intake of toxin Reduce absorption of toxin once in body (activated charcoal) Enhance elimination of toxin (cathartics or whole bowel irrigation)

During secondary assessment of a toxicologic patient what are some important questions to ask?

What toxin patient was exposed to When the exposure took place

During secondary assessment of an unresponsive patient what sort of exam should take place?

Rapid head to toe exam

Activated charcoal is only effective for what kinds of poisonings and ineffective to what kinds of poisonings?

Effective for pills because the activated charcoal binds to solids Ineffective for heavy metal and liquid poisonings

Narcan is the antidote for what kind of overdose?

Opiates

Atropine is the antidote for what kind of toxin?

Organophosphates

Oxygen is the antidote for what kind of toxin?

Carbon Monoxide

What is the dosage for Atropine Antidote for organophosphate poisoning?

Initial: 2-5 mg IV

What are good questions to ask an ingestion poisoning patient?

``` What did you ingest When did you ingest How much did you ingest Did you drink any alcohol Have you attempted to treat yourself Have you ever been under psych care? if so why What is your weight? ```

What does the pneumonic SLUDGE stand for in relation to surface toxins?

``` Salivate (Patient will be drooling) Lacrima (Patient will have lots of tears) Uticharia (Rashes and hives) Diarrhea GI Complaints Emesis (Vomiting) ```

Describe Carbon Monoxide

Odorless, tasteless gas given out usually by incomplete combustion Leading cause of poisonings in industrialized countries

What is the danger of having Carbon Monoxide in the body?

Carbon monoxide has a 250 times stronger affinity to bind with hemoglobin than oxygen Becomes carboxyhemoglobin when bound with hemoglobin and disallows oxygen from binding with the hemoglobin

CO-oximetry measures what values

Oxygen Saturation (SpO2) Carboxyhemoglobin percent (SpCO) Methemoglobin percent Pulse rate

What treatment will maximize hemoglobin oxygen saturation in the field?

CPAP

Cyanide is found in high in high levels where?

Combustion of plastics, wool, silk, synthetic rubber, polyurethane and asphalt Found frequently in structural firefighting

What are signs and symptoms of cyanide poisoning?

Burning sensation in the throat and mouth Headache HTN and Tachycardia followed by hypotension and arrhythmias Pulmonary Edema Seizures/coma Elevated lactate

Medications ending in the suffix "-olol" are what kinds of medications?

Beta blockers

Medications ending in the suffix "-pril" are what kind of medications?

ACE Inhibitors

Medications ending in the suffix "-dipine" are what kind of medications?

Calcium Channel Blockers

Medications ending in the suffix "-semides/-thiazides" are what kind of medications?

Diuretics

What are signs and symptoms of cardiac medication poisonings?

Nausea and vomiting Headache, dizziness and confusion Profound hypotension Cardiac arrhythmias (Bradycardia) Heart conduction blocks Bronchospasm and pulmonary edema (Especially in beta blockers)

In cardiac medication poisonings what is contraindicated even in bradycardia?

Atropine because they may not respond to the atropine

What are antidotes for cardiac medication poisonings?

Calcium for calcium channel blockers Glucagon for beta blockers digoxin-specific fab (digibind) for digoxin

What are signs and symptoms of caustic substance poisoning?

Facial burns Pain in lips, mouth, throat and gums Drooling, trouble swallowing Hoarseness, Stridor, shortness of breath Shock from bleeding and vomiting

Where are hydrocarbons found?

Commonly associated with fuels Lighter fluid, paint, glue, lubricants, solvents, aerosol propellants

What are signs and symptoms of hydrocarbon poisoning?

Burns due to local contact Wheezing, dyspnea and hypoxia Pneumonitis from aspiration inhalation headache, dizziness Delay in reflexes Cardiac arrhythmias

What are signs and symptoms associated with tricyclic antidepressant poisoning?

Dry mouth blurred vision Urinary retention Constipation

What is treatment of tricyclic antidepressant poisoning?

Mag-Sulfate If suspect mixed overdose with benzodiazepines, DO NOT USE FLUMAZENIL

Flumazenil is contraindicated in overdose with benzodiazepines, why?

Flumazenil is a benzodiazepine receptor antagonist and may put the patient into a seizure state. Flumazenil will then further stop similar medications (Versed, Ativan etc.) from working.

Lithium is used for treatment of what?

Bipolar Disorder

What is the toxicity range of salicylates?

300 mg/kg toxicity range depending if the pills are coated or not coated

Aspirin is contraindicated in patients under what age and why?

Under 19 years of age Risk of Reyes Syndrome (Brain Swelling)

What is the toxicity range for acetaminophen?

150 mg/kg considered toxic

What treatment is indicated for acetaminophen poisonings?

Activated charcoal

What's the dosage for benadryl for anaphylaxis?

25-50mg iv

What is the dosage for solumedrol for anaphylaxis?

125 mg iv

What is gastric lavage?

removing an ingested poison by repeatedly filling and emptying the stomach also known as "pumping the stomach"

In situations where a poisoning patient will "clamp down" with his teeth it is prudent to do what?

Use RSI to secure an airway and prevent aspiration as opposed to waiting for the patient to deteriorate to a point where intubation can be placed without the aid of neuromusuclar blockers

If chronic alcoholism is suspected consider what drug?

Administration of 100 mg of thiamine IV to address possible encephalopathy

What are signs and symptoms of inhaled poisoning?

Dizziness,headache, confusion, seizures, hallucinations, coma Tachypnea, cough, hoarseness, stridor, dyspnea, retractions, wheezings, chest pain or tightness, crackles or rhonchi arrhythmias

What is the top priority for a inhaled poisoning?

Removing the patient from the source of the poisoning