Toxicology Flashcards
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
Define venom
Toxin produced by snakes, spiders and some marine life
Delivered through fangs
What are the only 2 venomous spiders native to Ohio?
Brown recluse
Black widow
Most bites are ____ ______ until well after the fact.
Not Noticed
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
What is the major concern with related to snake bites?
Development of tissue necrosis and sepsis
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
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
Define substance abuse
Use of pharmacological substances for purposes other than medically defined reasons
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
Define addiction
Compulsive and overwhelming dependence on a drug; an addiction may be physiologic dependence, a psychological dependence, or both.
Define tolerance
The need to progressively increase the dose of a drug to reproduce the effect originally achieved by smaller doses.
Define withdrawl
Referring to alcohol or drug withdrawal in which the patient’s body reacts severely when deprived of the abused substance.
How many Americans have tried an illicit drug at least once?
28 Million People
How many Americans use illicit drugs regularly?
14.5 Million People
Define toxicology
Study of the detection, chemistry, pharmacological actions, and antidotes of toxic substances.
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.
What are the four routes for a toxin to enter the body?
Ingestion
Inhalation
Injection
Absorption
What is the most common route of entry for toxic exposure?
Ingestion
What medication is derived from the deadly night shade plant?
Atropine
With toxic ingestion, burns may occur where?
Lips, tongue, throat and esophagus
What is the phone number for Central Columbus Poison Control?
1-800-222-1222
Can inhalation be a route for rapid absorption?
Yes, due to absorption through the alveolar-capillary membrane in the lungs
Define organophosphates
Phosphorus-containing organic chemicals
Often used as pesticides
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
