Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Emergency Medicine > Toxicology > Flashcards

Toxicology Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

Initial Evaluation for a Toxicology Patient

A 
ABC's
ABGs as soon as practical
Obtain IV access
Treat coma promptly: glucose, naloxone, thiamine
Maintain circulation
Treat seizures
Cardiac monitoring and pulse oximetry
History
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Train of Overdose Effects

A

CNS depression
Myosis
Respiratory depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Medications to Treat Seizures in Toxicology Patients

A

Diazepam

Phenobarbital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Options for Decontamination of Ingested Toxins

A

Emesis
Gastric lavage
Activated charcoal
Whole bowel irrigation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Emesis as a Decontamination Option

A

Requires gag reflex
Limited efficacy if 1+ hour since ingestion
Ipecac + water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Contraindications to Inducing Emesis

A

Caustics
Low-viscosity hydrocarbons: gasoline, kerosene
Rapid-acting convulsants: meth, cocaine, cyclic antidepressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Indications for Gastric Lavage

A

Serious ingestions when emesis has failed
Patients are lethargic or uncooperative
Gag-reflex markedly depressed
Patients have ingested rapid-acting convulsants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Methodology of Gastric Lavage

A

Large bore NG tube
Tap water or saline at body temp in 250 mL increments
Continue until fluid returns clear and free of pill fragments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What poisons does activated charcoal not adsorb?

A

P: potassium
A: alcohol
I: iron
L: lithium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some cathartic actions?

A

Speeds up GI transit time
Screws up electrolytes
Lots more vomiting
Severe abdominal cramp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When is a whole bowel irrigation useful?

A

Sustained release and enteric coated tablets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Initial Laboratory Studies in a Toxicology Patient

A 
ABGs
Chem 7
ECG: wide QRS or prolonged QT
CXR: pulmonary edema
Flat plate abdomen??
Urine for toxicology screen
Draw and hold serum toxicology screens
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does management of the patient require in toxicology patients?

A

Understanding of absorption, distribution, elimination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Define First-Order Kinetics

A

Fixed PERCENTAGE of the toxin is removed per unit of time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Define Zero-Order Kinetics

A

Fixed AMOUNT of toxin is removed per unit of time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Define Drug Clearance

A

Volume of plasma that can be cleared of toxin per unit time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When is hemodialysis used in patients who have overdosed?

A

When toxin is relatively water-soluble and not highly protein bound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Indications for Hemodialysis in Overdose Patients

A

M: methanol
E: ethylene glycol
L: lithium
S: salicylate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Advantage of Hemoperfusion over Hemodialysis

A

Drug/toxin in direct contact with adsorbent material

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is hemoperfusion commonly associated with?

A

Thrombocytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What does hemoperfusion NOT do?

A

Correct electrolyte imbalances

Adjust pH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When is hemoperfusion useful?

A 
TRI: TCAs
P: paraquat
E: ethchlorvynol
P: phenobarbital
T: theophylline
D: digitoxin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Antidote for Acetaminophen

A

Acetylcysteine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

MOA of Acetylcysteine

A

Bind to NAPQI so it can’t accumulate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Antidote for Anticholinergics

A

Physostigmine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What other uses are there for physostigmine?

A

Myasthenia graves

Short term memory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Antidote for Benzodiazepines

A

Flumazenil: if infusion too rapid, patient will seize

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Antidote for Cyanide

A

Na nitrite

Na thiosulfate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Antidote for Methanol/Polyethylene Glycol (anti-freeze)

A

Ethanol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Antidote for Narcotics

A

Naloxone (Narcan)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Intoxicant for Osmolar Gap Greater than 30

A

An alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Acetaminophen Toxicity

A

Delayed hepatotoxicity (24-72 hours)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How soon should one get an acetaminophen level and begin treatment?

A

Within the first 16 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Treatment of Acetaminophen Overdose

A

Decontaminate
Give activated charcoal
Estimate severity (acetaminophen level)
Acetylcysteine therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

MOA of Acetylcysteine

A 
Substitutes glutathione
Binds NAPQI (metabolite)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

When should acetylcysteine be administered?

A

Early
MUST: 12-16 hours
PREFERABLE: 8-10 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Symptoms of Acetaminophen Overdose Within 4 Hours

A

Anorexia
N/V
Sweating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Symptoms of Acetaminophen Overdose 3+ Days Out

A

Encephalopathy
Marked elevation in LFTs
Renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Symptoms of Acetaminophen Overdose Greater than 1 Week Out

A

Begin to return to normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Cocaine and Amphetamine Overdose Symptoms

A 
Vasoconstriction
HTN
Bradycardia
Ventricular arrhythmias
Seizure and hyperthermia  may produce rhabdomyolysis and myoglobinuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Significant Cocaine Overdose Symptoms

A 
Euphoria
Excitement
Restlessness
Toxic psychosis
Seizures
HTN
Tachycardia
Hyperthermia
Possible MI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What drug does cocaine have a synergistic effect with?

A

Alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Treatment of Cocaine or Amphetamine Overdose

A 
GI decontamination
Diazepam
Nitroprusside
Monitor temperature and EKG
\+/- head CT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Why administer diazepam in cocaine or amphetamine overdose?

A

Severe agitation or psychosis

Treat seizures

45
Q

Why administer nitroprusside in cocaine or amphetamine overdose?

A

DBP >120

HTN encephalopathy

46
Q

MOA of Anticholinergics

A

Block cholinergic receptors both centrally and peripherally

47
Q

Symptoms of Significant Anticholinergic Poisoning

A 
Delirium
Blurred vision
Mydriasis
Hallucinations
Coma
Dry mucous membranes
Inhibition of sweating
Hyperthermia
Tachycardia
48
Q

When would you administer physostigmine in a anticholinergic overdose?

A

Peripheral and moderate central symptoms

49
Q

Treatment of Anticholinergic Overdose

A

Supportive care
GI decontamination
Physostigmine (severe symptoms)

50
Q

Conditions with Physostigmine Administration

A

Atropine available: bradycardia

Must be on cardiac monitor

51
Q

When must you never physostigmine?

A

TCA overdose
Asthma
Mechanical bowel
Bladder obstruction

52
Q

Main Anticoagulant

A

Warfarin (Coumadin)

53
Q

MOA of Warfarin (Coumadin)

A

Block vitamin K dependent clotting factors (II, VII, IX, X)

54
Q

When are peak effects seen with warfarin (Coumadin) overdose?

A

1-2 days

55
Q

Presentation of Excessive Anticoagulation

A 
Ecchymosis
Hematuria
Uterine bleeding
Melena
Epistaxis
Gingival bleeding
Hemoptysis
Hematemesis
56
Q

Treatment of Excessive Anticoagulation

A 
Supportive therapy
GI decontamination
Baseline PT & repeat in 24-48 hours
Vitamin K IV
FFP in bleeding emergency
57
Q

Examples of Items that Include Arsenic

A

Insecticides
Rodenticides
Wood preservatives

58
Q

Methods of Arsenic Absorption

A

Respiratory
GI
Binds with tissue proteins

59
Q

2 Clinical Syndromes of Arsenic Poisoning

A

Arsenic salt ingestion

Arsine gas inhalation

60
Q

Symptoms of Acute Arsenic Ingestion

A 
Crampy abdominal pain
Vomiting
Profuse watery diarrhea
Burning mucosa
Conjunctivitis
Tremor
Seizures
Garlic odor
Periorbital edema (1-2 days)
61
Q

Symptoms of Chronic Arsenic Ingestion

A 
Peripheral and sensory neuropathy
Malaise
Anorexia
Alopecia
Anemia
Stomatitis
62
Q

Arsine Gas Inhalation Effects

A

Highly toxic
Rapid intravascular hemolysis
Renal failure

63
Q

Treatment of Acute Arsenic Ingestion Poisoning

A

GI decontamination
GI lavage
Charcoal
Dimercaperaol (BAL) x 5 days

64
Q

Treatment of Chronic Arsenic Ingestion Poisoning

A

Penicillamine QID

65
Q

Treatment of Arsine Gas Inhalation

A

Transfusion

Adequate hydration

66
Q

Diagnosing Mild CO Poisoning

A

COHgb level

ECG

67
Q

Diagnosing Moderate to Severe CO Poisoning

A 
COHgb level
ABG
Chem 7
Serum lactate
CBC
EKG
Serum CK-MB and troponin
Urine myoglobin
CXR
68
Q

Treatment of CO Poisoning

A

100% FiO2 for 4 hours

69
Q

Symptoms of CO Poisoning

A 
Fatigue
Malaise
Flu-like
N/V
Confusion
Loss of memory
Emotional lability
Dizziness
Paresthesias
Weakness
Lethargy
Somnolence
Stroke
Coma
Seizures
Respiratory arrest
Chest pain
Myocardial ischemia
Palpitations
Dysrhythmias
Poor cap refill
Hypotension
Cardiac arrest
70
Q

Indications for Hyperbaric Oxygen Therapy Referral

A 
AMS or abnormal near exam
Hx of LOC or near-syncope
Hx of seizure
Coma
Hx of hypotension with exposure
Myocardial ischemia
Hx of prolonged exposure
Pregnant with COHgb levels >15%
Persistent acidosis (relative)
Concurrent thermal or chemical burns (relative)
71
Q

MOA of Digitalis

A

Enhance cardiac contractility
Slow AV conduction
Enhance automaticity

72
Q

Symptoms of Digitalis Poisoning

A 
Anorexia
N/V
Diarrhea
Abdominal pain
Blurred vision
Color vision disturbance
73
Q

Signs of Digitalis Poisoning

A 
3rd degree AV block
Bradycardia
Ventricular ectopy
Paroxysmal atrial tachycardia with AV block
HYPERkalemia
74
Q

Treatment of Digitalis Poisoning

A

Glucose + insulin therapy
Bradycardia: atropine, pacing
Ventricular ectopy: lidocaine
Digibind (severe)

75
Q

Symptoms of Excessive Ethanol

A

Ataxia
Dysarthria
Depressed sensorium
Nystagmus

76
Q

Treatment of Excessive Ethanol

A

Supportive
Watch blood glucose levels
Thiamine

77
Q

Symptoms of Amatoxin Associated Mushrooms

A

Severe gastroenteritis

Delayed hepatic and renal failure (48-72 hours)

78
Q

Treatment of Amatoxin Associated Mushrooms

A

Supportive
Admit to hospital
Baseline renal and hepatic functions

79
Q

Symptoms of Muscarine Associated Mushrooms

A

Salivation
Miosis
Bradycardia
Diarrhea

80
Q

Onset of Amatoxin Symptoms

A

6-24 hours

81
Q

Onset of Muscarine Symptoms

A

30 minutes-1 hour

82
Q

Treatment of Muscarine Associated Mushrooms

A

Supportive

Atropine (severe)

83
Q

Symptoms of Psilocybin Associated Mushrooms

A

Hallucination

84
Q

Onset of Psilocybin Symptoms

A

15-30 minutes

85
Q

Treatment of Psilocybin Associated Mushrooms

A

Supportive

86
Q

Symptoms of Isotonic Acid and Muscimol Associated Mushrooms

A

Mydriasis
Tachycardia
Hyperpyrexia
Delirium

87
Q

Treatment of Isotonic Acid and Muscimol Symptoms

A

Supportive

Physostigmine (severe)

88
Q

Onset of Isotonic Acid and Muscimol Symptoms

A

30 minutes to 2 hours

89
Q

Symptoms of Monomethylhydrazine Associated Mushrooms

A

Severe gastroenteritis
Hemolysis
Hepatic and renal failure

90
Q

Onset of Monomethylhydrazine Symptoms

A

6-12 hours

91
Q

Treatment of Monomethylhydrazine Associated Mushrooms

A

Supportive

IV pyridoxine

92
Q

SE of Opiates

A 
Sedation
Hypotension
Bradycardia
Hypothermia
Respiratory depression
93
Q

Diagnosis of Opiates

A

Toxic levels in urine

Reversal of symptoms with naloxone (Narcan)

94
Q

Treatment of Opiate Overdose

A

Naloxone (Narcan)

Admit to hospital

95
Q

Examples of Organophosphates

A 
Crop sprays
Home insecticides
Bug "bombs"
Flea collars
Chemical warfare agents
Terrorist agents
96
Q

MOA of Organophosphates

A

Inhibit cholinesterase causing accumulation of acetylcholine

97
Q

Symptoms of Organophosphate Poisoning

A 
Miosis
Excessive salivation
Bronchospasms
Hyperactive bowel sounds
Lethargy
Muscle fasiculation
Seizures
Bradycardia or tachycardia
98
Q

Pneumonic and Meaning for Organophosphate Poisoning Symptoms

A 
D: diarrhea
U: urination
M: miosis
B: bronchospasms
E: excitation
L: lacrimation
S: salivation
99
Q

Treatment of Organophosphate Poisoning

A 
Decontamination
Airway management
IV Atropine
Pralidoxime (2-PAM)
Admit to hospital
Avoid future exposures
100
Q

Methods of Bringing Phencyclidine (PCP) into the Body

A

Smoked
Snorted
Ingestion
Injection

101
Q

What type of agent is Phencyclidine (PCP)?

A

Sympathomimetic
Hallucinogenic
Dissociative agent

102
Q

Symptoms of Phencyclidine (PCP)

A 
Vertical and horizontal nystagmus
HTN
Tachycardia
Hyperthermia
Marked muscle rigidity
Dystonias
Seizures
103
Q

Goals of Treatment

A

Limit seizures

Limit violence

104
Q

Treatment of Phencyclidine (PCP) Overdose

A

Diazepam
Haloperidol
Monitor and prevent rhabdomyolysis

105
Q

What is the worst overdose to care for with the absolute worst outcomes regardless of skill?

A

TCAs

106
Q

Symptoms of TCA Overdose

A 
Mydriasis
Dry mouth
Tachycardia
Agitation
Hallucinations
Coma
Refractory seizures
Widening of QRS
Prolonged QT and PR intervals
Possible AV block
Torsades possible
Hypotension
107
Q

3-Cs of TCA Toxicity

A

Cardiac abnormalities
Convulsions
Coma

108
Q

Treatment of TCA Toxicity

A 
Gastric lavage
Instill charcoal
Continuous cardiac monitoring
Diazepam (seizures)
Lidocaine (ventricular arrhythmias, hypotension)

Emergency Medicine (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions