Toxicology Flashcards
General approach to the initial management of all toxicologic ingestions
- Initial Evaluation… ABCDEF… Airway, breahting, circulation, decontamination, enhanced elimination, find antidote, general management, Monitors, 02, Vitals, Focused History, Focused physical exam, ECG, Laboratory investigations
What are the 4 vital signs?
- Heart rate
- Blood pressure
- Blood Glucose
- Temperature
Different methods of decontamination?
- PPE should be wonr by all!!!
- Can decontaminate Skin and clothing… put them in new clothing, may need to wash hair! It can carry toxins very easily…
- Gastric Lavage
- Activated Charcoal
- Whole Bowel Irrigation
Gastic Lavage
clearing out stomache from pills/toxins! Flush IN saline… and flush pills out! Patient needs to have come in within 30 minutes! And taken a large amount! Flushes out the stomache!!
Activated Charcoal
A list of a few toxins that charcoal can be used for! Aspirin is a good one! Binds while still in GI tract and prevents it from being absorbed!!! Doesn’t work for Iron Lithium Lead… Doesn’t work for gasoline… etc. Can be used up to 4hours after ingestion… DOES HAVE SIDE EFFECTS… can cause vomiting… Can cause aspiration… if charcoal gets in lungs… it is VERY HIGH mortality rate! Not very much you can do… Just make sure they are wake and coherent so that they do not aspirate (vomit)
Whole Bowel Irrigation
(GoLytely is product you can use) 1.2L per hour, so that drug moves through GI tract quickly and doesn’t have time to be absorbed! Highly toxic medications, sustained release medicine, And where they are passed the point of Gastric Lavage and charcoal! Can use up to 12 hours after ingestion of toxin…
Discuss the utility of enhanced elimination in different situations (after toxin has been taken into bloodstream.. trying to eliminate from bloodstream)
- Kidney and Liver are big organ systems which help get rid of toxins in blood… Enhanced elimination helps liver and kidney go quickeR!! Help them to be quicker!
- Multidose Activated Charcoal (MDAC)
- Hemodialysis
Multi dose Activated Charcoal (MDAC)
Binds all the toxin in GI tract and excrete it all out… but by giving it often… increase Concentration of charcoal in GI tract and pulls toxin down concentration gradient from Bloodstream and back into GI tract and then excretes it!
Hemodialysis
Hemodialysis: Filters blood through and takes out toxins.. like external kidneys! Needs to be Water soluble, low protein binding…, low molecular weight … needs to be small enough to get through tubes!, low volume of distribution… sticks around in bloodstream Thus want something with low volume of distribution so that it will actually be in blood when you do hemodialysis!
- Activated charcoal and whole bowel irrigation don’t work very well for liquids! Liquids don’t stick around for very long!!!
Most common toxin?
Acetaminophen… tylenol! Antidote = N-acetylcysteine
