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Emergency Medicine > Toxicology > Flashcards

Toxicology Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What is the abbreviation for how to approach a toxicology case?

A 
A - Airway
B - Breathing
C - Circulation
D - Disability
E - Exposure/Elimination
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2
Q

What should you be concerned about in a carbon monoxide poisoning?

A

Unreliable Pulse Ox, can show 85%, but really is much lower than that.

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3
Q

What should you be concerned about in a patient with CN, Hydrogen Sulfide, and Sodium Azide poisoning?

A

Normal Pulse Ox, but cellular hypoxia, due to uncoupling of the electron transport chain

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4
Q

If a patient is hypotensive during intial assessment, what do you do?

A

Give 2L NS – if no improvement then add Norepi

– Check for fluid loss such as GI Bleed

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5
Q

If a patient has a calcium channel blocker overdose, what would you expect to see?

A

Hyperglycemia

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6
Q

If a patient has a beta blocker overdose what would you expect to see?

A

Hypoglycemia, Bradycardia, Heart Block

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7
Q

If you see QRS widening with tachycardia, what should you suspect?

A
  • -Sodium Channel Blocking Agents

- -TCAs, Antihistamines, Antipsychotics, Procainamides, Quinidine, Propranolol

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8
Q

What should be the first thing you do with a patient with Altered Mental Status?

A

Blood Glucose Check

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9
Q

If a patient develops seizures, what is the treatment of choice?

A

IV Lorazepam every 7 minutes until seizure stops.

– IV Propofol + Intubation if intractable

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10
Q

What drugs can you increase elimination by alkalinazation of urine?

A
  • Phenobarbitol
  • Methanol
  • Salicylates
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11
Q

What would you see in Hypoglycemia?

A
  • AMS
  • Slurred Speech (Brain poor functioning)
  • Diaphoretic
  • Seizures
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12
Q

If you see a patient with miosis, emesis, and bronchospasms, what would you be concerned of?

A

Cholinergic Syndrome

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13
Q

What are the symptoms common of cholinergic syndrome?

A

DUMBBELS

  • Defecation
  • Urination
  • Miosis
  • Bradycardia
  • Bronchorrhea
  • Emesis
  • Lacrimation
  • Salivation
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14
Q

What are the Killer Bs and why?

A

Cholinergic Syndrome

  • Bronchospasm
  • Bronchorrhea
  • Bradycardia
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15
Q

How do you treat someone with Cholinergic poisoning?

A

IV Atropine (Blocks Muscarinic receptors) Keep doubling the dose until mucous membranes are dry and bronchospasms stop

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16
Q

What would be the first line of treatment for pin point pupils, slow respirations, and comatose?

A

Opioid Intoxication – Narcan

17
Q

If a patient comes in with bradycardia, hypotension, hyporeflexia, and miosis, with limited responsiveness, what do you suspect?

A

Sedative Overdose – Benzo, Barbs, Alcohol

18
Q

What would you suspect if a patient comes in altered with dry mucous membranes, tachycardic with wide QRS, dilated pupils, and fever?

A

Anticholinergic Toxicity

19
Q

What are the anticholinergic toxidrome syndrome?

A 
Mad as a Hatter
Red as a Beet
Hot as a Hare
Dry as a Bone
Blind as a bat
Tachy like a pink flamingo
Seizing like a squirrel
Full as a Flask
20
Q

What is a characteristic finding in a TCA overdose?

A

Sinus Tach, Widened QRS, and aVR has a Terminal R-wave (More specific compared to widened QRS)

21
Q

What is the treatment for TCA overdose?

A

Sodium Bicarb to reduce the widened QRS and keep pH down, treat BP and seizures as needed
If very high overdose can use Lipid Fat emulsion

22
Q

What would you see for a Beta Blocker overdose?

A
  • Bradycardia
  • 1st Degree AV Block
  • QRS Prolongation
    + Hypoglycemia
23
Q

WHat is the treatment of a betablocker overdose?

A
  • Atropine, BP support
  • Glucagon IV bolus
  • Propanolol is most dangerous
24
Q

If you see hyperglycemia, hypotension, and prolonged PR interval, what might you have toxicity of?

A

Calcium Channel blockers

–Treat with IV high dose insulin, and BP support with fluids and pressors

25
Q

What effect does Digoxin overdose have on EKGs?

A
  • Downsloping ST depression with a characteristic “sagging” appearance
    Flattened, inverted, or biphasic T waves.
    Shortened QT interval.
26
Q

Other than EKG changes, what can a digoxin overdose look like?

A
  • N/V
  • Abdominal Pain
  • Confusion, Weakness
  • Eye halos around lights
27
Q

What is the antidote for Tylenol toxicity?

A

N-acetylcysteine, can’t get a APAP level until at least 4 hours from consumption

28
Q

What are the criteria for using Hyperbaric Oxygen Therapy in Carbon Monoxide?

A

Symptoms – AMS, LOC, Seizures, MI
Pregnancy with COHb over 15% (Or any level)
Neuro symptoms after 4 hours of oxygen therapy

Emergency Medicine (3 decks)

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