Toxicology Flashcards
What is the abbreviation for how to approach a toxicology case?
A - Airway B - Breathing C - Circulation D - Disability E - Exposure/Elimination
What should you be concerned about in a carbon monoxide poisoning?
Unreliable Pulse Ox, can show 85%, but really is much lower than that.
What should you be concerned about in a patient with CN, Hydrogen Sulfide, and Sodium Azide poisoning?
Normal Pulse Ox, but cellular hypoxia, due to uncoupling of the electron transport chain
If a patient is hypotensive during intial assessment, what do you do?
Give 2L NS – if no improvement then add Norepi
– Check for fluid loss such as GI Bleed
If a patient has a calcium channel blocker overdose, what would you expect to see?
Hyperglycemia
If a patient has a beta blocker overdose what would you expect to see?
Hypoglycemia, Bradycardia, Heart Block
If you see QRS widening with tachycardia, what should you suspect?
- -Sodium Channel Blocking Agents
- -TCAs, Antihistamines, Antipsychotics, Procainamides, Quinidine, Propranolol
What should be the first thing you do with a patient with Altered Mental Status?
Blood Glucose Check
If a patient develops seizures, what is the treatment of choice?
IV Lorazepam every 7 minutes until seizure stops.
– IV Propofol + Intubation if intractable
What drugs can you increase elimination by alkalinazation of urine?
- Phenobarbitol
- Methanol
- Salicylates
What would you see in Hypoglycemia?
- AMS
- Slurred Speech (Brain poor functioning)
- Diaphoretic
- Seizures
If you see a patient with miosis, emesis, and bronchospasms, what would you be concerned of?
Cholinergic Syndrome
What are the symptoms common of cholinergic syndrome?
DUMBBELS
- Defecation
- Urination
- Miosis
- Bradycardia
- Bronchorrhea
- Emesis
- Lacrimation
- Salivation
What are the Killer Bs and why?
Cholinergic Syndrome
- Bronchospasm
- Bronchorrhea
- Bradycardia
How do you treat someone with Cholinergic poisoning?
IV Atropine (Blocks Muscarinic receptors) Keep doubling the dose until mucous membranes are dry and bronchospasms stop
What would be the first line of treatment for pin point pupils, slow respirations, and comatose?
Opioid Intoxication – Narcan
If a patient comes in with bradycardia, hypotension, hyporeflexia, and miosis, with limited responsiveness, what do you suspect?
Sedative Overdose – Benzo, Barbs, Alcohol
What would you suspect if a patient comes in altered with dry mucous membranes, tachycardic with wide QRS, dilated pupils, and fever?
Anticholinergic Toxicity
What are the anticholinergic toxidrome syndrome?
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
What is a characteristic finding in a TCA overdose?
Sinus Tach, Widened QRS, and aVR has a Terminal R-wave (More specific compared to widened QRS)
What is the treatment for TCA overdose?
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
What would you see for a Beta Blocker overdose?
- Bradycardia
- 1st Degree AV Block
- QRS Prolongation
+ Hypoglycemia
WHat is the treatment of a betablocker overdose?
- Atropine, BP support
- Glucagon IV bolus
- Propanolol is most dangerous
If you see hyperglycemia, hypotension, and prolonged PR interval, what might you have toxicity of?
Calcium Channel blockers
–Treat with IV high dose insulin, and BP support with fluids and pressors
What effect does Digoxin overdose have on EKGs?
- Downsloping ST depression with a characteristic “sagging” appearance
Flattened, inverted, or biphasic T waves.
Shortened QT interval.
Other than EKG changes, what can a digoxin overdose look like?
- N/V
- Abdominal Pain
- Confusion, Weakness
- Eye halos around lights
What is the antidote for Tylenol toxicity?
N-acetylcysteine, can’t get a APAP level until at least 4 hours from consumption
What are the criteria for using Hyperbaric Oxygen Therapy in Carbon Monoxide?
Symptoms – AMS, LOC, Seizures, MI
Pregnancy with COHb over 15% (Or any level)
Neuro symptoms after 4 hours of oxygen therapy
