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Emergency Lectures > Toxicology > Flashcards

Toxicology Flashcards

1
Q

Intubation drug and dose if organophosphate poisoning?

A

Rocuronium

0.6mg/kg ideal BW

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2
Q

Intubation drug if hyperkalemia (like from digoxin toxicity)?

A

Rocuronium

0.6mg/kg ideal BW

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3
Q

What OD’s do we want to hyperventilate?

A

Acidotic patients

  • methanol
  • ethylene glycol
  • aspirin
  • iron
  • CN
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4
Q

What OD do we see QRS widening?

A

TCA’s

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5
Q

What can cause severe hypoxemia despite normal Pox?

A

CO

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6
Q

What will methemoglobinemia read at Pox?

A

Will drop Pox to 85 but then stay there despite worsening O2 status

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7
Q

First and 2nd step in treating hypotension?

A
  1. Give 2L NS or LR

2. Give IV NE @2-20 mcg/min

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8
Q

Hypotension + hypoglycemia seen with what OD?

- what also see

A

Beta-blocker

may also see bradycardia

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9
Q

Hypotension + hyperglycemia?

A

CCB

may also see bradycardia

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10
Q

QRS widening + tachycardia…think OD?

A

Sodium channel blockers

- treat w/ NaHCO3 (give Sodium bicarb)

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11
Q

How treat torsades?

A

Mg - 2g over 2 minutes

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12
Q

ABCDE…what’s D? Always think???

A

Disability - neurologic

  • always check glucose finger stick
  • can give Thiamine
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13
Q

How treat seizures? (letter D = disability)

A

Lorazepam 0.1mg/kg

Propofol + intubation if above ineffective

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14
Q

What is E in ABCDE? What do we do?

A

Elimination

  • cut off clothes / shower
  • want to remove exposure
  • want to remove pills/weapons
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15
Q

What are 2 things we might do to help with elimination?

A

Remove clothing
Give charcoal - does not help w/ elements
(Li, Fe, Pb, heavy metals)

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16
Q

When would we alkalize the urine? How?

A

PMS: phenobarbital, methanol, salicylates
METALS: methanol, ethylene glycol, Theophyline, Amanita mushrooms, Lithium, Salicylates

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17
Q

Give two ways to get rid of salicylates?

A

Alkanize with IV HCO3 2amp bolus + drip

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18
Q

Serum vs. Urine tox screen?

A

Serum: tylenol, aspirin, alcohol, TCA, benzos, barbiturate

Urine: MJ, cocaine, PCP, narcotics, amphetamines

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19
Q

What OD things might be seen on Xray?

A

Abdomen: iron pills, heavy metals, crack vials

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20
Q

Pt with confusion, diaphoresis, tachycardia, normal pupils, afebrile, slurred speech, combative?

A

Hypoglycemia
- can also have seizures

*always check finger stick w/ AMS

21
Q

Pt with respiratory distress, bradycardia, vomiting, diarrhea, diaphoresis, miosis?

A

Organophosphate poisoning = Cholinergic Toxidrome
SLUDGE + Killer B’s
Salivation, Lacrimation, Urination, Defecation, Emesis
Bronchorrhea + Bronchospasm + Bradycardia
(sputum production)

22
Q

Cholinergic Toxidrome - nicotinic?

A
  • fasciculations
  • muscle weakness
  • up to paralysis
23
Q

How do cholinergic OD pt’s die?

A

Killer B’s

Bronchorrhea + Bronchospasm + Bradycardia

24
Q

Pt with dilated pupils, tachycardia, HTN, febrile, wildly combative; complains of CP then has seizure?

A

Sympathomimetic Toxidrome:

  • all vitals elevated
  • agitation/mania

Think: cocaine, amphetamines, bath salts (cathionones)

25
Q

How treat Sympathomimetic Toxidrome?

A

BENZOS + FLUIDS

  • give 2mg Lorazepam and repeat PRN
  • fluids to protect kidneys (from rhabdomyolysis)
26
Q

Pt with cyanosis, pinpoint pupils, vomitus in mouth, atonal breathing, rhonchi, low temp, bradycardia?

A

Opioids

  • slow respirations (agonal breathing)
  • pinpoint pupils
  • coma
27
Q

How treat opioid OD?

A

IV/IM naloxone 0.4mg / 1.0 / 2.0mg if critically ill

**if fentanyl was added, need like 8-10mg

28
Q

Pt with agonal respirations (bradypnea), bradycardia, BP 60/p and pupils 3mm and minimally reactive; coma?

A

Sedative-Hypnotic Toxidrome:
- Benzos, barbs, alcohols, zolpidem

Tx: supportive: intubate + IVF + pressors

29
Q

Pt with CNS depression, mitosis, bradycardia, hypotension, bradypnea/apnea, hypothermia?

A

Sedatives

30
Q

Pt with tinnitus + tachycardia, tachypnea, diaphoresis, vomiting?

A

Aspirin/Salicylate Toxicity:

  • respiratory alkalosis - blow off acid
  • metabolic acidosis
  • tinnitus
  • Nausea/vomiting (ALWAYS)
31
Q

How treat salicylate OD?

A

Charcoal
Alkalinization of urine
Hemodialysis

32
Q

Pt with lethargy, dry MM, hot-flushed skin, tachycardia, ST w/ wide QRS, hypoactive bowel sounds, palpable distended bladder, dilated pupils. Febrile

A 
Anticholinergic Toxidrome: 
mad as
red as
hot as
dry as
blind as
Full as a flask
Tachy like a pink flamingo
33
Q

What are sources of anticholinergics?

A 
Antihistamines
TCA's
Anti-PD
Antipsychotics
Atropine/scopolamine
Jimson weed/nightshade/mandrake
34
Q

TCA Overdose EKG findings:

A

Sinus tachycardia
Terminal R wave in aVR
Wide QRS > 160ms
(r wave in aVR is normally tiny)

35
Q

How treat TCA overdose?

A

Charcoal
Gastric Lavage if <1hour
Intubate & hyperventilate
Alkalize urine w/ NaHCO3 1-2meq/kg

36
Q

How treat seizures from ??? overdose?

A

TCA overdose seizure

- treat w/ Lorazepam 0.1mg/kg

37
Q

Pt with dizziness, bradycardia, hypotension, afebrile, pupils midrange and reactive; FS 206 rest normal

A

CCB - low, low, hyperglycemia

BB - low, low, hypoglycemia

38
Q

What do BB and CCB do to sugars?

A

BB - lowers sugars

CCB - raises sugars

39
Q

How treat BB OD?

A

Atropine 0.5mg IV up to 3mg
IVF bolus
NaHCO3 for QRS widening (propranolol)
Calcium gluconate

40
Q

How treat CCB OD?

A 
High dose insulin 1u/kg bolus + drup at 0.5-1 u/kg/hour
Atropine 0.5mg IV up to 3mg
IVF bolus
NaHCO3 for QRS widening (propranolol)
Calcium gluconate
41
Q

Scooped ST depressions on EKG
Nausea, vomiting, abdominal pain
Neurologic: hallucinations, drowsy
Also ???

A

Digoxin toxicity

- also chromatopsia (yellow halos around lights)

42
Q

How treat digoxin toxicity?

A

Charcoal
Atropine 0.5mg up to 3mg (every 3-5 minutes)
Digibind - antibody frags

43
Q

Stages of Acetaminophen Toxicity?

A

Initial 0-24hrs: mild nausea; asymptomatic
Latent 1-2d: subclinical increase in LFT’s
Hepatic: 3-4d: RUQ pain, jaundice, acidosis, coagulopathy, renal failure (hepatorenal)

44
Q

How treat Acetaminophen toxicity?

A

Tylenol OD
- N-acetylcysteine <6 hours
(NAC)

45
Q

Pt with HA, dizziness, weakness, blurred vision, confusion, syncope/LOC
Also: dysrhythmias, CP, SOB, N/V

A

CO poisoning

46
Q

Why does car in garage kill you?

A

Carbon Monoxide

  • greater affinity for Hb than O2 so don’t carry O2
  • also blocks ATP
  • reduces myocardial contractility
47
Q

Treat CO poisoning?

A 
NBO at 100%
Ventilatory support
Get Blood gas
Consider co-asphyxiant (cyanide in furniture coverings)
Carboxyhemoglobin level w/ ABG
HBO
48
Q

When use hyperbaric oxygen in CO poisoning?

A

AMS / LOC / Seizure
Hypotension
MI
Pregger w/ COHb > 15% (baby at risk)

Emergency Lectures (3 decks)

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