Toxicology Flashcards
What is syrup of ipecac? When to use?
Induces vomiting to remove poison out of top of GI tract
- No role in ED setting
How does activated charcoal work?
Adsorbs poison from GI tract so it can be passed in feces
How do cathartics and whole bowel irrigation work?
Move Poison through GI tract to there is no time to absorb
When are cathartics recommended in ingestion?
Not recommended in any setting
Contraindication lavage in ingestion?
Ingestion of:
- Corrosive agent
- Hydrocarbons
- Unprotected air: intubated or reflex intact
When is activated charcoal contraindicated?
- Corrosive agent
- Hydrocarbons
- Unprotected air: intubated or reflex intact
Indications of activated charcoal?
- Tylenol
1. Lipophilic substance
2. Non polar substance
3. Phenytoin
4. Nortriptyline
5. Aminophylline
6. Phenobarbital / phenylbutazone
7. Carbamazepine
8. Digoxin / dapsone
When is whole bowel irrigation a good choice?
- Foreign body ingestion
- Iron Lead
- Slow release pharmaceuticals
Antidote tricyclic ingestion?
Sodium bicarb
Antidote organophosphate ingestion?
Atropine
Antidote digoxin ingestion?
Digoxin Ig
Antidote CCB ingestion?
- Calcium chloride
2. Glucagon
Antidote beta adrenergic ingestion?
- Glucagon
What are anticholinergics that can be ingested?
- TCAs
- Diphenhydramine
- Antihistamines
- Antipsychotics
- Jimson weed
Presentation anticholinergic ingestion?
“Hot as a hare, red as a beet, dry as a bone, blind as a bat and mad as a hatter, heart runs alone, bowel sounds gone” 1 Fever 2. Flushed, dry skin 3. Dilated pupils 4. Agitated 5. Tachycardia 6. Hypoactive bowel sounds
What are cholinergics that can be ingested?
- Nerve agents
- Organophosphate
- Insecticides
Presentation cholinergic ingestion?
"DUMBbbELLSss" Diarrhea Urination Miosis Bradycardia, bronchorrhea, bronchospasm Emesis Lacrimation, laryngospasm Salivation, sweating, secretions
Presentation sedative hypnotic ingestion?
- Hypothermia
- Bradypnea
- Normal pulse - bradycardia
- Hypotension
- Drowsiness, lethargy, coma, ataxia
- Midsize or miosis, nystagmus
- Hyporeflexia
- Dysarthria
Presentation black widow bite?
- Local: target skin lesion
2. Systemic: painful muscle cramping, hypertension, tachycardia
How do you calculate osmolality?
Calculated osmolality = 2 (Na) + BUN/2.8 + glu/18
When is glucagon used in ingestion?
- B-adrenergic blocker toxicity
2. CCB toxicity
How does N-acetyl cysteine work?
N-acetylcysteine (NAC)
- Sulfhydryl group donor
- Substitutes for natural sulfhydryl group donor, glutathione
- Increase glutathione synthesis
How is anion gap calculated?
= ([Na] + [K]) − ([Cl] + [HCO−)
When can fomepizole be used?
- Ethylene glycol toxicity
2. Methanol toxicity
What is the coma cocktail for ingestion?
- Place on 100% O2 non rebreather
- POC fingerstick blood glucose
- Narcan 0.4 to 2mg IV to reverse opiates
When is charcoal not useful?
- Metals: such as iron
- Booze
3 Hydrocarbons
