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child health diploma > Toxicology > Flashcards

Toxicology Flashcards

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1
Q

Peak time for poisoning in childhood

A

Toddlers peak time

Adolescents 2nd peak self harm

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2
Q

Childhood poisoning

A

Not usually self harm
History is difficult
Different types of materials ingested eg plant soil paint pesticides drugs
Usually very small amounts are NOT toxic
BUT one pill can kill
Smaller oesphagus and stomach limit the effectiveness of some decontamination
Always consider could this be Child abuse

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3
Q

One pill can kill

A 
Amphetamines
B blockers
CCB
Digoxin
Suphonlureas 
Tricyclics antidepressant
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4
Q

Other potential killers

A

Pesticides
Kerr /eucalyptus oil
Campho/ napthalin

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5
Q

Poisoning history and examination

A

History is unreliable
Suspicious
Time of the ingestion unknown (when was the child last well)
Calculate the max possible dose ingested
If >1 child with meds assume all children could have ingested or one did max ingestion

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6
Q

Management of poisoning

A 
Resuscitate 
Risk assessment 
Poisoning info 
Ongoing management 
Supportive care and monitoring 
DEAD decontamination/ increasing elimination / antidotes/ disposition
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7
Q

Examination of poisoning patient

A 
Id and treat immediate threats to life
Establish the baseline of clinical status 
Corroborate the history 
Consider toxin VS non Toxin causes 
Id complications of poisons

Full Neurological examination mental state pupils reflexes clonus focal signs
Evidence of trauma
Skin color sweating
Urine retention ? Full bladder ( anticholinergics)

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8
Q

Risk assessment in Posioning

A 
What substance eg paradox/ B blocker
Dose 
When  time since ingestion 
Clinical features 
Ix ECG ( TCA) / Sr Paracetamol
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9
Q

DD coma /altered state

Non toxic vs toxic

A 
Head injury  
CNS infection 
Hypo/hyperthermia 
Ictal / post Ictal
Drugs
Metabolic BSL /ARF
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10
Q

2ary complications of posioning

A 
Aspiration 
Rhabdomyalysis
ARF
Pressure areas
Hypoxic brain injury
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11
Q

Drug levels when are they helpful

A

Paracetamol levels 4 hours after ingestion helpful
Others only when clinically indicated eg phenytoin carbamazepine
Digoxin aspirin lithium

NOT HELPFUL cocain benzo Cocain opiates
ACE/ B Blockers CCB clonidine

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12
Q

Anticholinergic toxidromes

A

Blind as a bat / mad as a hatter /red as beet/ hot as a hare/dry on the bone the bowel and the bladder lose their tone
The heart races alone

Antihistamines TCA / Phenothiazines / Benstropine ( give for maxolon)
Agitated delirium
Dilated pupils 
Full bladder ileus  IDC
Tachycardia
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13
Q

Cholinergic Toxidromes
Seen with organophosphate
Chemical attack Vx gas
Carbamates

A 
DUMBELS
Diarrhoea
Urinartion
Miosis
Bronchorrhoea Bradycardia (this is what kills you)
Emesis 
Lacrimation 
Salivation
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14
Q

Sympathomimetics. Cocaine exctasy MDMA TCA

A 
Hypertension 
Tachycardia 
Dilated pupils 
Agitation 
Sweating 
Hyperthermia do poorly  treat aggressively

Pale sweaty patients

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15
Q

Serotonin toxicity SSRI SNRI and usually in combination or changes in meds

A

Neuromuscular examination
Hyper reflexive clonus eyes and ankle examination

Confusion, agitation, dilated pupiles sweating raised BP
Tachycardia

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16
Q

Opioid toxicity

A 
Respiratory depression  ( use Naloxone for resp depression NOT CNS depression)
Sedation 
Pinpoint pupils
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17
Q

Management of poisoning

A

Resuscitate ABC
Supportive care
DEAD

18
Q

Supportive care

A 
Metabolic glucose and control the pH
Sedation IV benzodiazepine
Seizures IV benzodiazepine DONT use phenytoin Na+ channel blocker
Body temp cool/ warm
Renal function. Hydration/ haemodialysis
19
Q

DEAD

A 
Decontamination GIT  ( do when the drug is still in the GI tract)
Activated charcoal 
Whole body irrigation. Colonic prep
Endoscopy
20
Q

Activated charcoal

A

Don’t use in ileus / pt decreased loc
1gm/kg
Taken orally or NG (CXR to check position)
Greatest benefit <=1 hour

21
Q

Complications of activated charcoal

A

Vomiting
Charcoal aspiration
Absorb the oral antidote
Bowl obstruction/ileu

22
Q

Indications for charcoal

A

Risk assessment suggests drug ingested would be toxi
Give <= 1hour
Longer if SR meds or LOTS of meds
Co operative pt
Pt has to be alert or the airway protected

23
Q

Contraindications to charcoal

A

Not for metals alcohol, corrosives , hydrocarbons MATCH
Low GCS
Ileus

24
Q

Whole body irrigation

A

Metals
Body packers
SR or enteric coated EC CCB
Contraindicated. Bowel obstruction, ileus, / unprotected airway

25
Q

Enhanced Elimination

A

1 multidose activated charcoal ( enterohepatic circulation) carbamazepine mushrooms
2 urinary alkalization. Salicylate ion trapping
3 heamodialysis use in antifreeze lithium/valproate/ carbamazepine

26
Q

Paracetamol overdose

A 
Toxic ingestion >200mg/kg
Nomogram SINGLE ingestion 
Known time of ingestion 
Level >4hours to ensure peak point 
IV N acetylcystein antidote

Chronic paracetamol overdose and SR overdose over 24-48 hours
Complex consult guidelines and toxicologist

27
Q

Clonodine

A

Clonodine used for ADD
CNS depression and bradycardia
IV fluids and iv Atropine
Naloxine controversial

28
Q

Red back spider bite

A

Commonest spider bite

Local effect pain redness swelling sweating piloerection
SYSTEMIC regional pain hypertension sweatiness

Treatment is ANALGESIA ++ note the pain can come back
Anti venom
Not effective
Controversial

29
Q

Funnel web spider. FWS ( needs pressure immobilizing and splinting)

A

Most venomous spider in the world
Uncommon to bite 1% of all bites
Anti venom works

Clinically  facilitation of the tongue
Tremor parasites 
Secretions ++
Piloerection 
N/V/BP pr up cardiac arrhythmia 
Management 
ABC
IV access
Anti venom 
Admit to icu
30
Q

Brown snakes

A

Commonest cause of snake bite death in Australia
All over Australia NOT TASmania

Features
Collapse a few mins later CPR
Consumptive coagulopathy VICC ( coag profile )

31
Q

Tiger snakes and Taipans

A

Neurotoxic /eyes ptosis and opthamoplegia
VICC coagulopathy
Give anti venom

32
Q

Death adders

A

Neurotoxic

NO Coagulopathy

33
Q

First aide for snake bite

A 
Do remove from danger 
Keep still 
Apply pressure bandage 
Immobilize the whole limb
Splint the limb ( leave the PIB on till A/E and bloods collected and ? AV given if necessary
34
Q

Pressure immobilization bandage indications

A

For ALL snake bites in Australia ( including the sea snake)
For Funnel web spider bites
Blue ringed octopus
Cone shell sting

35
Q

Describe the technique for pressure immobilization bandage

A

Firm bandage to the bitten site
Bandage the entire limb
Splint /immobilization of the limb

36
Q

Clinical diagnosis

A

Geography
Circumstances of the bite
Symptoms and signs
Lab results

37
Q

Anti venoms

A

Raised in horses
Given iv over 30mins ( diluted in NS)
Adverse reactions are common Anaphlaxis
Sr sickness

After one vial given cant take of the bandage and then get lots of blood tests

38
Q

Snake venom detection kids

A

NOt used much

39
Q

Box jelly fish

A

Tropical areas often remove
Can lead to child deaths
Cardiac arrest
Remove the testicles and apply vinegar and use Anti venom

40
Q

Blue bottles

A

Pain responds to HEAT

Put both limbs in hot water to avoid burns

child health diploma (73 decks)

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