Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Trauma > Toxicology > Flashcards

Toxicology Flashcards

1
Q

Acidic drugs like aspirin…

A

Increase respiration rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Basic drugs like benzos or opiates…

A

Decrease respiration rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does a GCS <9 indicate?

A

Potential airway problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does absent gag response indicate?

A

No patent airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Blue lips indicate…

A

Methaemoglobinaemia (haemoglobin in irreversible oxidised state from oxidant drugs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cherry red lips indicate…

A

Carbon monoxide (need a lot of exposure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which conditions are associated with Kussmal’s breathing?

A

DKA

Kidney failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Effect of opiates on breathing?

A

Reduce the rate and efficacy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What can added breath sounds signify?

A

Opiates

Paraquat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Where can you get IV access in an IVDA?

A

Behind elbow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What do small pupils indicate?

A

Opiates
Organophosphates
Other cholinergics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What do large pupils indicate?

A 
Alcohol
Anti-cholinergics
Amphetamines
Beta blockers
TCAs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Charcoal (1g/kg) is only useful if given when?

A

Within 1 hour of ingestion
Except with aspirin or TCAs
Agent of choice for GI decontamination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Precaution with charcoal?

A

Must secure the airway as aspiration of charcoal can cause a nasty pneumonitis
Charcoal does not absorb metallics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which substances are not well absorbed by charcoal?

A 
Pesticides
Hydrocarbons
Alcohols
Iron (metallics are not well absorbed)
Lithium 
Solvents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When would you use whole bowel irrigation (Klean-prep 1L/hour)?

A

Iron, heavy metals, “body stuffers/packers” and sustained released pills
Paracetamol, opiates, TCAs, aspirin and cocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What may suggest severe liver damage?

A

Peak ALT >1000 iu/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the risk of severe liver damage with a paracetamol OD of <75mg/kg?

A

Unlikely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the risk of severe liver damage with a paracetamol OD of >150mg/kg?

A

Likely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the risk of severe liver damage with a paracetamol OD of >6g total?

A

Potentially fatal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Complication of anorexia and paracetamol?

A

Liver will not be able to process paracetamol efficiently

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the antidote to a paracetamol overdose?

A

N-acetyl-cysteine (trade name Parvolex)

Infusion over 21 hours at least

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Symptoms of paracetamol OD:

A

N+V

Coma, severe metabolic acidosis (high conc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Signs of paracetamol OD complications:

A

Loin pain, haematuria and proteinuria after first 2 hours strongly suggests incipient renal failure
Right subcostal pain and tenderness, N+V and jaundice after 2-3 days suggests hepatic necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the half life of paracetamol?

A

4 hours

26
Q

What should you monitor when treating with NAC?

A

INR
U+Es
LFTs

27
Q

When should you measure paracetamol levels?

A

4 hours post OD (INR, U+Es, ALT)

28
Q

What to do past 12 hours paracetamol OD?

A

See whether total amount was >75mg/kg

29
Q

What is given to patient who has overdosed on opiates?

A 
IV Naloxone (IM if can't get IV access)
0.4-2mg for an adult and 0.01mg/kg for child may need as much as 4mg for severe case
Infusion at 1/2 waking dose given hourly may be needed
30
Q

Features of naloxone:

A

Very short t1/2 (methadone has a huge t1/2) so may have to repeat doses
If not in respiratory failure with good saturations then you don’t have to give naloxone and can observe

31
Q

Effects of TCAs:

A

Atropine-like anti-cholinergic effects at autonomic nerve endings and in the brain
Quinidine-like effect on myocardium (increased AP duration as well as a prolonged QT interval)

32
Q

Peripheral poisoning features of a TCA overdose:

A 
Sinus tachycardia
Hot dry skin
Dry mouth
Urinary retention
Hypotension
Hypothermia
33
Q

CNS poisoning features of a TCA overdose:

A 
Dilated pupils
Ataxia, nystagmus, squint
Decreased level of consciousness
Coma, seizures, respiratory depression
Increased tone, reflexes and plantars
34
Q

ECG poisoning features of a TCA overdose:

A

Prolonged PR, QRS and QT

Ventricular dysrhythmias

35
Q

What are the best indicators of toxicity in a TCA overdose?

A

ECG and GCS

36
Q

Management of TCA overdose?

A 
Repeat doses of activated charcoal
Give diazepam for fits and agitation
Correct hypoxia
Give NaHCO3 if acidotic/ECG changes (not anti-arrhythmics)
Correct hypotension with crystalloids
37
Q

When should you not use flumazenil in the context of a TCA overdose?

A

If the patient has also taken benzodiazepines

38
Q

What does a QRS >100ms indicate?

A

Cardiac toxicity

39
Q

ECG changes in TCA overdose:

A

QRS >100ms
Terminal R wave >3mm in aVR
R/S ratio >0.7 in aVR

40
Q

Early features of an aspirin overdose?

A 
Hyperventilation
Sweating
Tremor
Tinnitus
N+V
Hyperpyrexia
41
Q

Metabolic features of an aspirin overdose?

A

Hypo/hyperglycaemia
Hypokalaemia
Respiratory alkalosis
Metabolic acidosis

42
Q

Serious features of an aspirin overdose?

A

Renal failure
Pulmonary oedema
Seizures
Coma and death

43
Q

Salicylate >700

Salicylate >500

A

Potentially lethal

Moderate-severe

44
Q

How do you treat an aspirin overdose?

A

Activated charcoal
Rehydrate, monitor glucose, correct acidosis and K
If >500 then alkalise the urine
If >700 then consider haemodialysis

45
Q

Effect of cocaine of myocardium?

A

Quinidine-like effect: QRS widening and QT prolongation

46
Q

What is cocaine overdose?

A

A hyperadrenergic state

47
Q

Symptoms of a cocaine overdose?

A 
Agitation and anxiety
Hallucinations
Violence
Twitches, tremors
Grand mal seizures, status epilepticus
48
Q

Signs of a cocaine overdose?

A 
Dilated pupils and diaphoresis (sweating)
Hyper-reflexia
Hyperthermia
Hypertension
Tachypnoea
Dysrhythmia
Malignant hyperthermia
49
Q

Extreme outcomes of cocaine overdose:

A 
Cerebral infarction/haemorrhage
Spinal cord infarction
Myocardial ischaemia/infarction
Retinal artery occlusion
Pulmonary haemorrhage/barotrauma
Rhabdomyolysis (muscle failure)
50
Q

Treatment regimen for cocaine overdose:

A
  1. Benzos for severe agitation and seizures
  2. Alpha/beta blocker for hypertension and tachyarhythmia
  3. Nitroprusside for malignant hypertension
  4. GTN/benzos for MI
51
Q

How can cocaine overdose cause myocardial toxicity?

A

Increased platelet aggregation and thrombogenesis
Accelerated atherosclerosis
Increased myocardial O2 demand and direct myocardial toxicity

52
Q

What should you avoid giving for agitation in a cocaine overdose?

A

Anti-psychotics

53
Q

What does the common law permit?

A

The patient lacking mental capacity means that the doctor can give medical treatment to preserve life and in the patient’s best interests

54
Q

Symptoms of an insulin/sulphonylurea overdose?

A

Agitation
Sweating
Confusion, drowsiness, coma or convulsions
Tachycardia
Hypotension
Can have permanent neurological effect if prolonged

55
Q

Treatment for sulphonylurea overdose?

A

Ocreotide 50mcg 8-12 hourly IV or SC for patients with prolonged hypo

56
Q

Mechanism of ocreotide?

A

Prevents further release of insulin from the pancreas and reduces the dextrose requirement

57
Q

Management of insulin/sulph overdose:

A

Check blood glucose, U+Es and BM
Correct hypoglycaemia: 1-2ml/kg IV 50ml 50% dextrose
OR sugary drink if conscious
Then infusion of 10% or 20% dextrose titrated against blood glucose
K replacement guided by frequent U+E checks normally 10-20mmol K per litre of dextrose

58
Q

If patient refuses treatment with capacity then later becomes unconscious…

A

You cannot treat in absence of prior consent

59
Q

Children over 16 are…

A

Treated as adults

60
Q

What is the protocol if a child is <16?

A

They are assessed for Gillick competency
Conset by a competent child cannot be overridden by a parent (reverse dose not apply)
If any doubt then court order

61
Q

Indicators for lead poisoning?

A

Moderately raised blood levels
Children presenting with pica
Children presenting with encephalopathy
Abdominal pain and anaemia with no clear cause

Trauma (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions