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Trauma > Toxicology > Flashcards

Toxicology Flashcards

1
Q

Acidic drugs like aspirin…

A

Increase respiration rate

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2
Q

Basic drugs like benzos or opiates…

A

Decrease respiration rate

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3
Q

What does a GCS <9 indicate?

A

Potential airway problem

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4
Q

What does absent gag response indicate?

A

No patent airway

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5
Q

Blue lips indicate…

A

Methaemoglobinaemia (haemoglobin in irreversible oxidised state from oxidant drugs)

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6
Q

Cherry red lips indicate…

A

Carbon monoxide (need a lot of exposure)

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7
Q

Which conditions are associated with Kussmal’s breathing?

A

DKA

Kidney failure

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8
Q

Effect of opiates on breathing?

A

Reduce the rate and efficacy

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9
Q

What can added breath sounds signify?

A

Opiates

Paraquat

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10
Q

Where can you get IV access in an IVDA?

A

Behind elbow

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11
Q

What do small pupils indicate?

A

Opiates
Organophosphates
Other cholinergics

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12
Q

What do large pupils indicate?

A 
Alcohol
Anti-cholinergics
Amphetamines
Beta blockers
TCAs
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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

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14
Q

Precaution with charcoal?

A

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

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15
Q

Which substances are not well absorbed by charcoal?

A 
Pesticides
Hydrocarbons
Alcohols
Iron (metallics are not well absorbed)
Lithium 
Solvents
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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

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17
Q

What may suggest severe liver damage?

A

Peak ALT >1000 iu/L

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18
Q

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

A

Unlikely

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19
Q

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

A

Likely

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20
Q

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

A

Potentially fatal

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21
Q

Complication of anorexia and paracetamol?

A

Liver will not be able to process paracetamol efficiently

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22
Q

What is the antidote to a paracetamol overdose?

A

N-acetyl-cysteine (trade name Parvolex)

Infusion over 21 hours at least

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23
Q

Symptoms of paracetamol OD:

A

N+V

Coma, severe metabolic acidosis (high conc)

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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

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25
Q

What is the half life of paracetamol?

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)

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