Toxicology Flashcards
What does toxicology involve?
ODs of medications and drugs
(Because your lips are venom you’re POISON)
Who may be able to give a good collateral history from a patient who just had an OD
Friends & family
Paramedics
What key bit of info would you try and get form paramedics regarding patients who had an OD?
If any drugs or medication packets were found nearby the poor bugger
What are the key bits of info you need to find out when taking a history of an OD
What was taken
How much
When
Was it taken all at once or staggered
Was alcohol involved
When someone presents to the ED with an OD, what do you need to consider?
If they have capacity
If their gonna leg it
What tool is used for assessing ODs
Toxbase tool
What does ‘Toxidrome’ mean?
The signs and symtpoms that indicate a specific class of poisoning
Just pattern recognition ehhhh
What is the very first thing you do for all patients who present with an OD
ABCDE assessment
So what do you look for in the ABCDE assessment for patient’s who have had an OD
A -> patency
B -> resp rate
C -> pulse & BP
D -> mental status, pupils, reflexes, seizures
E -> temperature, skin changes, musous membranes
When checking out the E in ABCDE for a patient whos had an OD, what do you look for with regards to skin?
If it’s sweaty or dry
What are the 4 main types of toxidromes
Adrenergic (sympathomimetic) drugs
Sedative-hypnotic drugs
Opioids
Anti-cholinergics
What is another term for adrenergic drugs
Sympathomimetics
(they mimic the effects of the sympathetic system ehhhh)
How do sympathemimetic (adrenergic) drugs work?
Stimulate a & B adrenergic receptors
Prevent noradrenaline reuptake
Release noradrenaline
(keeps noradrenaline going strong)
How do adrenergic drugs affect noradrenaline?
They keep it presennt and active
(let’s it go a bit maaad ehhh)
How do anticholinergic drugs work?
Block Na channels
Block a-adrenergic receptors
What are the 3 consitent features for pretty much all toxidromes?
(symtpoms to always guess ehh)
Altered mental state
Hallucinations
Delirium
What are the ECG signs for anti-cholinergic toxidromes?
Wide QRS
Prolonged PR and QT interval
What is the difference between anti-cholinergic and opioid toxidromes regarding what happens to the pupils?
Anti-cholingeric -> dilated & non-reactive
Opioid -> pin-point
What is the difference regarding what happens to reflexes for:
A. Adrenergic toxidromes
B. Sedative-hypoxic toxidromes
C. Anti-cholinergic toxidromes
A. Brisk
B. Reduced
C. Brish -> absent
What toxidromes casue hypertension and hypotension
Hypertension
Adrenergic
Anti-cholingeric
Hypotension
Sedative-hypoxic
Opioids
What toxidrome is being described here:
“Hot as a hare, dry as a bone, mad as a hatter”
Anti-cholinergic
Hot as a hare -> pyrexia
Dry as a bone -> dry skin
Mad as a hatter -> confusion ehhh
For anti-cholingeric toxidromes, what are the indications to give 50ml of Sodium bicarbonate?
Metabolic acidosis
Prolonged QRS
Arrythmias
Still hypotensive after fluids
What are the key questions you need to think about regarding how an OD will be managed?
Do they need resus
What have they taken, how much and when
Have the paramedics brought anything
Do they need charcoal
What tests need to be done
Is there a specific antidotoe
What is the predictive clinical course
Is a psych assessment needed
How would manage resp. depression that can occur in opioid ODs?
Fire in a nasopharyngeal airway
Give 15L of O2
Montitor CO2
Do an ABG
Why is it important to monitor CO2 and do an ABG for opioid ODs?
To check for acidosis
Opioid ODs can cause hypoglycemia.
How can you treat hypoglycemia?
IV dextrose
(if you can’t give IV -> do IM glucagon)
What can happen to BG levels for opioid ODs?
Hypoglycemia
Why is charcoal often used for ODs?
As charcoal binds to the drug, limiting it’s effect
What is a sign of warfarin OD, and how would you treat it?
Sign -> Haemorrhage
Treatment -> Vit. K
Give examples of adrenergic drugs
Cocaine
Ampthetamines
Noval psychoactive substances
Decongestants
Noval psychoactive agents are examples of adrenegric drugs, what are they also known as?
Legal highs
Cocaine and amphetamines are examples of what type of drug?
Adrenergic
Give examples of sedative-hypoxic drugs
Benzodiazipeines
Barbituates
Ethanol
Zopidone (sleepign tablets)
Give an exmaple of a benzodiazpine, which is a type of hypoxic-sedative drug?
Diazepam
Baribituates are an example of sedative hypoxic drugs, what are they used to treat?
Epilepsy
Give examples of opioids
Codeine
Heroin
Methadone
MST
Heroin and methodone are what type of drug
Opioid
What are opioids used to treat?
Chronic pain
Give examples of anti-cholinergic drugs
TCAs (e.g. amitriptyline)
Antihistamine
Oxybutynin
Diphenhydramine
If someone presents with an OD of one of their anti-depressants or medicine for their urinary incontinence, what is the likley toxidrome?
Anti-cholinergic
(anti-depressant -> TCA)
(urinary incontience drug -> oxybutynin)
If someone presents with an OD after taking too much pain meds, what is the likely toxidrome?
Opioid
If someone presents with an OD of hayfever and allergy tablets, what is the toxidrome that will occur?
Anti-cholinergic
What are the clinical features for adrenergic (sympathomimetic) toxidromes?
Chest pain
Agitation
Tachycardia & tachypnoea
Sweating
Dilated pupils
Brisk refelexes
Arrythmias
Hypertension
What are the clinical features of sedative-hypoix toxidromes?
Brachycardia & bradypnoea
Slurred speach
Nystagmus & blurred vision
Reduced reflexes
Hallucinations
Coma
What are clinical features of opioid toxidromes?
Resp. depression
Bradycardia
Pinpoint pupils
Hypothermia
Seziures
What are the clinical features of an anti-cholinergic toxidrome?
Pyrexia (hot as a hare)
Dry skin (dry as a bone)
Confusion (mad as a hater)
Tachycardia
Brisk (then absent) reflexes
Dilated & non-reactive pupils
Urine retention
What types of toxidromes cause tachycardia and bradycardia?
Tachycardia
Adrenergic
Anti-cholinergic
Bradycardia
Sedative-hypoxic
Opioid
How is an OD of an adrenergic drug managed?
Measure
CK levels
ECG
Temperature
Give
Diazepan
GTN infusion
Sodium bicarbonate
What is sodium bicarbonate used to treat
Metabolic acidosis
Levels of what should you always check in adrenergic drug ODs?
CK
If CK levels are high in a adrenergic OD, what do you give?
IV fluids
How is an OD of a sedative-hypnotic drug managed?
Intubate & protect airway
Ventilation support
Correct hypotension
Give flumazenil (if OD’ on benzo)
How can you correct hypotension?
(need to do in sedative-hypoxic and opoiod ODs)
Give IV fluids
Lift legs
Vasopressors
What is the main management goal for sedative-hypoxic toxidroems?
Protect the airway
What is the ‘antidote’ for benzodiazpenie OD?
Flumazenil
How is an OD of an opioid drug managed?
Give Naloxone
Give 15L oxygen
Set up a nasopharyngeal airway
Do a GCS assessment
Montiro CO2 and ABGs
What is the ‘antidote’ for…
A. Adrenergic ODs
B. Sedative-hypoxic (benzo) ODs
C. Opioids
A. Diazepam
B. Flumazenil
C. Naloxone
What are the 2 ways that you give naloxone?
IV or IM
How long does naloxone last one given?
40mins approx
(so it’s long acting)
How are anti-cholingeric ODs managed?
Give charcoal
Give glucahon (if hypotensive or in shock)
Give sodium bicarbonate (
Check CK and ECG
What does diazpeam treat
Agitation
Arrythmias
When would you give sodium bicarbonate in an anti-cholinergic OD?
If metabolic acidosis occurs
(same for adregenric OD)
Alcohol OD would cause what type of toxidrome?
Sedative-hypoxic
(As alcohol is ethanol ehhhhh)
What is the antidote for a benzo OD?
Flumanazil
An OD of what is treated with alcohol?
Anti-freeze
