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Toxicology Emergencies Flashcards

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1
Q

4 primary methods of entry

A

Ingestion
Inhalation
Injection
Absorption

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2
Q

Assessment clues pointing towards ingestion:

A

Stained fingers, lips, or tongue
Sudden onset of stomach cramps w/, w/o n/v/d
Empty pill bottles
Plant partially chewed

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3
Q

Management of ingestion toxicology

A 
Immediately assess ABCs
Activated charcoal or syrup of ipecac
Prompt transport to ED
Possible IV access
Provide aggressive vent support and CPR if ingestion of opiate, sedative or barbiturate
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4
Q

Assessment clues pointing towards inhalation

A

Rapid onset of s/s

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5
Q

Management of inhalation toxicology

A 
Scene Safety
Consult poison control or local hazardous materials team members
Remove clothing
Take any containers with you
High concentration of oxygen
Iv access
Pulse ox
Call ALS backup early
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6
Q

Why should you never pull a shirt over the pt’s head?

A

The toxin can be introduced in the eye, nose or mouth. Always cut or unbutton.

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7
Q

Management of injection posioning

A 
Monitor airway
Administer high-flow oxygen
Be alert for n/v
Transport promptly 
Take all containers with you
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8
Q

s/s of absorption poisoning

A

Hx of exposure
Liquid or powder of skin
Burns, itching, irritation or redness of skin
Typical odors of the substance

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9
Q

Management of absorption poisoning

A

Avoid contamination
Remove irritating or corrosive substances from pt
Cut off all clothing
Brush off as much powder, flush skin with running water, and then wash with soap and water
Irrigates eyes for 20 minutes if needed
Obtain material SDS
Prompt transport
Continue irrigation and oxygen if possible while enroute

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10
Q

Why should you never flush off dry powder?

A

Water can activate a chemical reaction.

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11
Q

What type of chemicals react violently with water?

A

Phosphorus or elemental sodium

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12
Q

Major toxidromes

A 
Stimulants
Narcotics
Sympathomimetics
Cholinergic
Anticholinergics
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13
Q

s/s of stimulant toxidrome

A 
Restlessness
Agitation
Incessant talking
Insomnia
Anorexia
Dilated pupils
Tachycardia
Tachypnea
HTN or hypotension
Paranoia
Seizures
Cardiac arrest
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14
Q

Examples of stimulant toxidromes

A 
Amphetamine
Methamphetamine
Cocaine
Diet aids
Nasal decongestants
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15
Q

s/s of narcotic toxidrome

A

Pinpoint pupils
Marked respiratory depression
Drowsiness
Stupor Coma

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16
Q

Examples of narcotic toxidromes

A 
Heroin
Morphine
Hydromorphone
Fentanyl
Oxycodone
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17
Q

s/s of sympathomimetic toxidromes

A 
Hypertension
Tachycardia
Dilated pupils
Agitation
Seizures
Hyperthermia
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18
Q

Examples of sympathomimetic toxidromes

A

Epi
Albuterol
Cocaine
Methamphetamine

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19
Q

s/s of sedative-hypnotic toxidrome

A 
Drowsiness
Disinhibition
Ataxia
Slurred speech
Mental confusion
Resp. depression
Progressive CNS depression
Hypotension
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20
Q

Examples of sedative-hypnotic toxidrome

A

Diazepam
Secobarbital
Flunitrazepam

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21
Q

s/s of cholinergic toxidrome

A

SLUDGEM

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22
Q

Examples of cholinergic toxidromes

A

Diazonin
Orthene
Parathion
Nerve gas

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23
Q

s/s anticholinergic toxidrome

A 
Tachycardia
Hyperthermia
Dry skin
Dry mucous membranes
Dilated pupils
Blurred vision
Sedation
Agitation
Seizures
Coma 
Delirium
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24
Q

Examples of anticholinergic toxidromes

A 
Atropine
Antihistamines
Jimsonweed
Antipsychotics
Scopolamine
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25
Q

Antagonist

A

Affinity for a cell receptor preventing the cell from responding.

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26
Q

Potentation

A

Enhances the effect of one drug by another

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27
Q

Synergism

A

The total effect of two drugs are greater than the sum of the independent effects of the two.

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28
Q

Dosage of activated charcoal

A

1g/kg
Adults : 25-50
Children : 12.5 - 12.5

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29
Q

Contraindications of activate charcoal

A

Ingested acid, alkali, or petroleum product
Decreased LOC
Cannot protect their airways
Unable to swallow

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30
Q

Minor alcohol withdrawal s/s

A 
Restlessness
Anxious
Sleeping disturbances
Agitation
Tremors
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31
Q

Major ETOH withdrawal s/s

A

Increased BP
Vomiting
Hallucinations
Delirium tremens

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32
Q

What is delirium tremens?

A

Delirium resulting in tremors, restlessness, weakness, fever, diaphoresis, disorientation, hallucinations, confusion, hypotension, seizures, and possibly death.

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33
Q

Medical conditions alcoholics are more susceptible to

A 
Subdural hematoma
GI bleeding
Pancreatitis
Hypoglycemia
Burns
Hypothermia
Seizures
Dysrhythmias
Cancer
Esophageal varices
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34
Q

Management of ETOH-related condistions

A

Establish and maintain airway
Gag reflex present left lateral recumbent w/ suction ready
Non gag reflex - airway adjunct and vent BVM
High-concentration oxygen
Vascular access
Asses blood sugars
Suspect internal bleeding if s/s shock

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35
Q

How can you protect a patient with DTs from injury?

A 
Keep pt calm
Administer oxygen via nasal cannula
Vascular access
Manage hypotension w/ infusion of nl saline
Reassess breath sounds
Maintain ongoing dialogue
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36
Q

When do withdrawal seizures typically occur?

A

w/in 12-48 hours of last drink

37
Q

Narcotic

A

Drug that produces sleep or AMS

38
Q

Two classifications of narcotics

A

Opiate - natural drugs derived from opium

Opioid - synthetics

39
Q

Examples of common narcotics

A 
Morphine
Codein
Heroin
Fentanyl
Oxycodone
Meperidine
Propoxyphene
Dextromethorphan
40
Q

Pathophysiology of narcotics

A

Major effects on the CNS by binding with receptor sites in the brain and other tissues

41
Q

Naloxone dosage

A

0.4 - 2mg

42
Q

What should you do before administering Naloxone?

A

Place OPA or NPA and vet w/ BVM

43
Q

Onset of effects of snorting cocaine and smoking cocaine.

A

Nasal : effects w/ 1-2 minutes and peaks in 20-30 minutes

Inhalation : onset 8-10 seconds and does not last as long

44
Q

What potentially fatal complications can occur with cocaine use?

A 
Lethal dysrhythmias
AMI
Seizures
CVA
Apnea
Hyperthermia
45
Q

Management of stimulant OD

A

Maintain max oxygen levels
Prevent seizures w/ adequate sedation
Monitor serial vital signs
IV access
Manage hypotension w/ fluid infusion of nl saline
Call ALS backup for medication administration of benzo

46
Q

Smoking marijuana results in

A 
Bronchodilation
Slight tachycardia
Euphoria
Drowsiness
Decreased short-term memory
Diminished motor coordination
Increased appetite
Bloodshot eyes
47
Q

Management of marijuana use

A

Supportive care

48
Q

Adverse effects of spice

A 
Psychosis
Hallucinations
Tachycardia
Vomiting
Renal problems
Seizures
49
Q

Management of spice OD

A

Supportive care w/ fluids and airway maintenance.

Call ALS if seizures occur for medication administration

50
Q

Treatment for PCP or ketamine OD

A 
Secure the patient well
Assess ABCDEs
Manage life threats
Administer oxygen
IV access
Safe transport to facility
Call ALS for benzo administration to help calm agitated pt
51
Q

Treatment for mescaline or psilocybin mushrooms OC

A 
Pay attention to ABCDEs
Administer oxygen therapy
Monitor vital signs
Provide positive psychological support
Provide safe transport
IV access
52
Q

Mild to moderate barbiturate intoxication s/s

A 
Similar to ETOH intoxication
Drowsiness
Decreased inhibitions
Ataxia
Mental confusion
Staggering gait
53
Q

Increased doses of barbiturate intoxication s/s

A

Lethargic

Low level of responsiveness or unresponsiveness

54
Q

Effects of beznodiazepines

A

Sedation
Reduction of anxiety
Relaxation of striated muscle

55
Q

s/s benzodiazepines OD

A 
AMS
Drowsiness
Confusion
Slurred speech
Ataxia
General incoordination
56
Q

Withdrawal s/s of benzodiazepines

A

Tachycardia
Tremulousness
Confusion
Seizures

57
Q

What medical conditions are commonly treated with benzodiazepines?

A

Anxiety, seizures, ETOH withdrawal

58
Q

What medical conditions are commonly treated with barbiturates?

A

Sleep aids, antianxiety, seizures

59
Q

Management of sedative-hypnotic OD

A

Airway management first priority
Administer high-concentration oxygen
IV access
Shock - rapid infusion of 20-mL/kg bolus of nl saline and repeated doses up to 2L PRN

60
Q

s/s of cardiac drug OD

A 
Hypotension
Weakness or confusion
N/V
Rhythm disturbance
Headache
Difficulty breathing
61
Q

Management of cardiac drug OD

A 
Patent airway
Adequate vent
Administer high-flow oxygen
IV access
Sequential fluid boluses of nl saline for HTN
Contact medical control
62
Q

Major classes of cardiac drugs

A 
Antidysrhythmics
Beta-blockers
Calcium-channel blockers
Cardiac-channel blockers
Cardiac glycosides
Angiotensin-converting enzyme inhibitors
63
Q

s/s tricyclic antidepressant OD

A 
AMS
Dysrhythmias
Dry mouth
Blurred vision or dilated pupils
Urinary retention
Constipation
Pulmonary edema
64
Q

Management of TCAs OD

A

Maintain airway. Insert advanced airway if deterioration
Call ALS for cardiac monitoring, intubation, and medication administration.
Administer high-flow supplemental oxygen
IV access
Administer activated charcoal per medical control
Manage hypotension with boluses of nl saline
Assess blood sugars. Administer dextrose 50% in water.

65
Q

Early and late s/s of MOAI OD

A

Hyperactivity
Sinus tachycardia
Hyperventilation
Nystagmus

Chest pain
Palpitations
HTN
Diaphoresis
Agitate or combative behavior
Hyperthermia
Hallucinations
66
Q

Management of MAOI OD

A

Establish and maintain airway
Administer high-flow oxygen or provided positive pressure vent
IV access
Consider activate charcoal if recommended by medical control
Treat HTN with fluid boluses of nl saline
Call ALS for seizures to administer medications

67
Q

s/s SSRI OD

A 
N/V
Sinus tachycardia
Sedation
Tremors
Dilated pupils
Agitation
BP changes
Seizures
Hallucinations
68
Q

Management of SSRI OD

A 
Establish and maintain airway
Administer high-flow oxygen
IV access
Call ALS PRN
Consider single dose of activated charcoal
69
Q

s/s lithium OD

A

N/V
Hand tremors
Excessive thirst
Slurred speech

Ataxia
Muscle weakness
Incoordination
Blurred vision
Hyperreflexia
Seizures
Coma
70
Q

Management of lithium OD

A

Establish and maintain airway, insert advanced airway if needed.
Administer high-flow oxygen
IV access
Administer serial boluses of nl saline if hypotensive

71
Q

s/s NSAID OD

A 
Headache
AMS
Behavioral changes
Seizures
Bradydysrythmias
Hypotension
ABD pain
N/V
72
Q

Management of NSAID OD

A

Establish and maintain airway, insert advanced airway if needed
Administer high-flow oxygen
IV access
Administer fluid bolus of nl saline if hypotensive
Consider ALS if hypotension continues

73
Q

s/s salicylates OD

A 
N/V
ABD pain
Diaphoresis
Hyperpnea
Tinnitus
Pulmonary edema
Acid-base disturbances

Metabolic acidosis
Respiratory alkalosis-metabolic acidosis

74
Q

Management of salicylates OD

A

Establish and maintain airway, insert advanced airway PRN
Administer high-flow oxygen
IV access
Administer serial boluses of nl saline if hypotensive
Monitor CO2 levels
One dose of activated charcoal after consulting medical control

75
Q

Management of APAP OD

A

Administer high-flow oxygen
IV access
Recent ingestions - consider activate charcoal after medical control consult

76
Q

s/s GHB OD

A

CNS depression
Disinhibition
Passivity
Antegrade amnesia

77
Q

Management of GHB

A

Establish and airway management, insert an advanced airway if needed
Carefully monitor LOC
Assist breathing as necessary and administer high-flow oxygen
IV access
Provide rapid transport

78
Q

Pathophysiology of organophosphate poisoning

A

Overstimulate normal body functions controlled by parasympathetic nerves.

79
Q

Management of organophosphate

A 
Decontaminate and remove all clothing
Establish and maintain the airway
Suction PRN
Administer high-flow oxygen
IV access
Call ALS for medication administration and cardiac monitoring.
Transport immediately
80
Q

Management of CO poisoning

A

Remove pt from environment
Establish and maintain airway, insert advanced airway PRN
Administer high0flow oxygen with tight-fitting nonrebreather
IV access
Keep patient quiet and rest
Monitor LOC

81
Q

Management of lead poisoning

A

Establish and maintain airway, inserting an advanced airway
Administer high-flow oxygen
IV access with saline or hep lock
Only administer fluids if hypotensive

82
Q

s/s lead poisoning

A 
AMS
Mood changes
Memory deficit
Sleep disturbances
Headache
Seizures
Ataxia
ABD pain
Renal insufficiency
HTN
Gout
Anemia
83
Q

Management of iron poisoning

A

ABCs

84
Q

s/s iron poisoning

A

ABD pain
Vomiting
Diarrhea
Hypotension

85
Q

s/s chlorine gas poisoning

A

Burning sensation of eyes, nose, and through with slight cough.

Chest tightness
Choking
Paroxysmal cough
Headache
N/V
Diffuse wheezing
Cyanosis
Crackles
Shock
Seizures 
Loss of conscious
86
Q

Management of chlorine gas poisoning

A

Remove from exposure
Prioritize breathing
Irrigate burning or itching eyes with water

87
Q

s/s food poisoning

A

Abd pain and cramping

N/V/D

88
Q

Management of food poisoning

A

Establish and maintain the airway, inserting advanced airway PRN
Administer high flow oxygen
IV access
Fluid boluses w/ nl saline if hypotensive
Call ALS for backup PRN

Advanced EMT (33 decks)

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