Toxicology- Ross Flashcards
What three meds are VERY LETHAL to kids?
beta blockers, CCB and oral hypoglycemics (metformin, glipizides, other DM meds)
What is a coma cocktail and what is included in it?
combination of substances administered in an emergency to comatose individuals when the cause of the coma has not yet been determined.
D50 (dextrose), oxygen, naloxone and thiamine (DON’T ACRONYM)
Naloxone is helpful in small incremental doses of _____ a large dose in opioid dependent patient will result in ______. It can be given IM, IN, nebulization or IV. If patient has taken a long acting narcotic then a narcan drip may be necessary.
- 2mg, withdrawl
* Naloxone is commonly used
________ is used for anticholinergic ingestions
Physostigmine
When should we NOT give physostigmine?
do not give if there is a possibility of tricyclic overdose.
________ is a benzodiazepine antagonist. It can precipitate a withdrawal including seizures. These seizures can be intractable.The dose is _____ over ____ sec. Can give additional doses if it is effective. DO NOT give when there are co-ingestions. Typically used to reverse a conscious sedation procedure when Benzo’s have been given by health care provider
Flumazenil
0.2 over 30 seconds
When should you NOT give flumazenil?
DO NOT give when there are co-ingestions
__________ prevents hepatotoxicity in acetaminophen ingestion. Should be given within 8 hours have up to 4 days. Can be given orally or IV.
N-acetylcysteine
N-acetylcysteine should be given within how many hours of an acetaminophen ingestion?
8 hours
What do we give for digoxin toxicity?
Digibind for digoxin toxicity
We give ______ for snake bites
fab fragments
We give _____ _____ for cyanide overdose
Amyl nitrates
What are AEIOU TIPSS?
Used to recall the possible causes for altered mental status. A- alcohol E- electrolyte I- insulin O-oxygen & opiate U- uremia T- trauma I-infection P-psychosis S- stroke S-seizure
What are some options for gastric decontamination?
Ipecac, lavage, charcoal
**CHARCOAL IS THE BEST OPTION
In patients with overdose should we try gastric contamination methods if the pt has respiratory compromise?
NO
What is something to remember about ipecac?
It is only given when pt have ingestion and confirmed no other substance ingested
_______ is a very effective gastric decontam method for acetimenophen overdose?
activated charcoal
Should be given within one hour of ingestion and only one dose unless the ingestion is a delayed release or a highly toxic substance which gets absorbed by charcoal.
Can do multiple doses
You should avoid charcoal in which settings?
Avoid Charcoal in hydrocarbon, alkali or acid ingestions as these ingestions cause burns and charcoal is not helpful and can be harmful.
When is gastric lavage a good option?
Can be helpful in life-threatening substances for which treatment options are limited such as iron. It carries risk of aspiration and perforation and in almost all cases the risk out weighs the benefit.
When is whole bowel irrigation a good option?
Whole bowel irrigation: flushes the drugs or chemical rapidly through gi tract. Use is helpful in iron, lithium and heavy metals since these drugs are not absorbed by charcoal. (people have lots of diarrhea)
How is charcoal administered?
The pt drinks it and its given with 1g/kg sorbitol but subsequent doses are without sorbitol
When do we use hemodialysis?
For ASA overdose
need to have a drug with small volume of distribution (in the blood and not bound to tissue).
How do we dx an acute overdose in AMS patients?
think AEIOU TIPSS!
A patient comes in to the ER and is very distressed. the patinent has flushed skin, with extremely dilated pupils, sweating, and saying wild and crazy stories with hallucinations that people are very small. What type of toxidrome is this?
Anticholinergic
A patinet presents with confusion, weakness, lacrimation, defecation. What type of toxidrome is this?
Cholinergic
A patient presents with AMS, is unresponsive, meiosis and seems in shock. What is the most likely toxidrome?
opioid
A patinet presents with fever, tremor, aggitation, diaphoresis and uncoordination. What is the most likely toxidrome?
Serotonin
A patient comes in with delusions, paranoia, diaphoresis, hypertension, anxiety and dilated pupils but when you shine light on pupils they constrict. What is the most likely toxidrome
Sympathomimetic (this is a category of MDMA or cocaine)
What is an anion gap?
The anion gap test tells you how much acid is in your blood. Normal range is 3-10 and about 10 would be metabolic acidosis
Remember MUDPILES this is all the things that can cause acidosis
What med is best for sedating a patient?
Haldol
What do you do if a patient is not breathing sufficiently and has rising end tidal CO2?
Patients who are breathing insufficiently and have rising end tidal co2 as well as a lack of a gag are indications for intubation.
What is an antidote for opiate?
naloxone
**If patient receives naloxone for ingestion need to observe for at least 2 hours as re-sedation will occur in this time period.
What is an antidote for organophosphates?
atropine
What is an antidote for cyanide?
sodium nitrate and sodium thiosulfate
What is an antidote for benzos?
flumazinil but rarely given
This antidote for benzos is really only indicated for single intoxicant and with kids
flumazinil
What is a sympathomimetic toxidrome and what med do we use to treat it?
Toxidrome: a syndrome caused by a dangerous level of toxins in the body. This is the one where the eyes constrict when flashing a light (also HTN, tachycardia, seizures)– from cocaine, MDMA, meth
BENZOS BENZOS BENZOS
What should you abosoltely avoid giving to a patient with a sympathomimetic toxidrome?
Beta blockers (can go into hypotensive crisis)
In a patient with an anticholinergic cardiac toxicity that has wide complex tachycardia, sodium channel blockade, what is the tx?
sodium bicarb
In a patient with an anticholinergic cardiac toxicity that has torsades de pointes, what is the tx?
magnesium
In a patient with an anticholinergic cardiac toxicity that has ventricular dysrhythmias, what is the tx?
lidocaine
**A patinent presents with aggitation, word slurring, brought in restrained to stretcher, had been swinging arms and yelling incoherently. You think about giving her haldol or another cns depressant such as Olanzapine. Before administering it, what should you do and why?
GET A QT prior to administering
If you have a pt with an aochol withdrawl, what med should be given?
benzos
if you have an alcholic pt, what med can be given?
haldol (BUT REMEMBER TO CHECK QT) you would give B52 so 5mg benzo and 2mg haldol
How to treat an acute agitation episode?
B52
Benzo 5mg
Haldol 2mg
How to treat agitated delirium?
benzo and check electrolytes
What do you tx a withdrawl with?
fluids, anti-emetics and clonidone 0.1mg orally unless seizing
What is serotonin syndrome and how do you treat it?
Characterized by hyperthermia, agitation, hyperreflexia and myoclonus.
Tx with cyproheptadine which interacts at serotonin receptors
Toxic ingestions of acetaminophen are predicted when ingestion amounts are ________g/kg .
140
What is important to know in an acetaminophen ingestion?
important to know the time of the ingestion
If you don’t know a time obtain a level on presentation if elevated above 20ug/ml consider use of what?
N-Acetylcysteine (NAC) and repeat a level in 4 hours. You will also check LFT, PT/INR, BMP. If less than 20ug/ml repeat level in 4 hours.
What are the tx steps for acetaminophen overdose?
- Use of activated charcoal to prevent absorption
- Specific antidote is N-acetylcycstine (IV works best)
- Either tx pt immediately at level of 140 or treat at 20 which is the initiation level
Starting with a _______ is the best choice for unknown cause of agitation
benzos
