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ER > Toxidromes > Flashcards

Toxidromes Flashcards

1
Q

What are the changes that you expect to see in opioid poisoning?

A
  • Bradycardia\Bradypnea
  • Decreased bowel movement
  • Pinpoint pupils
  • coma
  • normal to low temperature
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2
Q

What is the antidote of opioid oversdose

A

Naloxone

If there’s respiratory depression

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3
Q

What are the anticholinergics that you’re aware of?

A
  • Antidepressant
  • Anti-Parkinson
  • Anti-psychotic
  • Anti-spasmodic & Anti-vertigo
  • Muscle relaxants
  • Jimson weed
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4
Q

What do you expect to see in anticholinergic toxicity?

A
  • Dry as a desert
  • Hot as a desert
  • Red due to desert
  • Dilated to look through the desert
  • Tachycardia & Absent bowel sounds
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5
Q

What is the antidote for anti-cholinergic toxicity?

A

Phyostigmine

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6
Q

What do you expect to see in cholinergic toxicity?

A 
Leaking from every orifice
SLUDGE-B 
- Salivation 
- lacrimation 
- urination 
- deification
- Gastric upset 
- Emesis 
- Bradycardia, Bronchospasm, Bronchorrea
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7
Q

What is the antidote for Cholinergic overdose

A

Atropine

Pralidoxime

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8
Q

What is the goal of atropine treatment in cholinergic overdose?

A

Drying the patient of secretions, no maximmum dose! Continue until dry

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9
Q

What is the dose of cholinergic toxicity?

A

2mg - double every 5 minutes - until reach dryness

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10
Q

What do you expect to see in sympathomimetic toxidrome?

A
  • agitated, delirium, seizure
  • dilated pupils
  • tachycardia, high BP
  • hot & sweating

[No change in bowel]

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11
Q

What is the antidote of sympathomimetic?

A

Benzodiazepines

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12
Q

Give examples of sedative hypnotics?

A
  • Barbiturate
  • Benzodiazepine
  • Sleep medications (Zolpidem & melatonin)
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13
Q

what is the antidote of benzo overdose

A

Fluma-Zenil

Given to avoid intractable seizure due to withdrawal in iatrogenic overdose

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14
Q

What are the differential diagnosis of high gap acidosis?

A

A CAT MUDPILES

  • Asprin
  • Carbamezapine
  • Alcohol
  • Toluene
  • Methanol\Metformin
  • Uremia
  • DKA
  • Paraldehyde
  • Isoniazed\Iron
  • Lactic aciosids
  • Ethylene glycol
  • Salicylate
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15
Q

How to get the toxin outside the patients body?

A
  • Decontaminate
  • Enhance elimination
  • invasive methods
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16
Q

What are the dermal, Opthalmic, and the GI decontamination methods?

A
  • Dermal: Water\soap - diphtotrene (chemical)
  • Ophthalmic: water - 0.9% normal saline
  • GI: activated charcoal, MDAC, Lavage, WBI
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17
Q

How to dermal decontamination?

A

1- Remove all attire (cloth, jewls)

2- Choose decontamination solution (water\soap - Diphoterine)

3- 5-15 minutes of decontamination

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18
Q

How to dermal decontaminate an open wound

A

Provide an additional 10-15 minutes of decontimation

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19
Q

How to provide ophthalmic decontamination?

A

1- provide ophthalmic anesthetic

2- 1 to 2 L of normal saline\BSS\ LR

3- aim to reach ocular PH of 7-7.2

4- monitor at 15-20 minutes intervals to insure no further particles present.

20
Q

What are the indications for single-dose activated charcoal?

A

1- given within 1hr of ingestion

2- ingestion of toxic amount of poison

21
Q

What are the contraindications of single-dose activated charcoal?

A

1- unprotected airway\or\ high risk for aspiration.

2- un-intact GI tract

22
Q

What are the complications of SDAC?

A

1- Vomiting\Aspiration

2- Corneal abrasion if there’s direct contact

23
Q

What are the poisonous indications of MDAC?

A

Ingestion of
(QPDTC) كبدتس!

  • Carbamazepine
  • Dapsone
  • Phenobarbital
  • Quinine
  • Theophylline
24
Q

What is the role of MDAC?

A
  • Prevents absorption\reabsorption

- Enhance elimination of xenobiotics

25
Q

What is the dose of MDAC?

A
  • 12g\h

- 25g Q4-6hrs

26
Q

What are the complications of MDAC?

A
  • aspiration

- GI OBSTRUCTION

27
Q

What are the substances that are not adsorbable by activated charcoal?

A

PHAILS!

  • Pesticide\potassium
  • Hydrocarbons
  • Acid\alkali\alcohol
  • Iron
  • Lithium
  • Solvents
28
Q

What is the device used in gastric lavage?

A

Ewald tube

  • Adults: 30-38Fr
  • Children: 24-48Fr
29
Q

How to preform gastric lavage?

A

1- keep in left lateral decubitus position
2- insert ewald tube and confirm placement
3- lavage with warm saline 250cc
4- repeat

30
Q

What are the contraindications to gastric lavage?

A

1- compromised airway
2- high risk patient of perforation\ hemorrhage \cogulopathy
3- corrosive or hydrocarbons

31
Q

What are the complications of gastric lavage?

A
  • perforation
  • aspiration
  • electrolyte imbalance
  • Laryngospasm- hypoxia - dysrhythmia
32
Q

What are the drugs that benefit from using WBI for decontamination

A
  • enteric coated drugs
  • sustained release drugs
  • high and high doses of iron
  • packets of illicit drugs
  • salicylate
  • lithum
  • lead or metals
33
Q

What are the contraindications of WBI?

A
  • perforation
  • compromised airway
  • GI bleeding & hemodynamically instability
  • intractable vomiting
34
Q

What are the complications of WBI?

A
  • N&V
  • cramps & bloating
  • aspiration
35
Q

What are the methods usually used for enhanced elimination

A

1- urine alkalinization
2- hemodyalsis
3- charcoal hemoperfusion

36
Q

What are the options for invasive decontamination

A

1- Endoscopy

2- Surgical laparotomy

37
Q

In which situation would endoscopy be beneficial at as an invasive procedure?

A

Removal of button batteries

38
Q

In which situation would surgical laparotomy be beneficial at as an invasive procedure?

A
  • bowel obstruction

- packer leakage

39
Q

What are the diagnostic studies to order in case of toxicity?

A

1- EKG

2- LABS

3- Chemistry

4- B-HCG

5- CBC

6- Urine drug screen

7- serum osomlality

8- acetaminophen & salicylate

40
Q

What labs would you order in toxicity suspicion

A
  • Digoxin
  • ETOH
  • Lithium
  • Lead
  • Phenobarb
  • Depakote
  • Theophylline
  • Phenytoin
    (As indicated)
41
Q

What are the chemistry labs to order

A
  • electrolyte

- anion gap

42
Q

In toxic alcohol, what important diagnostic study to order?

A

Serum osmolality

43
Q

How to investigate for paracetamol toxicity?

A

1- wait for 4 hours after ingestion
2- obtain Paracetamol levels
3- plot on nomogram to decide the antidote
4- if antidote indicate d give within 8 hours of ingestion

44
Q

What is the antidote for paracetamol toxicity?

A

NAC

N-acetyle cystine

45
Q

What are the radio-opaque substance on imagine?

A

BET-A-CHIP

  • Barium
  • Enteric coated drug
  • TCA
  • Antihistamine
  • Calcium, condom, chloral hydrates
  • Heavy metals
  • Iodine\iron
  • Potassium\phenothiazide

ER (2 decks)

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