Toxidromes Flashcards
issues regarding overdoses
total info unknown
multiple drugs may be involved
signs may force intervention when theres incomplete info
unconscious patients
______ rather than the specific agent should determine management strategy
clinical condition of the patient
what is the glascow coma scale
determines consciousness
lower number less consciousness
good things about intubation
endotracheal intubation provides airway control, minimizes aspiration of gastric contents, removes secretions, access to lungs allows optimization of oxygenation
hypotension can occur due to
trauma or blood loss check first
toxins can cause hypotension due to
depression of myocardial contractility, depress cns cardiorespiratory centers, GI fluid loss, peripheral vasodilation
management of hypotension
volume expansion with normal saline or blood products
vasopresssors - dopamine, norepinephrine
basic od algorithm
supportive care - airway, circulatory, electrolyte, blood sugar, seizure, arrhythmia obtain history physical examination determine if toxidrome present lab evaluation management strategies
define toxidrome
group of signs and symptoms associated with a particular toxin
why is repeated assessment needed
status of patient can change lots
may be delayed absorption or sustained release toxin
least helpful evaluation and why
labratory
time constraints
indications for lab testing
monitoring - diagnose severity or monitor course
diagnostic confirmation
screening
criteria for intervention or assess effectiveness of therapy
what is tox-screen
combo of analytical procedures to help identify multiple common drugs encountered in OD
methods of tox screen
immunoassays, TLC, gas chromatography
long turn around time but immunoassays relatively fast
is a tox screen good enough to confirm
no considered preliminary requiring confirmation with a specific assay
major problems for tox screen
not quick
false negatives - major, doesnt rule out toxic agent
false positives - check clinical manifestations
other lab investigations
ECG ab xray urine osmolality arterial blood gas electrolytes
hallmark management strategy
supportive care
treatments for patients with altered mental status in suspected drug overdose
dextrose 1g/kg D50W to exclude/treat hypoglycemia
thiamin 100mg iv to treat/exclude wernicke korsakoff syndrome
naloxone 2mg iv for resp comprimise
oxygen
how to decrease toxin absorption
orogastric lavage
oral activated charcoal
whole bowl irrigation ex iron
emesis with syrup of ipecac - banished
how to increase elimination of a toxin
hemodialysis -cant removee from tissue
charcoal hyyperperfusion - filter with charcoal dialyzes it off
multiple dose oral charcoal
explain multiple dose charcoal
GI dialysis , whatever in small bowel is adsorbed so low concentration in GI tract pulls drug out of surrounding area into GI tract and out
elderly woman od on digoxin
multiple dose charcoal bc she was at risk for bad things
antibodies if life threatening
unconscious and seizured hypotension od on citalopram and zopiclone
agressive fluid 150ml/hr
aspiration penumonia likely - antibiotics
