Toxidromes

Question 1

issues regarding overdoses

Answer 1

total info unknown
multiple drugs may be involved
signs may force intervention when theres incomplete info
unconscious patients

Question 2

______ rather than the specific agent should determine management strategy

Answer 2

clinical condition of the patient

Question 3

what is the glascow coma scale

Answer 3

determines consciousness

lower number less consciousness

Question 4

good things about intubation

Answer 4

endotracheal intubation provides airway control, minimizes aspiration of gastric contents, removes secretions, access to lungs allows optimization of oxygenation

Question 5

hypotension can occur due to

Answer 5

trauma or blood loss check first

Question 6

toxins can cause hypotension due to

Answer 6

depression of myocardial contractility, depress cns cardiorespiratory centers, GI fluid loss, peripheral vasodilation

Question 7

management of hypotension

Answer 7

volume expansion with normal saline or blood products

vasopresssors - dopamine, norepinephrine

Question 8

basic od algorithm

Answer 8

supportive care - airway, circulatory, electrolyte, blood sugar, seizure, arrhythmia
obtain history
physical examination
determine if toxidrome present
lab evaluation
management strategies

Question 9

define toxidrome

Answer 9

group of signs and symptoms associated with a particular toxin

Question 10

why is repeated assessment needed

Answer 10

status of patient can change lots

may be delayed absorption or sustained release toxin

Question 11

least helpful evaluation and why

Answer 11

labratory

time constraints

Question 12

indications for lab testing

Answer 12

monitoring - diagnose severity or monitor course
diagnostic confirmation
screening
criteria for intervention or assess effectiveness of therapy

Question 13

what is tox-screen

Answer 13

combo of analytical procedures to help identify multiple common drugs encountered in OD

Question 14

methods of tox screen

Answer 14

immunoassays, TLC, gas chromatography

long turn around time but immunoassays relatively fast

Question 15

is a tox screen good enough to confirm

Answer 15

no considered preliminary requiring confirmation with a specific assay

Question 16

major problems for tox screen

Answer 16

not quick
false negatives - major, doesnt rule out toxic agent
false positives - check clinical manifestations

Question 17

other lab investigations

Answer 17

ECG
ab xray
urine osmolality
arterial blood gas
electrolytes

Question 18

hallmark management strategy

Answer 18

supportive care

Question 19

treatments for patients with altered mental status in suspected drug overdose

Answer 19

dextrose 1g/kg D50W to exclude/treat hypoglycemia
thiamin 100mg iv to treat/exclude wernicke korsakoff syndrome
naloxone 2mg iv for resp comprimise
oxygen

Question 20

how to decrease toxin absorption

Answer 20

orogastric lavage
oral activated charcoal
whole bowl irrigation ex iron
emesis with syrup of ipecac - banished

Question 21

how to increase elimination of a toxin

Answer 21

hemodialysis -cant removee from tissue
charcoal hyyperperfusion - filter with charcoal dialyzes it off
multiple dose oral charcoal

Question 22

explain multiple dose charcoal

Answer 22

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

Question 23

elderly woman od on digoxin

Answer 23

multiple dose charcoal bc she was at risk for bad things

antibodies if life threatening

Question 24

unconscious and seizured hypotension od on citalopram and zopiclone

Answer 24

agressive fluid 150ml/hr

aspiration penumonia likely - antibiotics