Toxidromes Flashcards
What is the basic algorithm of care?
- supportive care (airway management, circulatory support)
- obtain hx
- physical examination
- determine if toxidrome is present
- lab evaluation
- management strategies
What happens with airway intubation?
- minimize aspiration of gastric contents
- ability to remove secretions
- access to lungs to allow optimization of oxygenation and ventilation
Hypotension attributable to toxins can occur due to what?
- depression of myocardial toxicity
- depress central nervous system cardiorespiratory centres (clonidine)
- GI fluid losses
- peripheral vasodilation
What can be used in the ER to manage hypotension?
- volume expansion (eg. 0.9% NaCl, blood products)
- vasopressors (eg. dopamine, norepinephrine)
What types of history information would be important to assess the toxic effect of the drug?
- age
- amount ingested
- time ingested
- medication hx
- time course of sx
- identification of meds or toxin
- symptoms
- circumstances of poisoning - accidental, suicide
- pre-hospital interventions
- associated conditions/past medical hx
What parts of physical examination would be important in the evaluation of the patient?
- vital signs
- temperature alterations
- skin (needle tracks, flushing, muscle tone)
- breath
- lungs - aspiration, wheezing
- heart arrhythmia
- abdomen - ileus, bowel sounds
- neurological (LOC, response to voice, pain, etc)
What is a toxidrome?
- a group of s/s associated with a particular agent or toxin (known as symptom complexes)
Lab assessment (serum concentrations) may be helpful in diagnosing the severity of the following medications:
- acetaminophen, salicylate, theophylline, ethanol, CO, iron, methanol, ethylene glycol, methemoglobin
What is a tox-screen useful for?
- when a combination of drugs is thought to have been used
What are some the other lab investigations that can be done on a patient?
- ECG (QT interval, etc)
- abdominal x-ray (iron)
- urine osmolality (osmol gap)
- arterial blood gas (acidosis)
- electrolytes
What are some of the management strategies that can be used when you’re unsure of the drug?
- supportive care
- empiric tx for altered mental status
- decreased absorption of the toxin
- increased elimination of the toxin
- antidote use
What would be used as the potential tx to be considered for a patient with altered mental status from a suspected OD?
- dextrose (0.5-1 g/kg)
- thiamine - prevents Wernicke-Korsakoff syndrome
- naloxone
- oxygen
What methods can be used to decrease the absorption of the toxin?
- orogastric lavage
- oral activated charcoal
- whole bowel irrigation
- emesis with syrup of ipecac
What methods can be used to increase the elimination of the toxin?
- hemodialysis
- charcoal hemoperfusion
- multiple dose oral charcoal
