Toxidromes and others Flashcards
When is activated charcoal NO indicated ( for what ingestions)
CHAMPS
C- camphor and caustics ( NaOH, KOH, CL)
H-hydrocarbones ( kerosene, gasoline, mineral oil)
A- Alcohol- ethanol, methanol. ethylene glycol , acids and alkalis
M- Metal ( arsenic, iron, mercury, lead)
P- pestisides ( organophosphates)
Arrhythmia associated with CCB
AV/SA node blocks and Prolonged QT
Arrhythmia associated with Beta Blockers
Ventricular Arrhythmia’s
Pearls- ALWAYS calls poison control when ingestion is suspected
call poison control- even in ED
Charcoal is useful following what ingestions
Carbamazepine, dapsone, phenobarbital, quinine, theophylline, salicylates, slow release preparations, dig and phenytoin
GIVE within ONE hour of ingestion
Terry overdosed on Acetaminophen after getting kicked off the soccer team.. when should you check a Acetaminophen level and what labs do you want to monitor
Check level at 4 hours,plot of monogram.. ( determines the severity of the toxicity)
Check LFTs/PT/PTT, lytes..
What is Alkalization and when is it indicated
Administering sodium bicarbonate IV to achieve urinary Ph 7-9..
Useful in eliminated: salicylates, barbiturates, methotrexate
Pearl
AST in the most sensitive lab test of hepatotxicity
Mgmt for acetaminophen OD
NAC within 8 hours of ingestion
Activated charcoal may be given 1-2 hours of ingestion
Mgmt of Methanol and Ethylene glycol
NO charcoal. Aggressive alkalization ( give sodium bicarb)
Antidote for Methanol and Ethylene glycol
Fomepizole ( for high anion gap acidosis consistent with ingestion of alcohol)
Mgmt of TCA’s ( anticholinergic)
Gastric lavage followed by activated charcoal, supportive therapy ( fluids, antiarrythmias, vasopressors), sodium bicarb
Rhythm that is common– prolonged QT
MGMT of CCB OD
ABCs, activated charcoal, calcium infusion, glucagon, hyperinsulinemia/euglycemia therapy- continuous insulin and dextrose infusion
Mgmt of BB oD
same as CCB
Mgmt of oral hypoglycemia OD
IV dextrose, glucagon, corticosteriods, diazoxide, octreotide ( treatment of choice for sulfonylurea induced hypoglycemia , avoids the need for IV dextrose)
Sympathomimetics toxidrome
HTN, tachycardia, arrhythmia’s, mydriasis, anxiety, excessive speech, anxiety, tremor, insomnia and hyperthermia
TX: consider benzos, lidocain, sodium bicarb, nitropruside and nitroglycerin- avoid Beta Blockers
Cholinergic toxidrome ( insectiside)
Characterized by SLUDE - salivation, lacrimation, urination, defecation, gastric cramping, emesis
others:increased secretions, confusion agitation coma, seizure, muscle weakness
antidote for a cholinergic OD
anticholinergic
anticholinergic toxidrome * TCAS, antidepressants)
hot as a fire, red as a beet,dry as a bone, blind as a bat, mad as a hatter..
hot, red/flushed/decreased salivation, urinary retention, mydriasis, mad, delirium
Antidote: physostimine
opioid toxidrome
coma, miosis, respiratory depression, bradycardia, hypotensions
Antidote: narcan
iron
chelation therapy when level is >45.. kids 1-5 are at greatest risk of toxicity.
