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PAR3011 - MEDICAL > Week 11 > Flashcards

Week 11 Flashcards

1
Q

what are the steps in the risk assessment-based aproach to poisoning?

A
  • resuscitation
  • risk assessment
  • supportive care and monitoring
  • Investigations
  • Decontamination
  • Enhanced elimination
  • Antidotes
  • Disposition
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2
Q

what is involved in RESUSCITATION in the risk assessment-based aproach to poisoning?

A 
Airway
Breathing
Circulation
Control seizures
Correct hypoglycaemia
Correct hyperthermia
Consider resuscitation antidotes
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3
Q

what is involved in RISK ASSESSMENT in the risk assessment-based aproach to poisoning?

A 
Agent
Dose
Time since ingestion
Clinical features 
Progress of the symptoms
Patient factors
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4
Q

What are the S&S of ANTIcholinergic toxicity?

A

Red as a beet
- flushed

Dry as a bone
- Anhydrosis

Hot as a hare
- Anhydrotic hyperthermia

Mad as a hatter
- Delerium/hallucinations

Full as a flask
- urinary retention

Tachycardia
Decreased/no bowel sounds

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5
Q

What are the S&S of CHOlinergic toxicity?

A

SLUDGE BBB

Salivation
Lacrimation
Urination
Defecation
Gastric Emesis
Bronchoraehea
Bronchospasm
Bradycardia
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6
Q

What causes cholinergic toxicity?

A

insecticides containing organophosphates

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7
Q

what are the keys to overdose resus?

A

 Resuscitation should continue until expert advice can be obtained on the
poison – can be prolonged.

 Transport early if in cardiac arrest and continue CPR to hospital

 Attempts at decontamination does NOT take priority over CPR

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8
Q

What should be noted about seizures in an overdose?

A

– if present, usually generalised. If partial seizures, this indicates a focal neurological
problem that requires further investigation.

– Common causes – Venlafaxine, bupropion, tramadol, amphetamines

– We treat with Midazolam.

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9
Q

What should be noted in ABC’s of overdose resus

A

– Patients can deteriorate quickly so monitor closely and be prepared for change in vitals, including cardiac arrest

– Attention to airway, breathing and circulation is paramount

– There is an increased risk of aspiration in these patients (been noted at GCS of 12).

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10
Q

what supportive care and monitoring is required ofr overdose?

A

 Drugs normally affect the respiratory system, cardiovascular system, the central nervous system.

 Respiratory system
– Full RSA needed.
– Intubation may be required if there is a lowered LOC.
– Secure the airway while you wait for MICA.
– Monitor ventilations regularly. Have bag mask at the ready.

 Cardiovascular system:
– 12 lead ECG essential – rate, rhythm, PRI, QRS width, ST,
– Some drugs will cause arrhythmias
– Fluids
– Monitor closely

 GCS – closely monitor. If changes start your ABCs again

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11
Q

Whata re the types of CNS depressants?

A

 Opiates – morphine, heroin, codeine, tramadol, methadone

 Sedative-hypnotic drugs - benzodiazepines & barbiturates

 GHB - Gamma Hydroxybutyrate

 Alcohol

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12
Q

What is the clinical presentation of an Opioid OD?

A

LIKELY:
 Lowered level of consciousness (drowsy)

 Respiratory depression leading to failure & death

 Pinpoint pupils

POTENTIALLY:
 Could be hypotensive
 May have vomited or be vomiting
 Check setting and history!
 Tramadol OD on the increase
– Doses > 500 mg may cause seizures in adults.
– Deaths have occurred following ingestion of 3-5 g.
– Rarely causes respiratory depression but frequently results in tachycardia,
agitation and seizures (due to serotonin syndrome) .

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13
Q

What are the clinical presentations for benzodiazapines?

A

 Drowsiness, confusion, dizziness

 Slurred speech

 Nystagmus, blurred vision

 Hypotension

 Ataxia, weakness, lack of coordination

 Coma

 Respiratory depression – even arrest

 Cardiac arrest

 Large doses – hypothermia, bradycardia, hypotension may occur

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14
Q

What is the clinical presentation of GHB?

A

 Causes a rapid onset of CNS and respiratory depression

 Other symptoms include myoclonic jerking, bradycardia, sweating,
agitation, vomiting, delirium, cheyne-stokes type breathing

 Recreational doses 30-40 mg/kg

 Can cause coma

 Co-ingestion of other drugs, especially CNS depressants,
increased the risk of respiratory depression, apnoea and death

 Recovery associated with brief period of agitation, delirium and
vomiting

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15
Q

what does Naloxone (Narcan ) do?

A

Opiate antagonist

 Competes for the same receptors as opiates

 Greater affinity

 Shorter half life than opiates – this a problem

 Administer after you have looked after the airway

 Consider size of patient to determine initial dose

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16
Q

What are the types of opioid overdoses in the ‘Other opiod arm’ of the CPG

A

prescription
latrogenic
polypharmacy
unknown

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17
Q

what is the clinical presentation of alcohol intoxication/OD

A

 CNS depression even coma

 Loss of inhibition

 Loss of judgement

 Can add to the depressive effects of other CNS depressants

 Vomiting, loss of airway protection

 Increase in self-confidence

 Agitation, aggression, disorientation

 Slurred speech, Ataxia, nystagmus

 Tachycardia, hypotension, hypothermia

 Inhibition of Anti-diuretic Hormone (ADH) - Increase in urine production - Loss of fluid
volume – Possible hypotension – Dehydration - Loss of electrolytes etc.

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18
Q

What is the clinical presentation of alcohol poisoning?

A 
– Confusion
– Loss of coordination
– Vomiting
– Seizures
– Irregular or slow breathing (less than eight breaths a minute)
– Blue-tinged or pale skin
– Low body temperature (hypothermia)
– Stupor – when someone’s conscious but unresponsive
– Unconsciousness – passing out
– hypotension

 Lose gag reflex

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19
Q

What are some cardiovascular complications of long-term alcohol abuse?

A

 Cardiovascular – Afib, cardiomyopathy,

clotting problems

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20
Q

What are some GIT complications of long-term alcohol abuse?

A

 Gastrointestinal – liver disease,
hepatitis, cirrhosis, oesophageal
varices, pancreatitis, chronic gastritis, GI
bleeds, enlarged liver

21
Q

What are some additional complications of long-term alcohol abuse?

A

 Malnutrition, Vitamin deficiency,
dehydration

 Alcoholic ketoacidosis, electrolyte
imbalances

 CNS - Memory problems (Wernicke’s
encephalopathy), subdural
haemorrhage

22
Q

What are some of the management considerations of alcohol intoxicated patients?

A
  • Hypoxia – breathing rate, depth, asphyxia,
  • Hypovolemia / dehydration
  • Analgesia
  • Nausea and vomiting
  • Aggression and compliance
  • Competency to make own decisions
23
Q

What are some of the pitfalls and dangers of alcohol intoxicated patients?

A
  • Failure to regard ethanol intoxication as potentially life threatening
  • Failure to detect and manage co-existing intoxications or other medical conditions in the intoxicated patient.
  • Believing patient is competent to make own decisions re welfare
  • Assault to the paramedics
  • Crowds could also be a problem
  • You may need to modify your behavior or language - You may elect to leave the scene
24
Q

what are some of the physiological problems caused by alcohol withdrawl?

A

– Autonomic excitation – tremors, sweating, anxiety, agitation, tachycardia,
N&V, hyperthermia, hypertension

– Neuro-excitation – hyper-reflexia, hallucinations, seizures, nightmares

– Delirium tremens – severe form has 8% mortality
 Present in 20% pts admitted to hospital

25
Q

How do you manage alcohol withdrawal?

A

 Resuscitation, supportive care and monitoring of all vitals

 Get a good history

 Exclude other non-toxicological causes e.g. hypoxia, metabolic

 Establish an IV

 Manage acute illness including dehydration and seizures

 Is the withdrawal part of a medical plan?

 Request MICA

26
Q

What are some common sources of methanol?

A 
– Antifreeze preparations
– Automobile and furniture polish
– Pesticides
– Industrial products (oils, detergents)
– Paint thinners
– Methylated spirits (ethanol + methanol)
27
Q

What are the clinical signs of methanol poisoning?

A 
– Early symptoms are similar to ethanol intoxication
 CNS depression
 Loss of inhibition
 Ataxia
 Nausea

– Initial severe symptoms in 12-24 hours
(relates to amount ingested)

– Possibility of seizures

– Vision blurring or loss

– Metabolic acidosis

– Death

28
Q

What is the management for methanol poisoning?

A

 ABC’s are paramount
 Pt is acidotic so will have respiratory compensation
– Hyperventilate to help blow off acid (remember respiratory unit)
 MICA for intubation and possibly sodium bicarbonate
 Treat seizures
 Check BSL
 Antidote = fomepizole – not available in Australasia
 Quick transport – need dialysis

29
Q

What are common stimulant & psychoactive drugs?

A
  • MDMA / Ecstasy
  • Methamphetamines
  • Cocaine
30
Q

what are the immediate S&S of MDMA/Ecstasy?

A
  • Enlarged pupils
  • Increased heart rate and blood pressure
  • Increased energy
  • Feeling of euphoria
  • Teeth grinding and jaw clenching
  • Anxiety and panic attacks
  • Overheating and dehydration
  • A ‘comedown’
  • Nausea, vomiting and dizziness
  • Visual distortions
  • Paranoia
  • Psychosis
  • Serotonin syndrome
  • Stroke.
31
Q

what are the long-term S&S of MDMA/Ecstasy?

A
  • Dependence / addiction
  • Long-term problems with depression
  • Impairments to memory and attention
  • Liver problem
32
Q

How does MDMA work?

A

MDMA/Ecstasy stimulates the body’s CNS. Onset of effects can take up to 60
minutes, people may therefore think the first pill isn’t working and take more.

33
Q

How does Methamphetamine work?

A

• Methamphetamine increases the amount of the neurotransmitter dopamine, leading to high levels of that chemical in the brain.

34
Q

What are the short-term effects of ICE?

A
  • Feelings of pleasure and confidence
  • Increased alertness and energy (often don’t sleep for days)
  • Repeating simple things like itching and scratching
  • Enlarged pupils and dry mouth
  • Teeth grinding and excessive sweating
  • Fast heart rate and breathing
  • Reduced appetite
  • Increased sex drive
  • It takes several days to come down from ICE
35
Q

What are long term effects of ICE?

A 
 Extreme weight loss due to reduced appetite
 Restless sleep
 Dry mouth and dental problems
 Regular colds or flu
 Trouble concentrating
 Breathlessness
 Muscle stiffness
 Anxiety, paranoia and violence
 Depression
 Heart and kidney problems
 Increased risk of stroke
 Needing to use more to get the same effect, Dependence on ice
 Financial, work or social problems
 Ice Psychosis
36
Q

What are the short term effects of Cocaine

A
  • Happiness and confidence
  • Talking more
  • Feeling energetic and alert
  • Quiet contemplation and rapture
  • Feeling physically strong, mentally sharp
  • Reduced appetite
  • Dry mouth
  • Enlarged (dilated) pupils
  • Higher blood pressure
  • Faster heartbeat and breathing
  • Higher body temperature
  • Increased sex drive
  • Unpredictable, violent behavior
  • Indifference to pain
37
Q

Whata re the long term effects of cocaine?

A 
Regular use may eventually cause:
• Insomnia and exhaustion
• Depression
• Anxiety, paranoia and psychosis
• Sexual dysfunction
• Hypertension and irregular heartbeat
• Heart disease and death
38
Q

What are the S&S of cocaine overdose?

A
  • Nausea and vomiting
  • Extreme anxiety
  • Chest pain
  • Panic
  • Extreme agitation and paranoia
  • Hallucinations
  • Tremors
  • Breathing irregularities
  • Kidney failure
  • Seizures
  • Stroke
  • Heart problems.
39
Q

What are the common clinical symptoms of CNS stimulants?

A

 Tachycardia and hypotension is common but hypertension and tachycardia also possible (adrenergic effect)

 Dilated pupils (myadrisis) –adrenergic effect

 Dysrhythmias

 Diaphoresis – adrenergic effect

 Agitation (adrenergic), hallucinations and paranoia

 Dry mucous membranes – adrenergic effect

 Fever, hyperthermia

 Seizures, tremors, hyper-reflexia

 Poly-pharmacy must always be considered with CNS stimulant use

 Ingestion by children is potentially lethal

 Known teratogenic effects, leading to miscarriage and fetal demise

40
Q

What are some cardiovascular effects of CNS stimulants?

A

 Toxicity results from sympathomimetic, vasospastic and sodium channel blocking
effects (cocaine).

 Vasospasms also means poor myocardial perfusion as well as promotion of
platelet aggravation

 Blocking of fast sodium channels results in dysrhythmias

 Increased vascular dissection

 Increased intracranial haemorrhage

 Acute cardiomyopathy

 Pulmonary oedema

41
Q

What are some major complications of CNS stimulants?

A

 Hyperthermia
– Can result from excited delirium (cocaine) or excessive exercise (MDMA)
– Further exacerbated by the environment they are in e.g. hot night club
– Can also be a sign of severe serotonin syndrome

42
Q

What can hyperthermia lead to?

A

– Rhabdomyolysis
– Impaired consciousness,
– DIC (disseminated intravascular coagulation)
– and multi-organ failure

43
Q

What are S&S of serotonin syndrome?

A

– Confusion, hallucinations
– Agitation or restlessness, anxiety, apprehension
– Dilated pupils
– Headache
– Changes in blood pressure and/or temperature
– Nausea and/or vomiting, diarrhoea
– Rapid heart rate, hypertension, increased RR
– Tremor, seizures
– Loss of muscle coordination or twitching muscles
– Shivering and goose bumps
– Heavy sweating, flushing
– Increased muscle tone, rigidity, hyper-reflexia

Life threatening if:
• High fever
• Seizures
• Rigid muscles
• Irregular heartbeat
• Unconsciousness
44
Q

what are some hallucingenic drugs?

A
  • LSD - (Lysergic acid diethylamide)
  • Magic mushrooms - psilocybin
  • Mescaline - peyote cactus
45
Q

what are S&S of psilocybin syndrome?

A

 Onset usually within 1 hour lasting 4‐6 hours
– Nausea and vomiting (more rare, may happen before psychological effects)
– Heightened colour perception
– Emotional effects
– Changes in perception
– Anxiety
– Delusions

46
Q

What are S&S of LSD?

A 
 Profound hallucinations
– thoughts / perceptions dream like
– sensory modalities confused
– thoughts disconnected to reality
– euphoria or dysphoria
– anxiety / panic attacks
– enhanced mood or depression
– calmness or aggression
– decreased libido?
47
Q

What are the S&S of ketamine?

A 
– Euphoria, relaxation, feeling detached from
body
– Hallucinations
– Disorganised thoughts, confused
– Anxiety, agitation, paranoia, panic
– Nausea, vomiting
– Slurred speech, get blurred vision, and lack
of co-ordination
– Sweating
– more sensitive to touch
48
Q

What are some S&S of high doeses of ketamine?

A

– be drowsy, have seizures or go into a coma
– have a near-death experience
– get amnesia, not be able to feel pain and have
stiff muscles
– become paranoid, experience panic, terror or
anxiety
– hallucinate and have bizarre or scary
experiences
– behave strangely.

PAR3011 - MEDICAL (32 decks)

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