Poisoning

Question 1

what is the first diagnostic test you do for poisoining during your initial assessment and a couple others

Answer 1

serum acetaminophen #1
EKG
UA drug screen (not very effective though and will not change management oftentimes)

Question 2

what do you do to stablize a patient with poison

Answer 2

ABCDEs
antidotes
Cocktail
Benzos for seizures (propofol 2nd line)
Rewarming

basically stabalize

Question 3

how to manage arrythmias

Answer 3

ABCDEs NOT and anitarrhytmic

Question 4

how to deontaminate eyes

Answer 4

numb
pH baseline
irrigate until pH is 7.2-7.4

alkali injuries are the worst

Question 5

how to treat GI decontamination

Answer 5

Activated charcoal if w/in the first hour and it might help, but rarely helps

Does not effectively absorb metals/corrosives/and alcohol

Whole bowel decontamination (if iron, lead, things that you can move out)

No longer do emesis!!!

Question 6

What is urinary alkalyzation used for

Answer 6

in aspirin toxicity

Question 7

when is hemodialysis used?

Answer 7

Used by a renal specilaist last resort

Question 8

What is the overall disposition for poising

Answer 8

<6 or > 24 hours

typically fine w/in 6 hours
mental health assessment if attempted suicide (admit if greater than 6 hours of symptoms)

Question 9

what are the medications where you need to be observed for extended periods of tme?

Answer 9

norepi
tramadol/venafaxine
amisulpride

Question 10

worries of TCA (Desipramine)

Answer 10

cardiac blocks
QT prolongation
narrow theraputic index

Question 11

MC atypical serotonergic antidepressant to develop seizure

Answer 11

buproprion

Question 12

what is trazadone

Answer 12

sleeping pill

Question 13

What is the worry of trazadone what is the treament

Answer 13

coningestion with other sedative medicaitons = coma

just like everything, DC after 6 hours

Question 14

What is the risk of SNRIs over SSRIs

Answer 14

seizures

Question 15

MOA of serotonin syndrome

Answer 15

increased serotinergic activity in the CNS

Question 16

s/s of serotonin syndrome

Answer 16

-hyperthermia

-hypertension

-altered mental status

-tremor

-tachycardia

-increased muscle tone

-seizures

Question 17

MOA of chlorpromazine

Answer 17

antagonist of 5-HT2A receptors and there are reports of successful treatment of serotonin syndrome.

Question 18

disposition of serotonin syndrome

Answer 18

admit all patients

as it takes 24 hours

Question 19

MAOI-Tyramine Reaction

Answer 19

HA after eating meats or fish that are not fresh, sauerkraut, aged meats and cheeses

treat HA

Question 20

presentation of antipsychotic OD

Answer 20

sinus tach and orthostatic hypotension with dry skin

just observe, make sure that they are able to ambulate

Question 21

what causes neuroleptic malignant syndrome

Answer 21

rigid and delayed fever after taking antipsychotics

take dantrolene or bromocriptine for symptoms

admit to the ICU

Question 22

What is the SE of lithium based on

Answer 22

GI upset with acute
sluggishness with chronic and myclonal jerk
excrete dilute urine leading to hypernatremia

Question 23

tx of lithium toxicitiy

Answer 23

get a lithium level
CBC
CMP
look for electrolyte abnormalities
NS until a little over euvolemic (to allow dilution)
miralex if they can drink
consider hemodyalsis in severe
disposition to the ICU
discharged if no longer symptomatic