23.3 Toxicology

Question 1

one pill can kill, dangerous ingestions?

Answer 1

amphetamines
beta blockers
CCBs
digoxin
opioids
sulphonylureas
TCA

Question 2

pesticides which ones?

Answer 2

paraquat: 1 mouthful

Question 3

what is the acronym DEAD?

Answer 3

decontamination
elimination
antidotes
deposition

Question 4

after ABCs what to watch out for?

Answer 4

full neuro exam
urinary retnetion
skin
bowel sounds

Question 5

which drug levels are helpful?

Answer 5

paracetamol
if indicated
phenytoin
carbamazepine
valproate
phenobarbitone

Question 6

anticholinergic toxidromes?

Answer 6

blind as a bat
mad as a hatter
red as a beet
hot as a hare
dry as a bone
bowel and bladder lose their tone, Retention
heart runs alone

Question 7

anticholinergic toxidromes, which causes agitated delirium?

Answer 7

plants

Question 8

pills that cause anticholinergic toxidromes present?

Answer 8

usually partially sedated

Question 9

anticholinergic toxidromes pupils?

Answer 9

dilated

Question 10

anticholinergic toxidromes bladder?

Answer 10

retention usually, IDC can be beneficial

Question 11

common causes of anticholinergic toxidromes?

Answer 11

anti-histamines
TCA
phenothiazine
plants: datura, brugmansia
benztropine (for dystonia)

Question 12

Cholinergic crisis classically think?

Answer 12

secretions

organophosphates

Question 13

Cholinergic crisis acrynoym for secretions?

Answer 13

DUMBELS

diarrhoea
urination
miosis
bradycardia, bronchorrea
emesis
lacrimation
salivation

Question 14

sympathomimetic syndrome is?

Answer 14

hot, sweaty patient
hypertension
tachy
dilated pupils
agitation
sweating
hyperthermia - treat

Question 15

sympathomimetic toxidrome causes?

Answer 15

• cocaine
• methamphetamines
• ecstasy, MDMA
• synthetic ‘marijuana’

Question 16

serotonin toxicity key examination findings?

Answer 16

hyperreflexia, clonus

sweating
hypertension
dilated pupils

Question 17

serotonin toxicity causes?

Answer 17

usualyl a combo of:

SSRIs/SNRIs
MAOIs
tCAs
tramadol
opiates
amphetamines/MDMA

Question 18

opioids toxidrome

Answer 18

• respiratory depression
• sedation
• pinpoint pupils

Question 19

opioids toxidrome when give naloxone indication?

Answer 19

the resp rate and the sats

Question 20

supportive care of poisoned patient sedation ?

Answer 20

benzodiazepines

Question 21

supportive care of poisoned patient seizures?

Answer 21

• IV benzos

- not phenytoin

Question 22

supportive care of poisoned patient body temp?

Answer 22

warm

cool control quickly

Question 23

supportive care of poisoned patient renal function?

Answer 23

hydration

dialysis

Question 24

GI decontamination main use?

Answer 24

activated charcoal

Question 25

why not GI decontamination with vomiting?

Answer 25

tears and ruptures

Question 26

how much GI decontamination activated carcoal measurement?

Answer 26

1g/kg | mix with water, orally or NGT

Question 27

indications for charcoal?

Answer 27

- within 1 hour of ingestion, or if slow release - cooperative patient - alert and protected airway

Question 28

contraindications for charcoal?

Answer 28

-Metals: LI, K, alcohols, hydrocarbons, corrosives ""MACH"" -low GCS -ileus

Question 29

whole bowel irrigation indications?

Answer 29

- lots of slow release - body packers - metals

Question 30

enhanced elimination, 3 kinds?

Answer 30

- multi dose activated charcoal - urinary alkalinisation (ion trapping, mainly for aspirin) - haemodialysis

Question 31

when to use enhanced elimination?

Answer 31

- methanol/antifreeze - lithium - aspirin - severe only - theophylline - alproic acid severe - carbamazepine

Question 32

what is toxic dose of paracetamol?

Answer 32

>200mg/kg

Question 33

paracetamol when to take the measurement?

Answer 33

4 hours post to get peak

Question 34

paracetamol antidote?

Answer 34

NAC

Question 35

redback spider bite treatment?

Answer 35

mainly analgesia | antivenom rare

Question 36

funnelweb spider bites?

Answer 36

- most uncommon bite - needs ANTIVENOM - look at tongue for fasciculation (can't fake it)

Question 37

brown snake characteristic of bite?

Answer 37

- early collapse - consumptive -coagulopathy - most common cause of death

Question 38

Do's for envenomation?

Answer 38

remove from danger immobilise keep still apply pressure bandage

Question 39

dangers of antivenom?

Answer 39

equine-derived, allergenic, can get anaphylaxis

Question 40

treatment of box jelly fish?

Answer 40

remove tentacles, vinegar | anti-venom available

Question 41

bluebottle sting treatment?

Answer 41

hot water without burning? | put both feet in the bucket of water as control to prevent burns