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EM > Tox > Flashcards

Tox Flashcards

1
Q

Correction factor for ETOH when correcting Osmolar Gap

A

ETOH X 1.25

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2
Q

Classic CO-Hgb SpO2 reading

A

85%

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3
Q

Opioid toxicity toxidrome

A

Respiratory and mental status depression, analgesia, miosis, orthostatic hypotension, nausea and vomiting (especially in opioid-naïve patients), histamine release resulting in localized urticaria and bronchospasm, ileus, and urinary retention secondary to increased vesical sphincter tone.

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4
Q

Naloxone onset

A

1-2 minutes

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5
Q

Naloxone duration of action

A

20-90 minutes

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6
Q

Naloxone dosing

A
  • * mild decrease LOC, minimal resp depression: 0.05-0.4 mg IV increments
    * apnea/near-apnea/cyanosis: 2 mg IV —> 4 mg IV —> 8 mg IV Q3min, max 12 mg if no response
    * infusion (if responded to bolus, and required repeat dosing): 2/3 of “wake-up dose” per hour
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7
Q

Opioid withdrawal syndrome

A
  • Hours: anxiety, yawning, craving, lacrimation, rhinorrhea, diaphoresis, myalgias
  • 12 hours: irritability, tremor, piloerection, mydriasis
  • 24-36 hours: insomnia, muscle spasms, abdo pain, nxvxdx
  • peak on day 3, resolve by day 5/6
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8
Q

Opioid withdrawal treatment

A
  • see Evernote “Opioid Overdose”
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9
Q

ETOH Withdrawal, Delerium Tremens

A

Read Evernote “ETOH”

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10
Q

Acetaminophen Toxicity

A

Review Evernote

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11
Q

Isoniazid Overdose

A
  • nx, LOC, ataxia
  • seizures, metabolic acidosis, protracted coma
  • seizures refractory to usual therapy, occur from vitamin B6 (pyridoxine) depletion
    • tx with benzo’s +
    • pyridoxine (gram for gram equivalent to isoniazid ingested)
      • for unknown, give 5 g IV (70 mg/kg peds) @ 1 g Q2-3 min until sz stop or 5 g dose reached
        • after sz stop give rest of dose over 4-6 hours
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12
Q

Anticholinergic Toxidrome

A
  • Dry as a bone
  • Red as a beet
  • Hot as a hare
  • Blind as a bat
  • dilated pupils may not appear for 12-24h
  • Mad as a hatter
  • Stuffed as a pipe
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13
Q

Anticholinergic Toxicity

A

Review Evernote

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14
Q

Anticonvulsant Overdose

A

Review Evernote

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15
Q

Antihypertensive Overdose

A

Review Evernote

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16
Q

Neuroleptic Malignant Syndrome Tetrad

How to differentiate from Serotonin Syndrome

A
  • usually shortly after starting/adjusting dose
  • not usually from OD
  • tetrad
    • fever
    • lead-pipe/cogwheel rigidity
    • autonomic dysfunction
    • altered LOC
    • develops over 1-3 days
  • *NMS vs SS
    • SS usually no multiorgan failure
    • NMS usually no diarrhea, myoclonus, hyperreflexia, or mydriasis
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17
Q

Antipsychotic Overdose/Side-effects

A

Review Evernote

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18
Q

Benzo Overdose

A

Review Evernote

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19
Q

Beta Blocker Overdose

A

Review Evernote

20
Q

Calcium Channel Blocker Overdose

A

Review Evernote

21
Q

Caustic Ingestions

A

Review Evernote

22
Q

Cocaine/Amphetamine Overdose

A

Review Evernote

23
Q

Cyclinc Antidepressant Overdose

A

Review Evernote

24
Q

Digitalis Toxicity

A

Review Evernote

25
Q

Dyshemoglobinemias

A

Review Evernote

26
Q

Gastric Lavage

A
  • 36-40F adult
  • 22-24F children
  • OG insertion from chin to xiphoid
  • Left lateral decubitus, HOB tilted down 20 degrees
  • Small amounts 200-300 mL adult, 10 mL/kg children to avoid pushing into duodenum
  • Warm/room temp saline or tap water
  • Continue until clear
  • Instill charcoal if indicated, before removing tube
  • Usually only helpful within 1 h ingestion of life-threatening toxins
27
Q

Dose of Activated Charcoal

A
  • Benefit within 1 h of ingestion, but possibly longer
  • Dose is 10:1 ratio of charcoal to drug or 1 g/kg, whichever is larger
  • Multidose: for substances that have prolonger absorption. 1 g/kg then 0.25-0.50 g/kg x 1-3 times Q 1-4 hours
28
Q

Whole Bowel Irrigation

A
  • PEG through NG or PO 1.5-2 L/h adult, 1L/h children 6-12, 0.5 L/h children <6 until clear rectal effluent.
  • May be useful for toxic substances not known to adsorb well to charcoal. No evidence.
  • Give Zofran or Maxeran to relieve nausea from gastric distension
29
Q

Urinary Alkalanization

A
  • Common: ASA, phenobarb
  • correct hypo K+
  • 1-2 mEq/kg sodium bicarb IV bolus over 1 hour
    • may need to repeat
  • infusion of 100 mEq bicarb/1L D5W @ 250 mL/h
    • add 20-40 K+ to solution as needed
  • Check urine pH q15-30 min, target 7.5-8.5
  • check lytes Q 2-4h
  • Keep serum pH <7.55, correct hypokalemia
30
Q

Hallucinogen Overdose

A

Review Evernote

31
Q

Hydrocarbon Toxicity

A

Review Evernote

32
Q

Industrial Toxin Overdose

A

Review Evernote

33
Q

Iron Overdose

A

Review Evernote

34
Q

Lithium Overdose

A

Review Evernote

35
Q

Marine & Diving Injuries

A

Review Evernote

36
Q

Metals & Metalloid Overdose

A

Review Evernote

37
Q

MAOI Overdose

A

Review Evernote

38
Q

NSAID Overdose

A

Review Evernote

39
Q

Cholinergic Syndrome

A
  • Defecation
  • Urination
  • Muslcle weakness/fasciculations, miosis
  • Bradycardia, bronchorrhea, bronchospasm
  • Emesis
  • Lacrimation
  • Salivation, seizures
40
Q

Pesticide Poisoning

A

See Evernote

41
Q

Salicylate Overdose

A

Review Evernote

42
Q

SSRI & Atypical Antidepressant Overdose

A

Review Evernote

43
Q

Elimination rate of ETOH, legal limit

A
  • legal limit = 17 mmol/L
  • Zero Order elimination
    • ~4 mmol/L/h in naive to 6 mmol/L/h in habituated drinkers
44
Q

Toxic Alcohol Poisoning

A

Review Evernote

45
Q

Antibioticl Overdose/Toxicity

A

Review Evernote

46
Q

Carbon Monoxide Poisoning

A

Review Evernote

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