Poisoning

Question 1

What are the key aspects of historical data in ingestions?

Answer 1

what was ingested?
How much?
When?
Why?

Question 2

What are the key elements of the physical exam in ingestions?

Answer 2

vital signs!!
mental status
pupils
skin color
track/marks/skin poppers
presence of sweat
bladder size (urinary retention?)

Question 3

Describe the anticholinergic toxidrome.

Answer 3

mad as a hatter (AMS)
blind as a bat (mydriasis)
Hot as Hades
Red as a beat
Dry as a bone (no sweating, urinary retention, constipation)

Question 4

What are the three typical medications taken in anticholinergic poisoning?

Answer 4

TCAs
antihistamines
overactive bladder meds like oxybutynin

Question 5

Describe the cholinergic toxidrome.

Answer 5

SLUDGE

Salivation
Lacrimation
Urination
Diaphoresis
Defecation
Gastrointestinal upset
excessive bradycardia or tachycardia (muscarinic or nicotinic)

Question 6

What are the main sources of cholinergic poisoning?

Answer 6

organophosphates (pesticides)

nerve agents

Question 7

What is the treatment for cholinergic poisoning?

Answer 7

atropine
2 PAM
decontaminate

Question 8

Describe the sympathomimetic toxidrome.

Answer 8

(Fight or flight)

Tachycardia
Hypertension
Mydriasis
Diaphoresis
Hyperthermia
Agitation

Question 9

What are the usual sources for sympathomimetic poisoning?

Answer 9

OTC cold medicine
cocaine
amphetamines
meth
dietary suppl
MDMA
Ecstasy

Question 10

What is the treatment for sympathomimetic poisoning?

Answer 10

sedation
hydration

treat any rhabdo or hyperthermia

Question 11

Describe the opioid toxidrome.

Answer 11

apnea
hypoxia
unresponsiveness
flash pulmonary edema

Question 12

What is the treatment for opioid poisoning?

Answer 12

naloxone

intubation if they need it

Question 13

What should be included in the diagnostic testing for poisoning?

Answer 13

EKG (QRS intervals, R waves, rhythm, etc)
Tox screen is mandatory
Acetaminophen level
ASA level
Electrolytes
Med levels if susp.

Question 14

What are the three decontamination methods?

Answer 14

activated charcol
whole bowel irrigation (w/ PEG)
gastric lavage

Question 15

What is the general time limit for activated charcol?

Answer 15

should be given within 1 hour of ingestion (but may work after that too)

Question 16

What is the antidote for acetaminophen OD?

Answer 16

NAC

Question 17

What is the management for ASA OD?

Answer 17

sodium bicarb and hemodialysis

Question 18

What effects can you see from TCA injection (in addition to the usual anticholinergic toxidrome)?

Answer 18

Cardiac, coma, convulsions

QRS widening with risk for arrythmia
seizures

Question 19

What is the management for TCA toxicity?

Answer 19

trx seizures with benzos

sodium bicarb for the QRS widening

Question 20

What three alcohols are considered toxic?

Answer 20

isoproanol (solvents, mouthwash, rubbing alc)
methanol (windshield wiper fluid)
ethylene glycol (antifreeze)

Question 21

Isopropanol is usually not life-threatening, but methanol and ethylene glycol are. WHat is the management?

Answer 21

Block alcohol dehydrogenase by giving simple ethanol or fomepizole

maybe hemodialysis. bicarb if large acidosis.