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Acute Care > Poisoning & overdose > Flashcards

Poisoning & overdose Flashcards

1
Q

What is flumazenil

A

Benzodiazepine antagonist

Precipiates withdrawal if dependent

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2
Q

Uses of flumazenil

A

May sometimes be used as an alternative to ventilation in children who are naive to benzo’s or in COPD to avoid need for ventilation

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3
Q

What are the most important things to find out with OD/poisoning

A 
Likely agents involved + coagents
Date and time of ingestion
Quantity
Route of exposure
Single OD/staggered/chronic
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4
Q

General examination of person who has ODed

A

Puncture wounds
Injuries
Self harm

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5
Q

Clinical signs of heroin OD

A 
Coma
Constricted pupils
Reduced resp rate
Reduced level of consciousness
Hypotension
Bradycardia
Delayed gastric emptying
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6
Q

Clinical signs of ecstasy OD

A 
Delirium
Tachycardia
Agitation
Dilated pupils
Hyperthermia
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7
Q

Organophosphate drug

Signs of OD

A

Malathion
Excessive cholinergic stimulation
Miosis, hypersalivation, vomiting, lacrymation, bradycardia

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8
Q

When are samples of ingested substance necessary?

A 
If poisoning is suggested to be from:
•	Ethylene glycol
•	Iron salts
•	Lithium salts
•	Methanol
•	Paracetamol
•	Salicylates (aspirin)
•	Theophyline
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9
Q

Aims of effective management of poisoning

A
  • Reduce absorption (activated charcoal if within 1 hr, whole bowel irrigation if drug smugglers)
  • Give an antidote
  • Increase elimination (multiple dose activated charcoal if drug undergoes enterohepatic circulation, urine alkylation for salicylates, dialysis)
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10
Q

What is activated charcoal ineffective for?

A

Alcohol + ionised drugs

  • Inorganic acids
  • Strong alkalis
  • Iron salts
  • Lithium salts
  • Methanol
  • Ethanol
  • Ethylene glycol
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11
Q

What is used in paracetamol poisoning?

A

Acetyl-cysteine

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12
Q

What is atropine used for?

A

Treatment of cholinergic excess (malathion poisoning)

To block PNS action of bradycardia (ß-blockers, digoxin)

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13
Q

What is used to treat iron poisoning

A

Desferrioxamine

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14
Q

How do you treat digoxin toxicity?

A

Using digoxin-specific antibdy fragments (Fab fragments)

Bind to digoxin, blocking uptake-> renal excretion

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15
Q

Use of fomepizole

A

Used to manage methanol and ethylene glycol poisoning

Blocks alcohol dehydrogenase, limiting toxic metabolites

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16
Q

Management of warfarin poisoning

A

Vitamin K (Phytomenadione)

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17
Q

What is used in ß-blocker toxicity

A

Glucagon

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18
Q

How much paracetamol can cause liver toxicity?

A

As little as 7g

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19
Q

When do you measure plasma-paracetamol level?

A

4-15hrs after ingestion

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20
Q

What factors are associated with a poor prognosis after paracetamol ingestion?

A

Prolonged prothrombin time
Raised creatinine
Low blood pH

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21
Q

When does maximal liver damage occur in an untreated paracetamol OD patient?

A

72-96hrs post ingestion

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22
Q

Pathophysiology of paracetamol liver damage

A

Metabolism pathways become oversaturated, build up of free radicals
Glutathione depletion
Free radicals cause liver damage

23
Q

When should acetyl-cysteine be administered?

A

Within 10hrs of ingestion
Only after plasma levels are known (treatment line) (unless late presenation or staggered OD
Course of 21hrs infusion

24
Q

Action of N-acetyl cysteine

A

Replenishes stores of glutathione

25
Q

What happens if Acetylcyteine gives rash/bronchospasm

A

Pause infusion
Give antihitamine and bronchodilator
Restart infusion

26
Q

Symptoms of iron overdose

A 
N+V + diarrhoea
Grey/black stools
GI ulceration
GI haemorrhage
Haematemesis
Rectal bleeding
CV collapse
27
Q

Management of iron OD

A 
Admit if >20mg elemental iron/kg
Gastric lavage/aspiration if<1hr post ingestion
Take serum iron level
Desferrioxamine
ABGs, LFTs, Abdo Xray (radio opaque)
28
Q

Management of opioid OD

A

Fluids

Naloxone infusion

29
Q

Signs of salicylate poisoning

A 
N+V
Dehydration
Deafness/tinnitus
Sweating/vasodilation
Hyperventilation
Tachycardia
Metabolic acidosis
30
Q

How does aspirin cause metabolic acidosis?

A

Disrupts cellular metabolism by uncoupling oxidative phosphorylation-> metabolic acidosis. (respiratory compensation)

31
Q

When does someone need to be admitted for aspirin OD?

A

> 125mg/kg or symptoms

32
Q

Management of salicylate OD (6 points)

A
  1. Activated charcoal within 1 hr
  2. IV fluids for hypotension and dehydration
  3. Measure plasma salicylate level and repeat every 2-3hrs
  4. Consider urine alkylisation if more than 500mg/kg bodyweight (Use sodium bicarbonate to maintain urine pH 7.5-8.5)
  5. Monitor potassium
  6. Consider haemodialysis is severe (eg coma, pulmonary oedema, severe acidaemia)
33
Q

TCA OD dangers

A

TCAs can cause cardiotoxicity in overdose (esp Dosulepin)

-> Tachycardia, wide QRS, wide QT, RBB

34
Q

Signs of TCA OD

A 
Antichoinergic effects
Drowsiness
Blurred vision
Dry mouth
Hot dry skin
Urinary retention
Tachycardia &amp; arrhythmias
Convulsions, coma
Hypokalaemia
35
Q

Signs of SSRI OD

A 
N+V
Agitation
Tachycardia
Convulsions
Serotonin syndrome
36
Q

How do you treat serotonin syndrome

A

Cooling
5HT antagonists
Benzodiazepines for convulsions

37
Q

Signs of serotonin syndrome

A 
Autonomic instability
Coagulopathies
Hyperthermia
Neuropsychiatric effects
Neuromuscular hyperactivity
Renal failure
Rhabdomyolysis
38
Q

Amphetamines are used to treat:

A

Narcolepsy
Nasal decongestant (pseudoephedrine)
Obesity
ADHD

39
Q

Signs of amphetamine/cocaine OD

A 
Agitation and rapid speech
Convulsions
Hallucinations
Hyperthermia
Cardiac arrhythmias
Rhabdomyolysis
Dilated pupils
Hypertension &amp; tachycardia
Loss of desire to sleep or eat
40
Q

Large amounts of cocaine can cause->

A

Vasoconstriction
Aortic dissection
Stroke
Chronic use= myocardial fibrosis, cardiomyopathy, cerebral vasculitis, fetal death

41
Q

Treatment of cardiac ischaemia after cocaine use

A

Nitrates
Diazepam
Aspirin

42
Q

Which drugs could a tachycardia be caused by?

A 
Salbutamol
Antimuscarinics
Tricyclics
Quinine
Phenothiazine
43
Q

Which drugs cause respiratory depression?

A

Opiates

Benzodiazepines

44
Q

Which drugs cause hypothermia

A

Phenothiazine

Barbiturates

45
Q

Which drugs can cause hyperthermia?

A

Amphetamines, cocaine, quinine, tricyclics, serotonin agonists

46
Q

Which drugs cause hypoglycaemia?

A

Insulin, oral hypoglycaemics, alcohol, salicylates, beta blockers

47
Q

Which drugs cause hyperglycaemia?

A

Organophosphates
Theophyllines
MAOi

48
Q

Which drugs can cause metabolic acidosis?

A

Alcohol, ethylene glycol, methanol, paracetamol, carbon monoxide

49
Q

What Qs need to be asked in a psychiatric assessment after an overdose?

A
  • Intentions at time: Planned? Precautions against being found? Seek help afterwards? Was method dangerous? Suicide note?
  • Present intentions: Still feel suicidal? Wish it had worked?
  • Problems leading to act: still issues?
  • Was the act aimed at someone?
  • Is there a psychiatric disorder? (depression, alcoholism, personality disorder, schizophrenia, dementia)
  • Resources: friends, family, work, coping mechanisms
50
Q

Name 13 risk factors that increase the chance of a future suicide

A
  • Original intention was to die
  • Present intention is to die
  • Presence of psychiatric disorder (eg depression, command hallucinations)
  • Alcoholism/drug abuse
  • Poor resources (socially isolated)
  • Previous suicide attempts/self harm
  • Unemployed
  • Homelessness
  • Chronic pain/disabling illness
  • Male
  • > 50yrs old
  • Plan
  • Said goodbye to friends, made a will, wrote a suicide note, funeral plan
51
Q

Name 8 protective factors against future suicide

A
  • Strong networks of friends and family
  • Having a major long term goal
  • Having a pet
  • Having a future event to look forward to (child’s graduation, wedding, holiday)
  • Having a strong religious faith that does not sanction suicide and affirms life
  • Having a dependent
  • Being in a loving relationship
  • Using suicide and crisis hotlines/seeking support
52
Q

Define self harm

A

Intentional destruction of body tissue without suicidal intent and for purposes not socially sanctioned
• Different from suicide as there is no desire to die.
• Usually 12-25yr olds
• Indication of an underlying mental illness or emotional instability

53
Q

Why do people self harm?

A
  • Seen as a maladaptive coping mechanism
  • Physical pain easier to deal with than emotional distress
  • Sensation seeking/antidissociation (every thing else seems numb in depression)
  • Self punishment
  • To communicate distress to others (BPD)
  • Release anger/tension/emotional pain
54
Q

Give 5 examples of self harm behaviour

A
  • Cutting, scratching
  • Burning, scalding
  • Ingestion of toxic substances

Acute Care (11 decks)

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