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IC Part II > Management of Poisoned Patients > Flashcards

Management of Poisoned Patients Flashcards

1
Q
  1. clinical stabilization
  2. clinical eval
  3. prevention of further toxicant absorption
  4. enhancement of toxicant elimination
  5. administration of antidote
  6. supporting care, monitor and followup
A

stepwise approach to poisoned patient

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2
Q

ABCDt of managing poisoned patient?

A

airway, breathing, circulation, drugs, temperature

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3
Q

TCAs, phenothiazines, beta blockers, calcium channel blockers, theophylline, and barbiturates can cause?

A

hypotension

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4
Q

amphetamines, cocaine, TCAs, digitalis, and theophylline can cause?

A

arrhythmias

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5
Q

cyanide, hydrogen sulfide, and carbon monoxide can cause?

A

cell hypoxia

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6
Q

beta blockers, calcium channel blockers, clonidine, and sedative hypnotics cause?

A

hypotension and bradycardia

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7
Q

TCAs, phenothiazines, theophylline, beta agonists, and vasodilators cause?

A

hypotension and tachycardia

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8
Q

salicylates, carbon monoxide, and chemicals producing metabolic acidosis or cellular asphyxia cause?

A

rapid respiration

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9
Q

sympathomimetics, anticholinergics, salicylates, uncouplers of oxidative phosphorylation cause (hypothermia/hyperthermia?)

A

hyperthermia

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10
Q

phenothiazines and ethanol cause?

A

hypothermia

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11
Q

opioids, phenothiazines, cholinesterase inhibitors, alpha blockers cause pupil _______

A

constriction (miosis)

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12
Q

amphetamines, cocaine, LSD, anticholinergics, PCP cause pupil _______

A

dilation (mydriasis)

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13
Q

vertical and horizontal nystagmus strongly suggests _______

A

phenylcyclidine

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14
Q

organophosphates, iron, arsenic, theophylline, mushrooms cause ______ bowel sounds

A

hyperactive

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15
Q

GCS score of _____ indicates severe head injury

A

8 or less

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16
Q

-renal failure
-DKA
-lactic acidosis
-drug induced metabolic acidosis (salicylates, methanol, isoniazid, iron)
cause?

A

elevated anion gap (normal 12)

17
Q 
Methanol
Acetone
Ethanol
Diuretics
Isopropanol
Ethylene glycol cause?
A

osmolar gap (normal 285)

18
Q

treatment for torsades?

A

magnesium sulfate

19
Q

constellation of clinical symptoms likely assoc’d with exposure to certain tox class of chemicals

A

toxidrome

20
Q
  • increased BP
  • increased pulse
  • slight increase temp
  • mydriasis
  • hyperalert, increased reflexes
A

sympathomimetics

21
Q
  • slight increase in BP
  • increased pulse and temp
  • mydriasis
  • decreased bowel sounds
  • altered mental status
A

anticholinergics

22
Q
  • slight decrease or no change in BP
  • decreased pulse
  • miosis
  • increased bronchial sounds
  • increased bowel sounds
  • altered mental status
A

cholinergic

23
Q
  • decreased BP
  • decreased pulse
  • decreased temp
  • miosis
  • rales (late)
  • decreased bowel sounds
  • decreased level of consciousness
A

opioids

24
Q

-not recommended after 30 min to 4 hours

A

gastric lavage

25
Q

will adsorb many toxins if given in a slurry immediately before or after lavage

A

activated charcoal

26
Q

use cholestryamine (resin binding) for ______ toxicity

A

digoxin

27
Q
  • procedure similar to prep for colonoscopy

- oral admin of PEG, removed rectally along with toxicant

A

whole bowel irrigation

28
Q

-change pH of urinary filtrate, resulting in ionization of weak acid, prevents reabsorption

A

ion trapping

29
Q
  • used for salicylate poisoning
  • pH increased using sterile sodium bicarb
  • pH from 5 to 8
A

alkalinization of urine

30
Q

-effective for toxicants with low volume of distribution, low protein binding, high water solubility, low molecular weight

A

hemodialysis

31
Q
  • blood passed through cartdige of adsorptive substane (mostly activated charcoal and cellulose or heparin containing gel)
  • can be used for lipid soluble and HMW chemicals
  • higher risk of thrombocytopenia
  • used for theophylline, amanita poisoning, paraquat
A

hemoperfusion

32
Q
  • patient blood delivered through hollow fiber tubes and plasma ultrafiltrate removed
  • fluid and electrolytes replaced
  • process continuous
A

continuous hemofiltration

33
Q
  • removal of patient plasma and replacing with donor plasma
  • used in NICU
  • high molecular weight and plasma protein bound toxicants
  • risk of allergic rxn
A

plasma exchange

34
Q
  • repeated doses to improve total body clearance
  • help elimination of drugs by removing drugs undergoing enterohepatic circulation
  • builds sink for toxicant where chemical enter gut due to concentration gradient
A

multiple dose activated charcoal (MDAC)

35
Q

fomepizole antidote for?

A

ethylene glycol

36
Q

hydroxocobalamine antidote for?

A

cyanide poisioning

37
Q

acidifies urine?

A

ammonium chloride, increases excretion of weak organic base

38
Q

alkalinizes urine?

A

sodium bicarb, excretes weak acids

39
Q

chelating agent used for Wilson’s disease, cystinuria, chelates copper

A

penicillamine

IC Part II (29 decks)

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