- TOXICOLOGICAL EMERGENCIES -

Question 1

Outline the general management and principles of drug poisoning

Answer 1

• Risk assessment (drug type, dose, time of ingestion, IR or SR, history, vital signs)
• Resuscitate first (airway, breathing, decontamination, elimination and antidote!)
• ECG
• BSL
• VBG

Question 2

Discuss the prevention and limitation of absorption following drug poisoning

Answer 2

• Activated charcoal (needs to be within 1-2 hours

Question 3

Outline the clinical manifestations of cardiovascular drug overdoses

Answer 3

• bradycardia
• hypoxaemia
• MI
• hyperkalaemia

Question 4

Outline the clinical manifestations of paracetamol overdoses

Answer 4

• <24hrs nausea and vomiting

- >24hrs hepatic necrosis, actute liver failure, jaundice etc

Question 5

Outline the clinical manifestations of benzodiazepine overdoses

Answer 5

• ACS
• Respiratory depression
• Variable pupil changes
• Hypotension
• Hypothermia

Question 6

Outline the clinical manifestations of tricyclic antidepressant overdoses

Answer 6

• Tachycardia
• Hypotension
• Fever
• ACS
• Absent bowel sounds
• Rigidity
• Dry mucous membranes
• Wide QRS with RAD

Question 7

Outline the clinical manifestations of a corrosive substance overdose

Answer 7

• crying
• drooling
• vomiting
• stridor
• haematemasis
• melena
• hypoventilation/apnoea

Question 8

Outline the clinical manifestations of an opioid overdose

Answer 8

• triad of respiratory depression, pinpoint pupils, decreased LOC
• bradycardia, hypotension, hypothermia
• needle tracks

Question 9

Outline the clinical manifestations of an amphetamine overdose

Answer 9

• HTN
• tachycardia
• mydriasis
• anxiety, delerium, paranoia
• diaphoresis
• hyperthermia
• seizures

Question 10

Outline the clinical manifestations of organophosphate overdoses

Answer 10

SLUDGE

• salivation
• lacrimation
• urination
• diaphoresis
• gastrointestinal upset
• emesis
• weakness paralysis
• bradycardia or tachycardia
• hypotension
• bronchospasm

Question 11

Outline the clinical manifestations of a serotonin inhibitor overdose

Answer 11

• irritability, aggitation
• hyperreflexia, tremor, trismus
• ataxia, incoordination
• flushing, diaphoresis
• diarrhoea
• fever

Question 12

Outline the components of history taking and risk assessment in drug poisoning

Answer 12

• Risk assessment (drug type, dose, time of ingestion, IR or SR, history, vital signs)
• Resuscitate first (airway, breathing, decontamination, elimination and antidote!)
• ECG
• BSL
• VBG

Question 13

Outline the common life-threatening complications of drug poisoning (ABC)

Answer 13

• CNS depression
• apnoea
• Brainstem breathing
• hypoxia
• hypotension
• bradycardia
• dysrhythmiaas
• acidosis
• hepatic failure

Question 14

What investigations affect the management of drug poisoning?

Answer 14

• ECG
• BSL
• VBG
• EUC
• Serum Paracetamol
• Beta-HCG

Question 15

What are the issues around the use of activated charcoal?

Answer 15

• aspiration risk
• upper airway, esophageal, gastric trauma
• pneumothorax
• dysrythmias
• co-operation

Question 16

What drugs do not bind well to charcoal?

Answer 16

• Cyanide
• Ethanol
• Ethylene glycol
• Iron
• Isopropanol
• Lithium
• Methanol
• Strong mineral acids and alkali
• Pesticides

Question 17

What can be done to inhibit absorption/enhance elimination?

Answer 17

• Gastric lavage
• activated charcoal
• laxatives
• whole bowel irrigation
• Haemodialysis

Question 18

What are some common antidotes used in the management of drug poisoning?

Answer 18

– Acetylcysteine for paracetamol poisoning
– Naloxone for opioid toxicity
– Benzodiazepines for stimulant toxicity
– Physostigmine for anticholinergic syndrome
– Novel inotropes for CVS toxicity
• High-dose insulin