A to E: Disability - Acute poisoning Flashcards
(19 cards)
What is the significance of acute poisoning?
For people aged <40:
- Leading cause of cardiac arrest
- Common cause of non-traumatic coma
- Major reason for hospital admission
- Accidental (typically children <5yrs)
- Illicit drugs (typically adolescents)
- Deliberate self-harm (adults)
Name four drugs commonly involved in overdose
- Paracetamol (50%)
- NSAIDS: ibuprofen; aspirin
- Benzodiazepines; zopiclone
- Drugs of misuse
- Opioids
- TCAs: amitriptyline
- SSRIs
Name four presenting features of acute poisoning (general)
- Able to provide Hx
- Majority present immediately after accidental intake
- Delay presentation: unaware; deliberate self-harm
- Direct observation: eating; materal around mouth; on clothes
- Consider acute poisoning in:
- Delirium
- Hypoglycaemia
- Abnormal LFTs
- Unexplained seizure
- Several people presenting with similar symptoms
- Recurrent/chronic unexplained symptoms in children
Name three presenting features of paracetamol poisoning
- Often asymptomatic: low threshold for urgent admission
- NaV: usually settles within 24h
- Persistent NaV ± right subcostal pain: hepatic necrosis
- Encephalopathy; hypoglycaemia; haemorrhage; cerebral oedema; death
-
Coma; reduced GCS: suggest polysubstance use
- Commonly alongside opioids or alcohol
Name three presenting features of aspirin poisoning
-
Hyperventilation
- Mixed respiratory alkalosis and metabolic acidosis
- Tinnitus; deafness
- Vasodilation
- Sweating
- Coma (if very severe)
Give four presenting features of TCA poisoning
- Dry mouth; mydriasis; urinary retention; tachycardia
- Seizures
- Coma
- Cardiac conduction defects (VT); arrhythmias
- Hypothermia
- Hypotension
- Hyperreflexia
- Respiratory failure
Give four presenting features of SSRI poisoning
- NaV
- Agitation
- Tremor
- Nystagmus
- Drowsiness; convulsions
- Sinus tachycardia
Give three presenting features of benzodiazepine poisoning
- Drowsiness
- Dysarthria
- Ataxia
- Nystagmus
- Respiratory depression; coma
List three presenting features of cocaine poisoning
- Agitation
- HTN crisis; tachycardia
- Mydriasis
- Hallucinations
- Hyperthermia
- Hypertonia; hyperreflexia
- Chest pain; arrhythmias; MI with angina
- Cocaine-induced artery spasm
Give three presenting features of opioid poisoning
- Drowsiness; coma
- Respiratory depression
- Pinpoint pupils
Give three presenting features of ecstasy poisoning
- Delirium
- Coma; convulsions
- Hyperthermia
- Rhabdomyolysis
- AKI; acute hepatitis
- DIC
- ARDS
- Hyperreflexia
Request four investigations for acute poisoning
- Obs: HRl BP; RR; Temp
- ECG
- Weight
- If unconscious or severe toxicity:
- U+Es
- Paracetamol concentration
- VBG/ABG
Outline the general management of acute poisoning
- Most can be treated with suppotive care and monitoring
- Serious clinical effects occur in <5%
- ABC assessment
- ALS algorithm for cardiac arrest; hypoglycaemia; seizures
- Benzodiazepines for sustained seizures or agitation
- Consult TOXBASE for advice and specific antidotes
What is the specific antidote for opioid poisoning?
Naloxone
400 mcg IV (also available via IM/SC/IN)
Consider repeat doses
What is the specific antidote for benzodiazepine poisoning?
Flumazenil
As long as no history or risk of seizures
What is the specific antidote for TCA poisoning?
Sodium bicarbonate
What is the specific antidote for cocaine poisoning?
Small dose of IV benzodiazepines
What is the antidote for salicylate poisoning?
Urinary alkalinisation + IV sodium bicarbonate
