Flashcards in Block 6 - Toxicology Deck (33):
What are the ABCDs of acute management and stabilization of the poisoned patient?
Discuss the A of acute management and stabilization of the poisoned patient.
Airway - position the patient to open the airway, suction any secretions or vomitus, evaluate airway-protective reflexes, consider endotracheal intubation
Discuss the B of acute management and stabilization of the poisoned patient.
Determine adequacy of ventilation, assist ventilation if needed, assess oxygenation and give supplemental oxygen if needed
Discuss the C of acute management and stabilization of the poisoned patient.
Evaluation perfusion, BP, cardiac rhythm, determine QRS complex and QT interval, attach continuous cardiac monitor
Discuss the D (x2) of acute management and stabilization of the poisoned patient.
Dextrose - quickly determine blood glucose by finger-stick test, give dextrose if patient is suspected of having hypoglycemia
Decontamination - perform surface and gastric decontamination to limit absorption of poisons
List the common mechanisms underlying drug-induced hypotension.
1. Hypovolemia, vomiting and diarrhea, sweating, venodilation
2. Depressed cardiac contractility
3. Reduced peripheral vascular resistance
What are common causes of drug-induced seizures?
1. Tricyclics/other antidepressants
2. Cocaine and amphetamines
What are the 4 methods of GI decontamination?
2. Gastric lavage
3. Activated charcoal
4. Whole bowel irrigation
What method of GI decontamination should be used in rare circumstances with a potentially lethal ingestion when medical care is more than 60 minutes away?
What method of GI decontamination is useful in ingestions of iron, lithium, sustained-released or enteric-coated pills, and drug packets or other foreign bodies?
Whole bowel irrigation
What method of GI decontamination is the most useful, broadly?
When is activated charcoal not effective?
Iron, lithium, potassium, sodium, alcohol
What method of GI decontamination is useful in obtunded or comatose patients, in recent ingestions, or in ingestion of anticholinergic agents or salicylates?
Treatment for acetaminophen overdose?
Treatment for anticholinergic and antihistamine overdose?
Activated charcoal and a cathartic agent (lavage for large ingestions)
Treatment for anticoagulant overdose?
Oral activated charcoal, vitamin K if PT prolongation occurs
Treatment of beta block overdose?
Aggressive gut decontamination (gastric lavage + activated charcoal), high doses of glucagon
Treatment of calcium antagonist overdose?
Aggressive gut decontamination before onset of ileus
Treatment of carbon monoxide poisoning?
Remove from exposure, given supplemental O2 in the highest available concentration
Treatment of cocaine, amphetamine, and other stimulant overdose?
Treatment of copper poisoning?
Penicillamine + dimercaprol (chelating)
Treatment of cyanide poisoning?
Prevent further exposure, oral activated charcoal, give B12 or sodium thiosulfate
Treatment of digitalis glycoside poisoning?
Treatment of ethanol, methanol, and ethylene glycol poisoning?
Ethanol - supportive care
Methanol/ethylene glycol - ethanol or fomepizole (prevents metabolism) + folic acid, B1, and pyridoxine
Treatment of gold poisoning?
Treatment of iron poisoning?
Gut decontamination, choleation with deforoxamine
Treatment of lead poisoning?
Acute - abdomen X-ray (if in stomach, get it out; if past pylorus, should be fine)
IV EDTA or oral succimer DMSA, also dimercaprol
Treatment of lithium poisoning?
Sodium polystyrene sulfonate
Fluid therapy is essential
Treatment of methemoglobinemia-inducing agent poisoning?
Resolves spontaneously (mild)
Methylene blue (severe)
Treatment of organophosphate poisoning?
Wash exposed areas with soap and water, atropine, 2PAM
Treatment of salicylate poisoning?
Alkalinization of the urine
Treatment of sedative hypnotic agent poisoning?
Flumazenil (reverse coma)