Block 6 - Toxicology Flashcards Preview

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Flashcards in Block 6 - Toxicology Deck (33):
1

What are the ABCDs of acute management and stabilization of the poisoned patient?

1. Airway
2. Breathing
3. Circulation
4. Dextrose
5. Decontamination

2

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

3

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

4

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

5

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

6

List the common mechanisms underlying drug-induced hypotension.

1. Hypovolemia, vomiting and diarrhea, sweating, venodilation
2. Depressed cardiac contractility
3. Reduced peripheral vascular resistance

7

What are common causes of drug-induced seizures?

1. Tricyclics/other antidepressants
2. Cocaine and amphetamines
3. Theophylline
4. Diphenhydramine
5. Isoniazid

8

What are the 4 methods of GI decontamination?

1. Emesis
2. Gastric lavage
3. Activated charcoal
4. Whole bowel irrigation

9

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?

Emesis

10

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

11

What method of GI decontamination is the most useful, broadly?

Activated charcoal

12

When is activated charcoal not effective?

Iron, lithium, potassium, sodium, alcohol

13

What method of GI decontamination is useful in obtunded or comatose patients, in recent ingestions, or in ingestion of anticholinergic agents or salicylates?

Gastric lavage

14

Treatment for acetaminophen overdose?

NAC

15

Treatment for anticholinergic and antihistamine overdose?

Activated charcoal and a cathartic agent (lavage for large ingestions)

16

Treatment for anticoagulant overdose?

Oral activated charcoal, vitamin K if PT prolongation occurs

17

Treatment of beta block overdose?

Aggressive gut decontamination (gastric lavage + activated charcoal), high doses of glucagon

18

Treatment of calcium antagonist overdose?

Aggressive gut decontamination before onset of ileus

19

Treatment of carbon monoxide poisoning?

Remove from exposure, given supplemental O2 in the highest available concentration

20

Treatment of cocaine, amphetamine, and other stimulant overdose?

Sedative agent

21

Treatment of copper poisoning?

Penicillamine + dimercaprol (chelating)

22

Treatment of cyanide poisoning?

Prevent further exposure, oral activated charcoal, give B12 or sodium thiosulfate

23

Treatment of digitalis glycoside poisoning?

Gut decontamination

24

Treatment of ethanol, methanol, and ethylene glycol poisoning?

Ethanol - supportive care
Methanol/ethylene glycol - ethanol or fomepizole (prevents metabolism) + folic acid, B1, and pyridoxine

25

Treatment of gold poisoning?

BAL

26

Treatment of iron poisoning?

Gut decontamination, choleation with deforoxamine

27

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

28

Treatment of lithium poisoning?

Gut decontamination

Sodium polystyrene sulfonate

Fluid therapy is essential

29

Treatment of methemoglobinemia-inducing agent poisoning?

Resolves spontaneously (mild)

Methylene blue (severe)

30

Treatment of organophosphate poisoning?

Wash exposed areas with soap and water, atropine, 2PAM

31

Treatment of salicylate poisoning?

Alkalinization of the urine

32

Treatment of sedative hypnotic agent poisoning?

Flumazenil (reverse coma)

33

Treatment of tricyclic antidepressant poisoning?

Treat symptoms