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Flashcards in Cardiac arrest in poisoning Deck (14):
1

ABCDE

Avoid mouth to mouth
High oxygen concentration
Paraquant high oxygen can cause lung injury-adjust according to ABG/sats

High risk of aspiration therefore intubate

2

Initial treatments

Activated charcoal:
Adsorbs certain drugs
Only in patients with intact or protected airway
Good for carbamazepine, dapsone, quinine, phenobarbital, theophylline

Gastric lavage:
Only helpful within 1 hour
Tracheal intubation

Whole bowel irrigation:
Oral iron, ingested illegal drugs

Laxatives/emetics never recommended

Urine alkalisation by giving IV sodium bicarbonate good for salicylate poisoning.

Haemodialysis in methanol, ethylene glycol, salicylates, lithium.

Local anaesthetics toxicity-use lipid emulsion

3

Paracetamol

Acetylcysteine

4

Organophosphates

High dose atropines 2-4mg

5

Cyanides

Sodium nitrite, sodium thiosulfate, hydroxycobalamin, amyl nitrite

6

Digoxin

Fab specific antibodies

7

benzodiazepines

LOC, resp depression and hypotension
Flumazenil for reversal of sedation and no Hx of seizures

S/E with withdrawl including seizure, arrhythmia, hypotension and withdrawl.

8

Opioids

Respiratory depression
Pinpoint pupils
Coma and resp arrest

IV IM SC or intranasal Naloxone
400mcg IV, 800mcg IM, 800mcg SC or 2mg IN

Large overdose 6-10mg

9

TCAs
Amitryptaline, Desipramine, imipramine, nortryptaline, doxepin, clomipramine

Hypotension, seizures, coma and arrhythmias
Anticholinergic effects
Broad complex VT, RAD deviation

Sodium bicarbonate

10

Local anaesthetics toxicity

Usually due to regional anaesthesia
Agitation, LOC, tonic/clonic convulsions, sinus bradycardia, asystole, VT

IV 20% lipid emulsion1.5ml per kg per hr
PAGE 121 figure

11

Cocaine

Agitation, tachycardia, hypertension, hypertherma, myocardial ischaemia

Small doses of IV benzodiazepines first line (midazolam, diazepam, lorazepam)

GTN can reverse coronary vasoconstriction

Nitrates as second line therapy only

12

Beta blockers

Isoprenaline

13

Managment

Prescribe activated charcoal if the overdose is within 1 hour. You should give activated charcoal only to patients with an intact or protected airway.
You may consider prescribing 50 mmol of sodium bicarbonate in moderate to severe overdoses.
Consider haemodialysis for some poisonings, e.g. methanol, ethylene glycol, salicylates, and lithium.
Consider the use of lipid emulsion (Intralipid) for cardiac arrest caused by local anaesthetic toxicity.

14

Summary

TOXBASE
Opioids: opioid poisoning causes respiratory depression, pinpoint pupils and coma followed by respiratory arrest. Supportive care and the opioid antagonist naloxone rapidly reverse these effects.
Benzodiazepines: overdose of benzodiazepines can cause loss of consciousness, respiratory depression and hypotension. Flumazenil, a competitive antagonist of benzodiazepines, should be used only for reversal of sedation caused by a single ingestion of any of the benzodiazepines and when there is no history or risk of seizures.