cards Flashcards
(16 cards)
Hx/ info to consider when someone has been poisoned`
Pt details - age, wt, sex, PMH, med Hx
Exposure- drug/toxin, animal/plant, co ingestants
Intent of poisoning - accidental, NAI
Details surrounding exp- time since, route, dose
Immediate action taken by pt
Basic vitals
Clincal effects/ symptoms
Results of already done IX
Which substances have a high risk of toxicity in children if accidentally ingested
Button batteries
Iron supplements
Opiods
Screening investigations for poisoning
ABG
ECG
Serum bicarb and potassium
BGL
Serum paracetamol
Which drugs are associated with QRS widening
Antidepressants- TCA, venlafaxine
Antiepileptics- carbamazepine, lamotrigine
Antihistamines- diphenhydramine
Antipsychotics- chlorpromazine
CV drugs- flecanide, propanolol
LA- bupivacaine, ropivacain
Others- buproprion
- chloroquine, hydroxychloroquine and quinine
-cocaine
PO potassium
Which drugs are associated with QT interval prolongation and torsades
antiarrhythmics- amiodarone, disopyramide, sotalol
antidepressants- citalopram, escitalopam, TCA
antihistamines - loratidine, dimenhydrinate, diphenhydramines
ABx- ciprofloxacin, clarithromycin, erythromycin, fluconazole, moxifloxacin. pentamidine
antipsychotics - amisulpride, chlorpromazine, haloperidol
chemotherapeutics - arsenic
Which bloods and when/why are they recommended for pts with suspected poisonings
Routine bloods are not routinely recommended in these pts. Do a UEC and CK if: seizures, abnormal ECG, rhabdo, hyperthermia
Serum level of toxin maybe
Which drugs can you obtain serum concentrations for to inform mng of poisoning
paracetamol
antiepileptics- carbamazepine, phenobarbital, phenytoin, sodium valproate
aspirin
digoxin
iron
lithium
potassium
theophylline
toxic etohs
Why/ when would a UDS be used in suspected poisoning
Mainly to ID illicit drug use and trigger referral to addiction drs
More comprehensive drug screens can be used in cases of suspected deliberate self poisoning, NAI in children or drink spiking
When would radiologic imaging (AXR, CXR) be considered in suspected poisoning
To locate radio-opaque FBs in the GIT
- iron/potassium tabs
- button batteries
-lead objects
-packages of drugs in packers/ stuffers
Management of carbon monoxide poisoning
- 100% HF via NRBM- Continue for a minimum of 6 hours and cease when all sx resolve rather than CO/ O levels
If severe, discuss with specialist for consideration of hyperbaric oxygen
Risk factors for developing hepatotoxicity in paracetamol overdose
Chronic ETOH
HIV
Anorexia
P450 inducers
Which NSAID is contraindicated with any form of CV disease
Diclofenac
Aspirin toxicity, expected metabolic panel
Initial resp alkalosis- stimulation of central resp centre causing increased resp effort
Then, metabolic acidosis due to direct toxicity
Indications for hemodialysis in salicylate overdose
Serum con > 700mg/l
Metabolic acidosis resitent to tx
Acute renal failure
pulmonary edema
seizures
coma
Acute management of caustic substance ingestions
ABCDE approach, particular caution to airway swelling and compromise, look for peri-oral oedema
Urgent upper GI surgical referral if signs of perforation present (surgical emphysema, mediastinal widening on chest x-ray)
Neutralisation of ingested substance (e.g. with milk) should be avoided as the resulting exothermic reaction will release heat and may cause further injury
High dose IV PPI
Symptomatic ingestion (drooling, vomiting, dysphagia, odynophagia, chest pain) requires urgent assessment with upper GI endoscopy to assess the degree of ulceration (Zargar classification). Extensive injury on endoscopy should prompt consideration of urgent surgical exploration
Asymptomatic ingestion can usually be discharged after a trial of oral fluid and a period of observation
Potassium sparing diuretics
STEAK
Spironolactone
Triamterene
Eplerenone
Amiloride
