Clinical mgmt, Caustics, Violatile agents

Question 1

Most common cause of poisonings

Answer 1

Ingestion (83%)

Question 2

Prolonged QT toxin antidote

Answer 2

Magnesium

Question 3

Caustics vs Corrosive

Answer 3

Caustic: Cause tissue injury via chemical reaction
Corrosive: one that will destroy and damage substances (type of caustic substance)

Question 4

3 things that cause damage in caustics

Answer 4

1. Concentration and duration of contact
2. Amount and state (liquid, solid, etc)
3. Physical properties such as tissue penetration

Question 5

Solid vs liquid caustic ingestion site of injury

Answer 5

Solid: proximal injury (oropharynx, proximal esophagus)
Liquid: distal injury (stomach)

Question 6

Common acids

Answer 6

Toilet bowl cleaners
Batter liquids
Rust removers and metal cleaners
Cement cleaning
Drain cleaning
Zinc chloride

Question 7

Common bases

Answer 7

Bleaches (most common)
Drain and oven cleaning products
Ammonia (tub cleaners)
Swimming pool cleaners
Dishwasher detergent
Hair relaxers
Flintiest tablets
Cement

Question 8

What should not be used for caustic airway management?

Answer 8

Blind insertion devices and nasotracheal airways (due to damaged soft tissue)
Go straight to crich or needle crich
No NG tube, no charcoal

Question 9

Why do you not induce emesis for caustic ingestion

Answer 9

Can cause an exothermic reaction (similar to trying to neutralize)

Question 10

HF properties

Answer 10

Colorless gas or liquid
Used to make refrigerants, herbicides, aluminum, METAL ETCHING

Question 11

Electrolyte abnormalities in HF exposure

Answer 11

Hyperkalemia
Hypomagesemia
Hypocalcemia

Question 12

Pain in HF acid

Answer 12

Out of proportion to injury

Question 13

Tx for HF

Answer 13

SQ 5% calcium gluconate (not CaCl)
Ice packs (slows diffusion of fluoride ion)

Question 14

Lab abnormality in field for cyanide

Answer 14

Markedly elevated lactic acid (>10)

Question 15

Why is cyano antidote kit not used
What is in it

Answer 15

Causes methoglobinemia
Amyl nitrite, sodium nitrite, sodium thiosulfate

Question 16

How does hydroxycolbamin work in cyanide

Answer 16

Combines with cyanide forming really excreted cyanocolabamin

Question 17

AE of hydroxycobalamin

Answer 17

Reddish skin and urine
Allergic reaction
Hypertension

Question 18

Toilet bowl cleaner and bleach makes

Answer 18

Chloramine gas

Question 19

Hallmark symptoms of phosgene

Answer 19

Dyspnea
Cough is prevalent (may be dry, later frothy and pink for non cariogenic pulmonary edema)
Symptoms can be delayed - usually admitted for 1-2 days

Question 20

Phosgene odor

Answer 20

Freshly mown hay

Question 21

Blistering agents also called

Answer 21

Vesicants

Question 22

Immediate and delayed effects of blistering agents

Answer 22

immediate - desquamation/fluid filled painful blisters, corneal damage
delayed- pulmonary edema, secondary infection
can be carcinogenic (bone marrow suppression)

Question 23

Lewisite facts

Answer 23

Pain and irritation in seconds to minutes
Geranium odor
Causes low BP and shock (Distributive shock)
Has antidote - Dimercaprol (chelating agent)

Question 24

Ogranophosphate type of toxin

Answer 24

Cholinergic (bradycardia, bronchorrhea , bronchoconstriction)

Question 25

Neuromuscular effects of organophosphates

Answer 25

Twitching, paralysis, weakness, respiratory failure

Question 26

Intermediate syndrome of organophosphates

Answer 26

Late effect 1-4 days after clinical improvement Return of weakness and neuromuscular symptoms

Question 27

Atropine in cholinergic tox has no effect on what

Answer 27

Pupils

Question 28

Hydrocarbon DC criteria

Answer 28

6 hour obs and negative chest X-ray

Question 29

hgb shift for CO

Answer 29

Shifts to left preventing release of O2

Question 30

CO effects besides O2 curve

Answer 30

Binds to other iron containing proteins -Myoglobin (dysrhythmias and cardiac dysfunction -Cytochrome oxidase (metabolic acidosis)

Question 31

Non combustable source for CO poisoning

Answer 31

Methylene chloride (paint thinner) Transdermal absorption, may continue to rise as it is already absorbed

Question 32

Why are pregnant patient at higher risk for CO poisoning

Answer 32

Fetal Hgb has higher affinity for CO

Question 33

CO elimination

Answer 33

Room air: 240-360 minutes O2 (100%): 80-90 minuts Hyperbaric: 22 minutes