ED - Flashcards
(33 cards)
Antidotes
Lead poisoning Paracetamol Morphine Salicylate Organophosphate Methanol Iron
Dimercaprol and calcium EDTA N-acetylcysteine Naloxone Sodium bicarbonate Atropine & pralidoxime Ethanol +/- dialysis Deferoxamine
Activated charcoal
Up to 4 hours? ( where is drug absorbed in GI tract )
Advantages (2)
Disadvantages (4)
Absorbs most substances
Better than induced vomiting or gastric lavage
C/I in anyone with reduced LOC or ileus
Aspiration may cause fatal bronch obliterans
Doesn’t work for metals, corrosives, pesticides
Not good for water soluble like etoh, potassium
Causes constipation
Syrup of Ipecacuanha
Advantages (1)
Disadvantages (5)
Induces vomiting within 30 mins
Doesn’t fully empty stomach
Must be given within an hour
Prolonged vomiting, diarrhoea, drowsiness
C/I in reduced LOC
Not for corrosive, hydrocarbons, petrochemicals
Gastric lavage
Indication
Commence…
2 disadvantages
Serious poisoning when already intubated
Commence within an hour
Contraindicated for corrosives, hydrocarbons, petrochemicals
Psychologically traumatic (if conscious)
Whole bowel irrigation
Indication
Delayed presentations
Slow release drug poisoning
Drugs not absorbed by activated charcoal eg iron
Toxidrome
Anticholinergic
Sx
Offending drugs
Tachycardia Hyperthermia Mydriasis Warm dry skin Urinary retention Ileus Delerium
Antihistamines
Atropine
Belladonna alkaloids
Psychoactive drugs
Toxidrome
Cholinergic- muscurinic
Sx
Offending substances
Antidote
Salivation, lacrimation, urination, diarrhoea, bronchorrhoea, wheeze, bradycardia, vomiting
Organophosphates
Pyridostigmine
Mushrooms
Atropine
Toxidrome
Cholinergic- nicotinic
Sx
Drugs
Antidote
Insecticides, nicotine, black widow spider bites
Tachycardia, hypertension, fasciculation, GI cramps, emesis, miosis
Atropine
Toxidrome
Cardiac meds
Sx
Antidote
Ca channel, beta blockers, digoxin
Bradycardia, arrhythmia, hypotension, dizziness, heart block, nausea, vomiting
Glucagon
Digoxin immune fab (digibind)
Calcium chloride
Toxidrome
Iron
Sx
Antidote
Dyspepsia Nausea Vomiting Diarrhoea Dark stools
Deferoxamine
Toxidrome
Sulfonylureas
Sx
Antidote
Sulfonylureas
Hypoglycaemia Tachycardia Diaphoresis Clammy skin Mental status change Coma
Octreotide
Toxidrome
Aspirin
Sx
Rx
Tinnitus Nausea Vomiting Fever Disoriented Lethargy Tachypnoea
Sx >150mg/kg
BG
Initially respiratory alkalosis followed by raised anion gap metabolic acidosis
Urinary alkalosis
AC
No antidote
Toxic mechanism
Salicylate
Irreversible blockage ofCOX-1 pathway, modify COX-2 pathway
Reduced prostaglandin synthesis and platelet aggregation
Halts electron transport in mitochondria- lactic acidosis
SSRIs
Which can cause torsades
Mechanism
Risk of serotonin syndrome
Rx
Citalopram & Escitalopram at high doses
Serotonin toxicity mild and only in 20%
Occur within 4 h, gone within 12h
If 3 or less tabs observe
If more or symptoms- hospital
Benzodiazepines
AC
Toxidrome
Serotonin syndrome
Meds
Rx
Confusion, agitation lethargy, coma
Hyperthermia, tachycardia, mydriasis
Diaphoresis, N& V, diarrhoea
Hyperkinesia, hyperreflexia, trismus, myoclonus, cogwheel rigidity
Cause: SSRI, lithium, triptans, MAOI, cocaine
Benzodiazepines
Cypohepatadine - antihistamine with anti-serotinergic effects
Basic Life Support
A
B
C
A - look feel listen for breath sounds. If no- Open airway
B- maintain open air way
Give 5 breaths if no breathing
C - assess pulse
If no / <60 bpm start CPR
5: 1 infant
15: 2 larger child
Causes of child death
<1 month
1month - 1year
> 1year
Congenital abnormalities
Immaturity
Sepsis
Cot death
Metabolic/resp/sids
Congenital abnormalities
Sepsis
> 1year trauma
Differences in children
Airway
Big head Short nasal passage (<6 mo obligate nasal breathers) Adenotonsillar hypertrophy Loose teeth Large tongue Compressible floor of mouth High anterior larynx Posterior epiglottis Short, soft trachea Cricoid narrowest part
Differences in children
Breathing
Narrow airways
Diaphragm breathers
Ribs more horizontal- contribute less to WOB
Chest wall more compliant
Differences in children
Cardiovascular
Circulating blood volume 70-80mL/kg
Stroke volume 1.5mL/kg at birth
Cardio output dependent on HR
Left ward shift of Oxyhaemoglobin curve at birth due to 70% HbF
Radiation dose comparison
CXR
CT head
CT abdo
Barium meal
Cxr 2.4 days
Ct head 243 days
Ct abdo 3.3 years
Barium meal 1 year
A flight from Australia to the UK equivalent to 3 CXRs
Iron overdose
4 clinical stages
AXR shows
Serum levels
GI phase: direct corrosive effect on bowel - nausea, vomiting, abdo pain +- GI bleeding
Latent phase: silently accumulating in mitochondria
Metabolic acidosis and shock: systemic toxicity, shock, metabolic acidosis, depressed cardiac function, hepatic necrosis
Bowel obstruction: pyloric stenosis and obstruction due to inflammation
AXR- radiopaque tabs
Toxic : >20mg/kg elemental iron
Lethal dose 60-180mg/kg
Carboxyhaemoglobin toxicity
Example
3 main mechanisms
House fire
Reversible binding to Hb
250x affinity of O2 to Hb
Shifts curve to left ( increases O2 affinity for Hb)
Reversible binding to myoglobin
Reversible binding to cytochrome P450- prevents oxidative metabolism
Resus
Reversible causes
Hypoxaemia
Hypovolaemia
Hypo/hyperkalaemia
Hypo/hyperthermia
Tamponade
Tension pneumothorax
Toxins
Thromboembolism
