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Clin Med IV: Emergency Medicine > EM Toxicology > Flashcards

EM Toxicology Flashcards

(60 cards)

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1
Q

what are methods to protect airway

A

positioning (head tilt, jaw thrust)
Removal of any secretions
nasal or oral airway
administration of reversal agent

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2
Q

what drugs generally cause respiratory depression

A

barbituates
opioids
sedative-hypnotics
ETOH

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3
Q

what drugs can cause hypoxia from aspiration pneumonia or pulmonary edema

A

cocaine, opioids, sedative-hypnotics, antipsychotics, TCA

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4
Q

what drugs can cause bradycardia or AV block

A

opioids
clonidine
BB
TCAs

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5
Q

what drugs cause QRS prolongation

A

cocaine
BB
TCAs

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6
Q

what drugs can cause tachycardia

A

cocaine
PCP

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7
Q

what drugs can cause v-tach/V-fib

A

amphetamines
cocaine
TCAs
CCB

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8
Q

what drug can cause QT prolongation

A

Methadone

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9
Q

what drugs cause hypotension

A

opioid
sedative-hypnotics

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10
Q

what drugs can cause hypertension

A

amphetamines
cocaine
marijuana

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11
Q

if patient has low respiratory drive, what is the first treatment of choice

A

Narcan

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12
Q

what is hyperthermia associated with

A

several toxidromes (sympathomimetics, serotonin, neuomuscular malignancy)

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13
Q

how quickly should activated charcoal be administered

A

within 1 hour while toxin is within the stomach

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14
Q

what are contraindications to charcoal

A

altered LOC to prevent aspiration

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15
Q

what are SE of charcoal

A

constipation, impaction, stomach cramps, abd distention, vomiting -> aspiration

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16
Q

What is the toxidrome for cholinergics

A

SLUDGEM
Salivation
Lacrimation
Urination
Defecation
Gastroenteritis
Emesis
Miosis

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17
Q

what drug class casues “red as a beet, dry as a bone, blind as a bat, mad as a hatter”

A

anticholinergics

ex. scopolamine

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18
Q

what is the use of physostigmine

A

for life-threatening anticholinergic toxicity
Increases acetylcholine

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19
Q

what are the symtpoms of cyanide

A

HA
Nausea
Dyspnea
syncope
seizure
coma
agonal respirations
lactic acidosis

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20
Q

what is the toxic level of acetaminophen

A

150mg/kg

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21
Q

how is cyanide poisoning treated

A

cyano-kit

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22
Q

What is the Rumack-Matthrew Nomogram used for

A

acetaminophen toxicity
(probably toxicity, treat vs likely safe)

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23
Q

what is the treatment for Acetamenophen toxicity

A

NAC (N-acetylcystine)

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24
Q

what is used to reverse opioid over dose

A

Naloxone
Narcan

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25
what is Naloxone
competitive opioid antagonist can be given IM, IV, IO, IN onset: <2min if IV lasts: 20-60min
26
what is the initial dose of Narcan
0.2 - 0.4mg repeat every 2-3 minutes, increasing dose
27
what is the max dose of Narcan
10-20mg (relative)
28
what occurs with salicylate OD
stimulates respiratory drive -> hypervent -> resp alkalosis -> dehydration -> compensatory metabolic acidosis
29
what is the treatment of salicylates OD
sodium bicarb for metabolic acidosis fluid resuscitation glucose amenable charcoal whole bowel irrigation
30
What are symptoms of salicylate OD
tinnitus, lethargy, seizures, hypoglycemia, hyperthermia, hypokalemia
31
what are s/s of non-TCA antidepressant overdose
CNS depression - ataxia, sedation, coma, resp depress seizures sinus tach and HTN sinus brady or hypotension QRS/QT prolongation
32
what occurs with serotonin syndrome
Triad: autonomic instability, AMS, neuro abnormality (hyperreflex/clonus) tachy HTN diaphoresis hyperthermia mydriasis tremor
33
what is the treatment of serotonin syndrome
Benzos Cyproheptadine
34
what is the toxic dose of TCAs
<10x therapeutic dose 10-20mg/kg life threatening onset: 30-60 min after ingestion
35
how does TCA manifest
anticholinergic effects, alpha blockade and **electrical derangements** prolonged PR, QRS, QT seizures acidosis hypotension
36
what is the treatment for carbdon monoxide poisoning
100% O2 until CO < 5%
37
what are symptoms of CO overdose
HA drowsiness Nausea MI/angina change in cognition syncope seizure coma hypotension cardaic arrest
38
what is mild intoxication with antipsychotics
sedation small pupils orthostatic hypotension dry mouth abscence of sweating tachy
39
what are severe signs of antipsychotic intoxication
coma seizures respiratory arrest QT/QRS prologation poikilocytosis
40
what is neuroleptic malignant syndrome
can see with antipsychotic intoxication muscle rididity bradykinesia sweating AMS volatile vital signs lactic acidosis rhabdomylosis
41
what is the treatment of antipsychotic intoxication
benadry or benztropine for drug-induced extrapyramidal d/o sodium bicard for CNS effects Vasopressors for hyptension amenable to charcoal
42
what are symptoms of benzodiazepine intoxication
hypothermia bradycardia bradypenia hypotension CNS depressioin hyporeflexia dry mouth no pupillary changes
43
What is the treatment of benzo intoxication
drug specific antidote: Flumazenil
44
how quickly do alcohol levels drop
15-30mg/dL/hr
45
what are common presentations of alcohol abuse/intoxication
coma respiratory depression aspiration hypothermia hypotension brady
46
what is the treatment for alcohol intoxication
first line: Naltrexone (oral or depor injection) Antabuse Topiramate (off label)
47
what is Wernickes
acute/subacute AMC, CN6 palsy, gait disturbance give thiamine
48
what is Korsakoff
Irreversible confabulation associated with chronic alcohol abuse and low thiamine Amnesia Apathy
49
how do we treat anticholinergic OD
supportive care Benzos IV hydration cooling measures if hyperthremic Physostimgine Bicarb if wide QRS
50
what is the treatment of amphetamine OD
activated charcoal if large single ingestion can tx agitation with benzos/antipsych BB for tachy may need cooling
51
what causes mortality with amphetamine use
ventricular arrhythmias status epilepticus intracranial hemorrhage hyperthermia
52
what causes mortality wiht cocaine use
arrhythmias status epilepticus intracranial hemorrhage hyperthermia
53
what is the treatment of cocaine OD
supportive care, tx complications: ASA, nitrates, CCB for angina Benzo - HTN/tachy/agitation
54
what is the #1 cause of drug-induced shock
Beta-blockers higher risk if combo with CCB/TCAs
55
what are symptoms of BB OD
classic triad: hypotension, bradycardia, hypoglycemia AMS seizure and come AV block, QT prolongation, vasodilation HTN Hypokalemia bronchospasm respiratory arrest
56
what is the treatment of BB abuse
follow ACLS algorithm (atropine for brady) glucagon if resistant brady/hypotension amenable to charcoal
57
what is the primary presentation of CCB abuse
bradycardia with hypotension - no QRS prolongation initially + hyperglycemia
58
what is treatment of CCB abuse
ACLS alorithsm calcium chloride or gluconate to counter redcued contractility insulin and glucose vasopressors for sock amenable to CCB
59
what are withdrawal symptoms of Marjuana
irritability, difficulty sleeping, decreased appetite, anxiety
60
what are withdrawal symptoms from opioids
restlessness, pain, insomnia, d/v, cold flashes, leg movements

Clin Med IV: Emergency Medicine (18 decks)

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