Emergency Med Flashcards
(55 cards)
Gastric lavage is rarely done for toxic ingestions and is CI in which 2 cases?
- AMS - risk of aspiration
2. Caustic ingestion: more burns of the esoph/oropharynx
Is ipecac ever used in the ED for toxic ingestions?
NO (needs 15-20 mins to work and you can’t give antidote during this time!)
Are cathartic agents like sorbitol ever used for toxic ingestions?
NO (does not elim ingestion w/out absorprtion)
Is forced diuresis (fluids + diuretics) ever done in toxic ingestions to increase urinary excretion?
NO– causes pulm edema
When is whole bowel irrigation (WBI) (use of laxatives like goLytely, PEG solutions) used for toxic ingestions? (3 cases)
- massive iron ingestion
- lithium
- Swallowing drug filled packets (smuggling)
If the answer is not clear as to what someone O/Dd on, you should guess…
ASA or acetaminophen– most common causes of death!
Best initial management of AMS of unclear etiology after drug intox is…
- narcan (naloxone)
- dextrose
Opioid ingestion and DM w/hypoglycemia are extremely common. Naloxone and glucose work instantaneously and have no adverse effects. if they don’t work —> intubate
if narcan and dexrose don’t work after toxic ingestion and person has AMS of unclear etiology you should…
intubate
what is the risk of using flumazenil in BDZ O/D?
BDZ O/D is not fatal, but you can have seizures from acute withdrawal. If you give flumazenil, there’s a chance of seizures from acute withdrawal. Also, if it’s polysubstance intox, BDZ might be preventing seizures caused by other substances (like TCAs). Once BDZs are reversed –> seizures
charcoal can be given o who with a pill O/D?
ANYONE– not dangerous. That said, it does not bind heavy metals (iron, lithium, etc)
What is the toxic amt of acetaminophen?
> 8-10g
txt for toxic amts of acetaminophen?
N-acetylcysteine (NAC)
how do you txt acetaminophen O/D that occurred >24 hrs ago?
you don’t– do nothing!
if amount of acetaminophen ingestion = unclear then you should…
get a drug level (pretty sure this is most accurate 4 hours post ingestion)
does charcoal make NAC innefective in tylenol O/D?
NO
6 common signs of ASA O/D
- tinnitis
- hypervent
- Resp alk (from hypervent) and metabolic acidosis from lactate (intereferes w/oxidative phosphorylation –> anaerobic gluc metab)
- Renal tox
- AMS
- Increased Anion Gap (metabolic acidocis) from salicylates
Txt of ASA tox?
Na-bicarb –> alkalinizes urine –> increases urinary excretion
blood gas i/s/o ASA tox?
mild alk pH (7.45) from resp alk (low CO2)
low bicarb from lactic acidosis (metabolic acidosis)
If TCA tox is suspected you should…
GET EKG, look for QRS prolongation/QT prolongation/torsades
Main Sx of TCA O/D (3)
- seizure
- arrhythmias (torsades)
- antichol: constipation, dry mouth, urinary retention
TXT of TCA O/D? how does it work?
NA-bicarb– protects heart from arrhythmia (unlike ASA where it alkalinizes urine and increases urinary excretion of ASA)
should you try to neutralize caustic ingestions w acidic/basic solutions?
NO– causes heat release from exothermic rxn/makes it worse!
how do you txt caustic (acidic or basic) ingestions?
flush with water, endoscopy to see damage/look for stricture!
Gas heaters, wood burning stoves, automobile exhaust, fires all makes you worry about…
CO poisoning
