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Environment and Toxicology Emergencies Flashcards

1. Explain the concepts related to care of an emergency department patient experiencing an environment and toxicology emergency. 2. Describe the various patient presentations related to environment and toxicology emergencies. 3. List interventions necessary for a patient presenting with an environment and toxicology emergency. (277 cards)

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1
Q

types of burns

A

chemical
electrical
radiation
thermal

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2
Q

pathophysiology of first 24 hours of burns

A

coagulation necrosis of soft tissue leading to release of vasoactive substances

capillary wall compromised, increase in permeability

vasodilation

edema peaks at 24 hours, next 18-24 hours cap permeability normalizes and third spacing resolves

fluid loss

altered tissue perfusion, airway swelling, hypovolemia leading to hypovolemic shock, decreased CO, cellular chock

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3
Q

assessing burns

A

ABCDE - trauma patients

modified for properties of causative agent and resulting injury

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4
Q

safety in burn treatment

A

decontamination
isolation
PPE

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5
Q

airway in burn tx

A

cervical spinal motion restriction

modified jaw-thrust maneuver to open airway and stabilize c-spine in neutral alignent

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6
Q

indictions for early intubation in burn patients

A 
agitation, decreased LOC
hoarseness, stridor, vocal change
progressive edema
oral, nasal erythema
can't handle secretions
extensive facial burns
carbonaceous sputum

NOT singed nasal hair alone

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7
Q

airway risks d/t burns

A

risk for obstructed airway
inhalation injury
cric or trach may be needed

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8
Q

breathing in burn tx

A

supplemental O2
CO or cyanide poisoning
circumferential burns

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9
Q

tx for circumferential burns

A

chest wall escharotomy
electrocautery
fasciotomy

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10
Q

circulation sx in burns

A

profound hypovolemia
hypovolemic shock
decreased CO
cellular shock

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11
Q

treatment of cellular shock in burns

A

IVs, careful fluids with LR
monitor I/O, cardiac output
BP cuffs and art lines may be unreliable

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12
Q

complications of cellular shock in burns

A

fluid shifting
mostly first 4-6 hours for 24+ hours

hypovolemic shock likely if >20% burned

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13
Q

disability assessment in burns

A

generally alert

if not, assess for other injurie

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14
Q

exposure assessment in burns

A

stop burning process
keep patient warm
cover with clean, dry sheet
no ice or cold fluids

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15
Q

chemical burns overview

A

powders, gases, liquids

inhalation, ingestion, skin contact

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16
Q

safety in treating chemical burns

A

PPE, isolation

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17
Q

treatment for chemical burns

A

remove clothing
brush of dry powders

irrigate with copious water for 15 min until pt reports burning has stopped

use material data safety sheets, poison control, toxicologist

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18
Q

special substance considerations with chemical burns

A

metallic lithium
sodium
K+
magnesium

react poorly with water and may potentiate injuries

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19
Q

acid burns

A

coagulation of tissue causing necrosis

generally more damaging to stomach

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20
Q

common acidic chemicals that cause burns

A

battery acid
inegar
sulfuric acid

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21
Q

alkaline burns

A

penetrate deeply into tissue and liquefy tissue

more damaging to esophagus

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22
Q

common alkaline chemicals causing burns

A

lye/drain cleaner
alkaline batteries
baking soda
ammonia

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23
Q

sx chemical ingestion burns (acidic or alkaline)

A 
oral burns
red, white, yellow
maybe bleeding
drooling, vomiting
stridor, hoarse voice
SQ emphysema
abd pain, distention
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24
Q

intervene for chemical ingestion

A

strict NPO
do not induce vomiting
toxicologist

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25
characteristics of hydrofluoric acid
fluoride ion seeks Ca systemic toxicity clear, colorless liquid corrosive, toxic used during oil refinement and precursor to many chemicals
26
sx hydrofluoric acid exposure
``` depends on concentration usually affect digits pain worsens as it penetrates tetany Chvostek sign Trousseau sign dysrhythmias ```
27
Chvostek sign
spasm or twitch of facial muscle elicited by tapping facial nerve in region of parotid gland
28
Trousseau sign
sign of latent tetany in which carpal spasm can be elicited by compressing the upper arm with tourniquet or blood pressure causing ischemia to distal nerves
29
assessing hydrofluoric acid exposure
EKG | serum Ca, sx hypocalcemia
30
intervene for hydrofluoric acid exposure
analgesics | 2.5% calcium gluconate
31
how to use calcium gluconate for hydrofluoric acid exposure
combine 1 ampule Ca gluconate with 100 g water-soluble lubricating jelly cover with plastic dressing hold in place
32
mechanisms of thermal burns
``` scald flame flash contact tar steam ```
33
intervene for thermal burns
stop burning process < 10%: moist, cool dressings ``` >10%: dry, sterile dressings or clean sheet maintain body temp protect wounds avoid breaking blisters no topical agents ```
34
tar/asphalt burns
adheres to skin creates tough barrier, difficult to remove tar may continue to burn skin
35
intervene for tar/asphalt burns
``` stop burning fat emollient to loosen tar abx ointment citrus-based products peel off cool tar treat underlying burns as thermal ```
36
Rule of 9s to estimate burn size
surface area of each section of body is a multiple of 9 perineum = 1% head = 18% in children, 9% in adults
37
palm method to estimate burn size
better for scattered burns patients hand = 1% TBSA
38
depths of burns
superficial partial thickness (1st degree) deep partial thickness (2nd) full thickness (3rd and 4th)
39
tissue affected by depth of burn
1st: epidermis (superficial) 2nd: epidermis, partial dermis 3rd: entire epidermis, dermis destroyed 4th: underlying fat, fascia, muscle and/or bone affected
40
sx of burns based on depth
1st: redness, hypersensitivity, pain 2nd: red, blistered, wet, weepy, whiter, edematous 3rd: whitish or charred, coagulated vessels may appear 4th: often similar to 3rd
41
healing of burns based on depth
1st: heals on its own in days without scarring 2nd: may heal spontaneously over 2-3 weeks, minimal scarring 3rd: scar formation, skin grafting 4th: scar contracture formation, skin grafting, surgical intervention
42
fluid resuscitation in burns overview
only deep partial and full thickness burns in calculations, do not include 1st degree LR time fluid resuscitation for first 24 hours after injury
43
Parkland formula for burn fluid resuscitation
4mL LR x BSA % x kg half of volume in first 8 hours other half in next 16 hours
44
ABLS: advanced burn life support guidelines
adults (thermal, chemical) 2ml LR x kg x %BSA adults (high voltage) 4mL LR x kg x %BSA accounts for renal damage peds 3mL LR x kg X %BSA
45
pediatric considerations in fluid resuscitation for burns
``` greater BSA/kg impaired thermoregulation limited glycogen stores thinner skin, deeper burns small airway, less edema for obstruction lower to ground, inhalation scald burns most common consider abuse, neglect ```
46
characteristics of carbon monoxide
may be associated with burn injuries or might be separate colorless, odorless, tasteless byproduct of organic material combustion hemoglobin binding affinity 200+ x greater than O2
47
sx CO poisoning: 10-20%
``` HA n/v loss of coordination flushed skin dyspnea ```
48
sx CO poisoning: 20-40%
confusion lethargy visual changes angina
49
sx CO poisoning: 40-60%
arrhythmias sz coma
50
sx CO poisoning: over 60%
cherry-red skin death Cheyne-Stokes respirations
51
carboxyhemoglobin levels in CO poisoning
amount of CO bound to Hg is associated with pt presentation smoker can have baseline increased level
52
assessing CO poisoning
SpO2 unreliable need carboxyhemoglobin level
53
intervene for CO poisoning
high-flow oxygen for at least 4 hours via nonrebreather to reduce CO half-life severe exposures require burn center transfer and/or hyperbarics
54
define electrical burns
surface wounds usually small but there are severe internal injuries caused by current flow, arc flash, or clothing ignition
55
sx low voltage electrical burns
delayed pain onset | fatal dysrhythmias
56
sx high voltage electrical burns
tissue heated immediately with tissue necrosis arrhythmias compartment syndrome rhabdo hypovolemia
57
intervene for electrical burns
``` EKG LR 1-2 L/hr I/O -adults 75-100 ml/hr -peds: 1ml/kg/hr ```
58
black widow spider characteristics
red hourglass on abdomen dark, secluded, damp spaces almost always one bite
59
sx black widow spider bite
``` pain at time of bite halo ring large muscle cramps HTN, tachycardia N/V paresthesia, weakness ```
60
intervene for black widow spider bite
``` ice, elevate tetanus muscle relaxants antihistamines (sustemic edema) antivenin with caution ```
61
characteristics of brown recluse spider
dark, violin-like spot dark, undisturbed places nocturnal southern US
62
sx brown recluse spider bite
``` painless at time of bite bluish, irregular ring pruritus, blisters, redness edema F/C, N/V malaise, myalgia necrotic ulcerating wound eschar ```
63
intervene for brown recluse spider bite
ice, elevate tetanus wound care
64
snake pupils
venomous: elliptical (minus coral snakes) nonvenomous: round
65
snake bites
venomous: two fangs, produce punctures nonvenomous: several rows of small teeth, produce scratches
66
snake head shapes
venomous: triangular d/t venom glands nonvenomous: rounded
67
presence of pit between eye and nostril in snakes
venomous: yes, in pit vipers nonvenomous: no
68
tail in snakes
venomous: single row of subcaudal plates nonvenomous: double row
69
snakes that produce hemotoxic venom
pit vipers rattlesnakes copperheads cotton mouths
70
snakes that produce neurotoxic venom
coral snakes
71
local rxn to hemotoxic snake venom
``` rapid pain redness, swelling ecchymosis loss of limb fxn severe tissue necrosis ```
72
systemic rxn to hemotoxic snake venom
``` tachycardia, tachypnea, dyspnea constricted pupils ptsos, diplopia muscle twitch, paresthesias difficulty speaking confusion bleeding disorders ```
73
sx neurotoxic snake venom
bite less red and swollen effects can delay up to 12 hrs general: local paresthesais, diplopia, ptosis, difficulty swallowing resp: resp distress, pharyngeal spasm, hypersalivation, cyanosis, trismus
74
interventions for dry snake bites
no venom | abx and tetanus
75
interventions for envenomation snake bites
``` + venom IV prior to tourniquet removal immobilize, raise limb monitor for compartment syndrome consider antivenin ```
76
antivenin
ideally w/in 4 hours effective up to 24 hrs availability: Crotalid, poison center monitor for anaphylaxis
77
tick removal
forceps close to skin and mouth of tic remove, pulling straight back to counter direction entered remove like splinter if parts remain do not squeeze or crush save for species identifiation
78
early sx Lyme disease
erythema migrans rash (in70-85%) circular (bullseye) rash w/ flu-like sx
79
late sx Lyme disease
``` monoarticular arthritis multiple skin lesions Bells palsy memory loss meningitis heart block myocarditis painful arthritis ```
80
intervene for lyme disease
abx: oral doxy bid x 2 weeks salicylate for pain pacemaker for heart block
81
sx Rocky Mountain spotted fever
fever, chills HA rash incubates 2-14 days
82
rash in Rocky Mountain spotted fever
maculopapular, nonpruritic spots on soles, ankles, palms, wrists, forearms becomes nonblanching and petechial spreads in centripetal fashion
83
complications of Rocky Mountain spotted fever
renal failure thrombocytopenia hyponatremia impaired liver fxn
84
intervene for Rocky Mountain spotted fever
doxycycline
85
characteristics of rabies
viral disease transmitted via bite of rabid animal via saliva bats, raccoons, skunks, foxes
86
sx of initial stage of rabies
parethesia, pain, itching
87
sx of prodromal stage of rabies
``` HA, fever runny nose, sore throat myalgia GI sx acute, progressive encephalitis hydrophobia, aerophobia ```
88
intervene for rabies
early, aggressive wound management with soap and water use sunlight to dry and sterilize contaminated materials
89
characteristics of stingrays
1+ venom-coated barbed stingers on tail for self-defense can cause painful injuries, esp to lower extremities if entering their territory
90
sx stingray sting
severe pain, swelling, bleeding at site possible systemic effects that could be life threatening
91
intervene for stingray sting
``` hot water immersion for 2 hrs pain management tetanus barb removal wound irrigation wound cultures, abx ```
92
characteristics of jellyfish
nematocysts are stinging darts that fire when tentacles make contact
93
sx jellyfish stings
local moderate to severe pain reddened welts
94
intervene for jellyfish stings
``` irrigate remove tentacles with ppe pain management acetic acid aka vinegar baking soda paste ``` cold or heat not determined, depends on species
95
define contact dermatitis
allergic rxn after exposure to urushiol oils from poison ivy, oak, and sumac
96
intervene for contact dermatitis
OTC topical agents or benadryl sx may be worse with inhalation or existing allergy avoid contact standard wound care, allergy tx based on severity
97
characteristics of giardia
protozoan parasite that causes giardiasis lives in intestines
98
transmission of giardia
spread by water contaminated with fecal matter
99
sx giardia
``` diarrhea, steatorrhea abd cramping bloating weight loss malabsoprtion ```
100
intervene for giardia
rehydrate metronidazole, tinidazole, nitazoxanide
101
characteristics of tapeworms
taeniasis caused by Taenia | 2-25 meters
102
transmission of tapeworms
raw/undercooked beef or pork
103
sx tapeworm
``` GI discomfort nausea flatulence diarrhea hunger pains may pass proglottids (tapeworm parts) ```
104
intervene for tapeworm
praziquantel
105
characteristics of pinworms
small, thin, white roundworm lives in colon/rectum females may leave through anus whle person sleeps to lay eggs
106
transmission of pinworms
oral-fecal
107
sx pinworm
mild sx or none | anal itching
108
diagnosing pinworm
tape test
109
intervene for pinworm
mebendazole, pyrantel pamoate, albendazole
110
types of lice
pediculus humanus capitis (head) pediculus humanus corporis (body) pthirus pubis (pubic)
111
transmission of lice
person to person
112
sx lice
itching, sores from scratching | sleeplessness
113
intervene for lice
topical meds, shamppoo combine wash clothes, linens, combs in hot water vacuum floor, furniture
114
define scabies
itch mite that buries in upper layer of skin
115
transmission of scabies
direct, prolonged skin to skin contact
116
sx scabies
intense pruritus, esp at night papular itchy rash vesicles, scales key areas: hands and other moist areas (axilla, groin)
117
intervene for scabies
premethrin cream head to toe and again one week later crotamiton lotion/cream, not for children wash clothes, linens in hot water thoroughly clean, vacuum rooms
118
transmission of ringworm/tineas
spread to people and animals via fomites
119
sx ringworm/tineas
circular, red, scaly, itchy rash central clearing
120
intervene for ringworm/tineas
tineas pedis, corporis, cruris (feet, body, groin): otc/topical antifungal tineas capitis (scalp): systemic antifungal (griseofulvin, terbinafine)
121
define arterial gas embolism
high-pressure air forced into arterial circulation
122
complications of arterial gas embolism
trapped air in lung expands, leading to rupture of lung tissue, releasing gas bubbles into arterial circulation
123
causes of arterial gas embolism
divers ascending too quickly, panicky, or while holding breath also normal ascents with COPD
124
sx arterial gas embolism
``` chest tightness, dyspnea pink, frothy sputum pneumothorax sx limb paresthesia vertigo altered LOC visual disturbances SZs sensory loss ```
125
intervene for arterial gas embolism
O2 needle decompression hyperbarics avoid Trendelenburg
126
define decompression sickness
bubbles growing in tissues causing local damage aka "the bends" due to inadequate decompression after exposure to increased pressure
127
pathophysiology of decompression sickness
during diving, nitrogen absorbed by body tissues but during ascent if pressure is reduced too quickly, the nitrogen forms bubbles and enters bloodstream
128
sx decompression sickness
``` sob, crepitus, cough numbness, tingling HA visual loss, diplopia fatigue, dizziness, unconsciousness, SZs paresthesias, paralysis joint discomfort, progressive pain ```
129
intervene for decompression sickness
O2, fluids, analgesia urgent hyperbarics consider antiplatelet, antithrombin meds and heliox (helium-oxygen)
130
define heat cramps
sweat-induced electrolyte depletion r/t intense physical activity and hot environment
131
sx heat cramps
``` muscle cramps weakness thirst nausea tachycardia pale, cool, moist skin ```
132
intervene for heat cramps
electrolyte replacement cool environment rest
133
define heat exhaustion
prolonged period of fluid loss r/t exposure to warm environment without fluid and electrolyte replacement left untreated, may progress to heatstroke
134
sx heat exhaustion
``` rapid onset of heat cramps anorexia, vmoiting general malaise muscle incoordination HA, syncope temp normal to elevated (98.6-104) ```
135
intervene for heat exhaustion
IV fluid, electrolytes cool environment rest
136
define heat stroke
temp at or above 105.8F or 40C CNS, cardiac, cellular fxns affected
137
causes of heat stroke
strenuous physical activity in hot environment and unable to dissipate body heat non-exercise induced
138
non-exercised induced causes of heat stroke
young and elderly more vulnerable environmental med related: - thyroid - sympathomimetics - haldol - antihistamines - anticholinergics - propanolol
139
sx heat stroke
``` rapid onset N/V/D hot, dry skin tachycardia, tachypnea decreased LOC posturing, SZs, dilated/fixed pupils hypotension, decreased urinary output coagulopathies ```
140
intervene for heat stroke
``` cool rapidly room temp IV fluids monitor electrolytes, clotting I/Os control shivering (benzos) ```
141
define frostbite
type of burn injury d/t formation of ice crystals in tissue, leading to cellular damage, vasospasms, arterial thrombosis
142
frostbite overview
damage to cells irreversible days to weeks to determine extent of underlying damage may be associated with hypothermia
143
sx frostbite
burning, numbness, tingling white, waxy skin color stinging, hot feeling after thawing blisters
144
intervene for frostbite
``` assess for hypothermia analgesia circulating water immersion debride nonhemorrhagic blisters gently handle tissue loose, bulky clothing tetanus ```
145
tissue handling in frostbite
do not rewarm or thaw if there is a possibility of re-freezing frozen tissue should never be rubbed because further tissue damage will occur
146
characteristics of mild frostbite
``` brief exposure, early rewarming bright red or normal skin color warm digits sensation clear blisters blisters to digit tips ```
147
characteristics of deep frostbite injury
prolonged exposure, delayed rewarming ``` mottled/purple skin cool digits no sensation hemorrhagic blisters proximal blisters only ```
148
primary cause of hypothermia
ambient environment
149
secondary cause of hypothermia
medical condition that decreases body temperature
150
mild hypothermia
``` 90-95F vasoconstriction shivering cold sensation coagulopathy ```
151
moderate hypothermia
``` 82.4-90F bradycardia confusion, agitation metabolic acidosis cold-induced diruesis ```
152
severe hypothermia
68-82.3F coma resp depression profound hypovolemia
153
profound hypothermia
68F apnea asystolic arrest
154
intervene for hypothermia
passive rewarming active external rewarming active internal rewarming
155
passive rewarming for hypothermia
dry skin, remove wet clothing warm environment
156
active external rewarming for hypothermia
forced-air warming system | warm water immersion
157
active internal rewarming for hypothermia
``` warm IV fluids heated, humidified oxygen peritoneal lavage w/ heated dialysate rapid fluid infuser cardiac bypass, HD ```
158
complications of hypothermia
refractory v.fib until rewarmed other dysrhythmias
159
cardiac dysrhythmias in hypothermia
a.fib osborn or J waves bradycardia v.fib
160
intervene for cardiac dysrhythmias in hypothermia
volume replacement rewarm body core before periphery to prevent rewarming shock (leads to fibrillation) caution with IV meds
161
induced emesis s/p ingestion
not routinely used serious side effects marginally effective
162
contraindications for activated charcoal s/p ingestion
corrosive agent, hydrocarbons decreased/absent bowel sounds toxins not bound by charcoal
163
toxins that are not bound by activated charcoal
``` iron lead lithium toxic alcohols caustics ```
164
dosing activated charcoal
multidosed for: - extended release meds - carbamazepine - dapsone - quinine - theophylline - enteric coated tablets q4-6 hr for 12-24 hrs
165
indications for gastric lavage s/p ingestion
life-threatening poisons symptomatic pts w/in 1 hr ingestion or who ingested agent that slows GI motility ingestion of sustained-release meds or massive or life-threatening amounts of a substance
166
cathartics s/p ingestion
magnesium sulfate, magnesium citrate, sorbitol added to activated charcoal to enhance GI elimination contraindicated if bowel sounds are absnet
167
whole bowel irrigation s/p ingestion
electrolyte solution most common for ingested agents not well absorbed by charcoal contraindicated in GI pathology
168
indications for HD s/p ingestion
severe poisonings with sx: - metabolic acidosis - electrolyte abnormalities - renal failure
169
contraindications for HD s/p ingestion
``` substance highly protein-bound rarely fatal agents agents with antidotes HD unstable pts bleeding disorders poor vascular access ```
170
define toxidrome
set of toxic sx caused by particular class of medication
171
define sympathomimetic toxidrome
mimic neurotransmitters of SNS | epi, dopamine, norepi, catecholamines
172
drugs that are sympathomimetic
``` cocaine amphetamines methamphetamine ephedra alkaloids MDMA, ecstasy albuterol dopamine tricyclic antidepressants MAOIs ```
173
sx sympathomimetic toxidrome
``` HTN, tachycardia, tachypnea hyperthermia CNS excitation tremors, SZs hyperreflexia mydriasis diaphoresis ```
174
intervene for sympathomimetic toxidrome
sedation nonpharm cooling BP, pulse control pharm management
175
pharm management of sympathomimetic toxidrome
benzos nitroprusside haldol neurmuscular blocks
176
complications of cocaine overdose
``` ventricular arrhythmias MI, aortic dissection rhabdo, lactic acidosis hyperglycemia SZs, strokes placental abruption, premature delivery nasal septum perforation ```
177
intervene for cocaine OD
same as sympathomimetic toxidrome but consider condition-specific complications
178
sedative-hypnotic toxidrome
barbiturates depress CNS and may be classified as sedatives non-barbituates may be considered hypnotics
179
types of barbituates
phenobarbital | thiopental
180
types of nonbarbituates
benzos | antihistamines
181
sx sedative-hypnotic toxidrome
hypotension, bradycardia bradypnea hypothermia arrhythmias
182
intervene for sedative-hypnotic toxidrome
``` aspiration precautions early intubation beta-adrenergic agonists flumazenil for benzos antiarrhythmics ```
183
cholinergic toxidrome
cholinergic drugs mimic or enhance action of acetylcholine of PNS and have muscarinic and nicotinic effects
184
examples of cholinergic substances
``` pesticides/insecticides organophosphates (sarin) pilocarpine bethanechol choline some mushrooms ```
185
sx cholinergic toxidrome
``` SLUDGE: salivation lacrimation urination defecation GI upset emesis ```
186
intervene for cholinergic toxidrome
control hypoxemia 2nary resp distress atropine 2PAM (Pralidoxime) benzos for SZs
187
pralidoxime (2PAM)
for cholinergic toxidrome restores action of acetylcholinesterase to break down acetylcholine administered with atropine to dry secretions
188
anticholinergic toxidrome
blocks acetylcholine and inhibits parasympathetic nervous system
189
types of anticholinergic medications
``` antihistamiens tricyclic antidrepressants cyclobenzaprine antispasmodics mydriatics ipratropium bromide atropine antiparkinson meds ``` also nightshade (Bella Donna) and Jimson weed (Devil's snare)
190
mnemonic to remember anticholinergic toxidrome
``` blind as a bat mad as a hatter red as a beet hot as Hades dry as a bone bowel and bladder lose their tone heart runs alone ```
191
sx anticholinergic toxidrome
``` HTN, tachycardia tachypnea, hyperthermia mydriasis decreased bowel sounds dry mucous membranes, flushing urinary retention agitation, delirium, hallucinations ```
192
intervene for anticholinergic toxidrome
``` sedate with benzos cooling haldol physostigmine slow IV pushes continuous EKG/tele ```
193
physostigimine
for cholinergic toxidrome PNS alkaloid that inhibits cholinesterase rapid administration can result in resp failure and heart paralysis
194
opioid toxidrome
opiates and narcotics that depress CNS
195
sx opioid toxidrome
respiratory, CNS depression miosis hypotension, bradycardia bradypnea, hypothermia
196
intervene for opioid toxidrome
intubate, ventilate narcan -duration 30-60 min -repeat dose may be needed
197
opiate withdrawal
sudden cessation of opiates after physical dependence
198
types of opiates
``` heroin morphine hydrocodone oxycodone codein ```
199
sx opiate withdrawal
``` rhinorrhea, sneezing, yawning lacrimation abd, leg cramps N/V/D dilated pupils ```
200
assessing opiate withdrawal
last dose route of use tox screen
201
intervene for opiate withdrawal
supportive care benzos for cramps, anxiety, insomnia clonidine for lacrimation, diarrhea, tachycardia opioid substitute (methadone)
202
types of hallucinogenic
LSD PCP GHB (date rape drug)
203
sx LSD toxidrome
sympathomimetic effects euphoria fear, anxiety, panic hallucinations, paranoia, psychosis
204
intervene for LSD toxidrome
reduce stimulation restraints for safety benzos for agitation haldol for psychosis
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sx PCP toxidrome
``` violent, combative behavior increased strength lack of pain sensation nystagmus miosis ```
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intervene for PCP toxidrome
``` reduce stimulation benzos for agitation haldol for psychosis antihypertensives restraints ```
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sx GHB toxidrome
depressed LOC to coma with significant resp depression hypertension, bradycardia SZ
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intervene for GHB toxidrome
intubate, ventilate benzos for agitation sexual assault kit
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toxic inhalants
toxic ingestion via lungs
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methods of using toxic inhalants
sniffing - inhaling from container huffing - soaking cloth in solvent and inhaling bagging - fumes from a bag
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types of toxic inhalants
``` aerosols gases solvents cleaning products food products ```
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sx toxic inhalation
``` sudden sniffing death CNS stimulation or depression arrhythmias, cardiac arrest eye, resp, GI irritation wheezing ataxia with wide gait epistaxis burns long term use = organ damage ```
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intervene for toxic inhalation
well-ventilated space decontaminate intubate, ventilate benzos
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interventions for alcohol ingestion in general
intubate, ventilate HD monitor for Wernicke-Korsakoff syndrome
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tx for ethylene glycol or methanol ingestion
ethanol or fomepizole to block metabolism of ethylene glycol and methanol fomepizole preferred, don't need to monitor for low BG and can be given with HD sodium bicarb for acidosis
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tx for ethanol specific ingestion
IV fluids monitor BG nutritional support (B1, thiamine)
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Wernicke-Korsakoff syndrome
``` in alcohol ingestion lack of vitamin B1 mental confusion taxia ophthalmoplegia ```
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sx alcohol withdrawal/DT
``` AMS, confusion, disorientation hallucinations, agitation tremors tachycardia, tachypnea, HTN hyperthermia ```
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delirium tremens
tremors hallucinations anxiety disorientation
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intervene for alcohol withdrawal/DT
benzos | antispychotics
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types of alcohol
ethanol isopropanol ethylene glycol methanol
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characteristics of ethanol
alcohol beverages least toxic leads to intoxication
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characteristics of isopropanol
rubbing alcohol less toxic than others metabolite is acetone
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sx isopropanol ingestion
fruit breath odor 2/2 acetone hyperglycemia urine ketones CNS depression
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characteristics of ethylene glycol
antifreeze, deicing agents odorless, syrupy liquid with sweet taste
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sx ethylene glycol ingestion
``` intoxication tachycardia, HTN hyperventilation metabolic acidosis renal failure ``` large doses: nystagmus, ataxia, SZs, coma
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characteristics of methanol
windshield wiper fluid, canned fuels, solvents light, volatile, flammable sweeter than ethanol
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sx methanol ingestion
similar to ethanol but 10-30 hrs later metabolites cause profound metabolic acidosis, destroy optic nerve N/V abd pain
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iron ingestion
usually via nutritional supplements
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assessing iron ingestion
multiple types of iron - specify type and amount 40-60mg/kg of elemental iron causes severe sx
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intervene for iron ingestion
``` gastric lavage NO activated charcoal whole bowel irrigation serum iron level hypovolemic shock tx chelation with deferoxamine ```
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deferoxamine
tx for iron ingestion via chelation turns urine pink - continue tx until urine color normal
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initial stage of heavy metal toxicity
0-2 hours N/V, abd pain hematemesis, bloody stools hypotension
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second stage of heavy metal toxicity
2-48 hrs GI disturbances resolves dehydration
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third stage of heavy metal toxicity
48-96 hrs metabolic acidosis, coagulopathy hemorrhage, shock hepatic, renal failure
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define cyanide
cellular asphyxiant
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sources of cyanide
industrial processes terrorism foods byproduct of long-term nitroprusside
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sources of industrial cyanide
insecticides industrial fumigants metal plating plastic burning
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sources of cyanide in food
apricot pits orange seeds cassava
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types of cyanide exposure
inhalation dermal ingestion parenteral common byproduct of fires
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sx cyanide poisoning
``` hypoxia, resp distress HA, dizziness, SZs metabolic acidosis arrhythmias, hypotension burning sensation in mouth bitter almond breath ```
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intervene for cyanide poisoning
``` 15 LMP nonrebreather amyl nitrate intubate, ventilate sodium nitrite sodium thiosulfate decon vasopressors benzos ```
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why is it easy to OD on acetaminophen?
found in many OTC and Rx meds in which it is not obvious that the med contains acetaminophen
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pathophysiology of acetaminophen toxicity
toxic to liver in small doses metabolites destroy liver cells which leads to necrosis and damage toxicity at levels > 140 mg/kg alcohol abuse or liver disease at increased risk
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intervene for acetaminophen toxicity
gastric lavage if recent or above 7.5 grams activated charcoal level 4 hours after ingestion contact poison center for chronic ingestion or past 24 hours N-acetylcysteine if toxic level
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administration of N-acetylcysteine for acetaminophen ingestion
within 8 hours of ingestion for best results can be started up to 24 hours after poisoning
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sx of acetaminophen ingestion at 0-24 hours
malaise nausea diaphoresis
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sx of acetaminophen ingestion at 24-48 hours
RUQ pain elevated LFTs decreased urine
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sx of acetaminophen ingestion at 72-96 hours
``` malaise hypoglycemia jaundice, enlarged liver coagulopathies coma ```
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sx of acetaminophen ingestion at 7-8 days
recovery with potential liver damage
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type of salicylate
aspirin
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salicylate toxicity
``` CNS hematologic cardiovascular gastrointestinal acid-base electrolyte status ```
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sx salicylate toxicity
``` tachypnea, tachycardia N/V/abd pain diaphoresis, fever, dehydration tinnitus hypoglycemia electrolyte imbalance AMS, SZs hemorrhagic gastritis coagulation abnormalities ```
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intervene for salicylate toxicity
``` fluids, I/O, electrolyte monitoring HD activated charcoal sodium bicarb tx hypoglycemia repeat labs q 6-12 hrs ```
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indications for HD in salicylate toxicity
``` severe poisonings renal failure serum levels > 75 mg/dL decreased renal fxn significant acidosis severe fluid/electrolyte disturbances ```
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NSAIDs overview
analgesics, antipyretics, antiinflammatories ibuprofen, naproxen safer than acetaminophen, less likely to be toxic
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NSAID toxicity
acute ingestion under 100 mg/kg is not toxic over 300 mg/kg is severe
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sx NSAID toxicity
``` drowsiness, lethargy, SZs GI irritation renal failure, hepatotoxicity apnea metabolic acidosis ```
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intervene for NSAID toxicity
monitor gastric lavage actvated charcoal SZ precautions, benzos
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characteristics of tricyclic antidepressants
peripheral anticholinergic and CNS effects
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pathophysiology of tricyclic antidepressant toxicity
false low Na levels d/t being highly protein bound and lipid soluble Na channel blockade cannot be removed via HD long elimination half-life
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sx of tricyclic antidepressant toxicity
cardiotoxicity adrenergic compromise anticholinergic activity
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cardiotoxicity in tricyclic antidepressant toxicity
``` tachydysrthymias prolonged PRI, QT wide QRS hypotension AV bocks ```
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adrenergic compromise in tricyclic antidepressant toxicity
decrease LOC syncope SZs coma
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anticholinergic activity in tricyclic antidepressant toxicity
``` tachycardia dry mouth urinary retention hyperthermia mydriasis ```
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intervene for tricyclic antidepressant toxicity
``` intubate gastric lavage activated charcoal cathartic agents sodium bicarb for pH isotonic fluids vasopressors, benzos prn ```
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overview of beta blocker and calcium channel blocker toxicity
negative chrono-, dromo-, and inotropic effects severe pediatric toxicity with one tablet sx may have rapid progression and be resistant to conventional therapy onset may be late
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sx beta blocker/calcium channel blocker toxicity
``` bradycardia, hypotension cardiac conduction abnormalities confusion, AMS, syncope SZs, coma N/V hyperglycemia (CCB), hypoglycemia (BB) ```
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intervene for beta blocker/calcium channel blocker toxicity
``` gastric lavage activated charcoal pacing for refractory brady glucagon calcium chloride atropine vasopressors correct glucose abnormalities ```
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use of glucagon in beta blocker/calcium channel blocker toxicity
positive ino- and chronotropic effects antidote for meds that reduce intracellular Ca
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use of calcium chloride in beta blocker/calcium channel blocker toxicity
calcium gluconate contraindicated due to decreased bioavailability of calcium
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digoxin overview
negative chronotropic positive inotropic meds and plants
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risk of digoxin toxicity
concurrent use of other cardiac meds or diuretics presence of hypokalemia
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acute sx digoxin toxicity
peak 30 min to 12 hrs arrhythmias, hypotension hyperkalemia lethargy, coma
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chronic sx digoxin toxicity
anorexia N/V yellow/green halos
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intervene for digoxine toxicity
serum levels activated charcoal treat electrolyte, glucose, volume abnormalities atropine or TCP for brady monitor K+, arrhythmias, CHF digoxine-immune fab antidote
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indications to use digoxin-immune fab antidote in digoxin toxicity
large ingestion in previously health adults (10 mg) bradycardia refractory to atropine ventricular arrhythmias levels above 10 ng/mL hyperkalemia over 5.5

CEN (12 decks)

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