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Poison/Toxicology > Exam 3 > Flashcards

Exam 3 Flashcards

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1
Q

Tetanus prophylaxis vaccines

A
  • Tdap or Td
  • Give if it ws given >5 yrs ago
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2
Q

4 Don’ts in general bite management

A
  1. Suck the venom out
  2. Apply a tourniquet or pressure bandages
  3. Drain the bite site
  4. Capture the snake & bring it to the ED
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3
Q

Pit Vipers head, fangs

A
  • Triangle shaped, vertically elliptical pupils, heat-sensing pit behind nostrils
  • Front, mobile fangs, small row of teeth, persistent reflexes
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4
Q

PV Venom effects 3

A
  1. Local tissue damage
  2. Coagulopathies
  3. Neurotoxic
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5
Q

PV diagnosis

A
  • Quantify swelling: distance from bite, circumference
  • Lab monitor: CBC, platelets, PT/INR, aPTT, fibrinogen…
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6
Q

PV management

A
  • ABCs
  • Maintain limb at heart level
  • Pain: IV opioids, avoid NSAIDs, icepacks
  • Life-threatening bleeding: blood products + antivenom
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7
Q

PV antivenom indication

A
  1. Progression of local tissue damage
  2. Coagulopathy: PT >15 s, fibrinogen <150, platelets <150K
  3. Systemic signs: HoTN, anaphylaxis, neurotoxicity
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8
Q

PV FabAV (CroFab): allergy, initial dose, maintenance dose

A
  • Latex, papaya, pineapple, papain, bromelain, sheep
  • 4-6 vials
  • 2 vials Q6H x3
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9
Q

PV F(ab’)2 (Anavip): allergy, initial dose, maintenance dose

A
  • Papain, cresol, horses
  • 10 vials
  • 4 vials PRN
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10
Q

PV antivenoms counseling points 4

A
  1. Repeat labs in 3-5 days
  2. Hypersensitivity rxns possible w/ future antivenom
  3. Avoid activities with bleeding risks for 14 days
  4. Monitor serum sickness
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11
Q

Coral snakes body, fangs

A
  • Red on yellow, kill a fellow vs Red on black venom lack
  • Much smaller fangs, hang onto victim and chew
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12
Q

CS clinical manifestations

A
  • Minimal/No local tissue injury
  • Speech: slurred, dysphagia
  • Ocular: diplopia, ptosis (drooping)
  • Neuromuscular: paresthesias/weakness/fasciculations (minor), paralysis (life-threatening)
  • Pulmonary: stridor, resp paralysis
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13
Q

CS management supportive care when?

A

Intubate at earliest signs of bulbar paralysis

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14
Q

CS antivenom Antivenin

A
  • Requires skin testing prior to administration
  • 3-5 vials in 250-500 mL NS
  • Initial rate: 25-50 mL/hr for the first 10 mins
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15
Q

CS Antivenin counseling point

A

Serum sickness

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16
Q

Alkalis: dissociated ___ –> ___ necrosis

A

hydroxide ions (OH) –> liquefactive

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17
Q

Acids: dissociated ___ –> ___ necrosis

A

hydrogen (H) –> coagulative

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18
Q

Household chemicals imaging should be done when?

A

within 12 hrs of ingestion (no later than 24 hrs)

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19
Q

HC management: decontamination for oral & dermal exposure

A
  1. Remove clothing, jewelry, irrigation with water
  2. Blisters should be popped
  3. No role for gastric decontamination
  4. Dilutional therapy avoid unless asymptomatic + w/i first few mins of ingestion
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20
Q

HC management: symptomatic & supportive care

A
  1. Airway inspection, intubation
  2. Airway inflammation: dexamethasone
  3. HoTN: IV fluid repletion
  4. Surgical intervention as necessary
  5. No role for empiric antibiotics
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21
Q

HC ocular exposures tx

A
  1. Remove contact lenses, false eye lashes etc
  2. Immediate + copious irrigation: hold eyes open for at least 15 mins, use room temp (tepid) water or 0.9% NaCl
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22
Q

HC ocular exposures when to refer

A

Strong or concentrated caustic/pain, swelling, lacrimation or photophobia despite irrigation

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23
Q

Hydrofluoric acid: cause of toxicity, binds to ___, result in ___

A
  • Liberation of F- ions, not H+
  • Extra/Intracellular Mg, Ca
  • Hypomagnesemia, hypocalcemia –> ventricular arrhythmia
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24
Q

Hydrofluoric acid toxicity local tissue injury, absorption, systemic effects

A
  • Minimal visible damage
  • Deep penetration
  • Life threatening cardiac effects: hypocalcemia, hypomagnesemia, hyperkalemia
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25
Hydrofluoric acid toxicity management
1. Decontamination: water, saline 2. Airway management: avoid succinylcholine due to hyperkalemia 3. Pain control: topical calcium gluconate gels, avoid sedating analgesics, nebulized calcium for pulmonary exposures 4. Electrolyte repletion **calcium + Mg**
26
Hypochlorite examples & management
1. Household bleach: dilute with water 2. Industrial strength cleaners/swimming pool disinfectants: symptomatic, supportive care
27
Hypochlorite combination: chlorine vs chloramine
1. Chlorine (hypochlorite + acid) dissolution --> hypochloric acid + hypochlorous acid 2. Chloramine (hypochlorite + ammonia) dissolution --> hypochlorous acid + ammonia + oxygen radicals
28
Single-use detergent sacs toxicity clinical manifesfations
- GI, pulmonary, ocular, metabolic - CNS **seizures**
29
Single-use detergent sacs toxicity diagnosis
- Changes in mental status or **resp difficulty**, persistent ocular symptoms
30
Single-use detergent sacs toxicity management
- Decontamination w water - Resp difficulty w/ hypoxemia: oxygen, bronchodilators, intubate if necessary - Prolonged V/D: IV fluid - Seizures: BZD
31
Hydrogen peroxide mechanism of toxicity
1. Local tissue injury: [low] = irritant, [high] = corrosive 2. Gas formation: H2O2 interacts w/ tissue catalase --> O2, H2O liberation
32
H2O2 clinical manifestations [High]
**Gas embolization** - Gastric/Intestinal perforation - Rapid deterioration in mental status, HoTN, cardiac ischemia, coma, intestinal gangrene
33
H2O2 toxicity management [Low]
Dilute w water, remove contaminated clothing + jewelry
34
H2O2 toxicity management [High]
- Decontamination: oral - no role for gastric, ocular - copious irrigation w/ tepid water - Monitor airway & intubate prn - Trendelenburg position if evidence of gas in the heart - Gastric suctioning if abdominal distention - Life threatening gas emboli: hyperbaric O2
35
Ethanol mechanism of toxicity
- Oxidation of ethanol --> acetyl-CoA + change in redox potential --> **hypoglycemia**
36
Ethanol toxicity diagnosis
- Changes in **mental status**, serum ethanol, complete metabolic panel, head CT
37
Artificial nail removal contains ___ which endogenously converted to ___
Acetonitrile -> cyanide
38
Toothpaste toxicity: ingredient of concern ___, give ___
Fluoride --> milk
39
Magnet toxicity: refer to healthcare facility when
2 magenets or 1 magnet + metallic object
40
Solvent-based paints abuse potential: methods of administration
- Sniffing - Huffing: pour substance onto fabric and place over mouth/nose - Bagging
41
Paint mechanism of toxicity on cardiac
Increased sensitivity or myocardium to epinephrine
42
Paint toxicity clinical manifestation stage 3
**Seizures**, coma, death
43
Paint toxicity management
1. GI decontamination no role 2. Airway management 3. Arrhythmias: avoid exogenous catecholamines 4. Electrolyte replacement 5. BZD for seizures/agitation
44
Mothballs contain 1 of 3 main ingredients:
1. Paradichlorobenzene 2. Naphthalene 3. Camphor
45
Paradichlorobenzene management
Dilute with **water** (not milk), antiemetics prn
46
Naphthalene: when to refer, mechanism of toxicity, tx
- Ingestion of >1 mothball - Oxidant stress --> **hemolysis** + methemoglobinemia --> anemia - Transfusion (packed RBCs), **methylene blue**
47
Camphor: when to refer, management
- Ingestions >30 mg/kg - Symptomatic & supportive, BZD --> propofol, barbiturates
48
Alcohol addiction
**1. Psychological dependence** 2. Physical dependence 3. Tolerance
49
Alcohol ADEs - chronic users
1. Alcoholic liver disease 2. Alcohol and heart- cardiomyopathy 3. Alcohol and hematopoietic- malabsorption 4. Fetal alcohol syndrome
50
Alcohol withdrawal syndrome symptoms
1. Abstinence syndrome 2. Hallucinosis - visual and auditory, 'pink elephants' 3. Seizures 4. Delirium tremens - **autonomic hyperactivity** 5. Wernicke-Korsakoff syndrome
51
Alcohol withdrawal syndrome treatment
**Naltrexone, acamprosate**, CDPX, oxazepam, haloperidol
52
Osmolality is affected by __, __, ___, ___, and ___
Ethyl ether, isopropanol, methanol, ethylene glycol, acetone
53
Isopropyl alcohol metabolism
Acetone (ketonemia)- kidney (ketonuria), lungs (acetone breath)
54
Isopropyl alcohol treatment
1. ABC 2. Decontamination - AC x 3. Elimination enhancement - dialysis 4. Lab: high osmolal gap, high serum ketones, hypoglycemia
55
Methanol toxicity clinical presentation
Blindness, **"snowfield" vision**
56
Methanol treatment
1. ABC 2. Decontamination- AC x 3. Elimination enhancement: hemodialysis 4. Ethanol therapy- block formation of toxic metabolites 5. Folic acid therapy 6. Fomepizole- slow down metabolism
57
Ethylene glycol metabolism cofactors for nontoxic**
Thiamine, pyridoxine
58
Ethylene glycol clinical presentation
1. CNS depression 2. Cardiopulmonary: tachy 3. Renal 4. Lab: large anion gap acidosis, osmolal gap, urine oxalate crystals, hypocalcemia
59
Ethylene glycol treatment
1. Decontamination: AC x 2. Elimination enhancement: hemodialysis 3. Ethanol therapy 4. Metabolic acidosis: sodium bicarbonate 5. Pyridoxine, thiamine, Mg 6. Antizole (Fomepizole)
60
Opiate overdose symptoms & treatment
**1. Pinpoint pupils**: none 2. coma: naloxone 3. resp depression: naloxone, ventilation 4. bradycardia: naloxone 5. HoTN: fluids, naloxone 6. hypothermia: rewarm 7. pulmonary edema: (+) end expiratory pressure, naloxone
61
Heroin methods of administration
1. IV, PO, SQ, smoke, snort 2. Chasing the dragon 3. Speedball 4. Moon-rock, speedball rock 5. Body packing
62
Heroin clinical presentation
1. Coma/lethargy 2. Pinpoint pupils - except demerol 3. Constipation 4. Desire for sweets 5. Resp depression 6. HoTN 7. Hypothermia 8. Infectious: endocarditis, AIDS, hepatitis, tetanus, meningitis 9. Crush injuries: rhabdomyolysis, can fall, immobility 10. "necklace" 11. Milk/ Ice
63
Heroin treatment
1. ABC 2. Lab: heroin x useful, chemistry 3. **No physostigmine** 4. Designer drug problems: fentanyl, alpha-methyl-fentanyl, fluorofentanyl, sufentanyl 5. Naloxone **IV**: monitor pupils, respirations 6. Nalmefene
64
Heroin withdrawal early s/s
Craving for drugs and anxiety
65
Heroin withdrawal intermediate s/s
Yawning, perspiration, runny nose, lacrimation
66
Heroin withdrawal late s/s
Rise in BP & RR, pulse rate, fever, resetlessness, N
67
Heroin withdrawal tx
1. Other opioids questionable: morphine, propoxyphene w codeine 2. Opioid antagonist Naloxone: risky 3. **Methadone** 4. Naltrexone 5. **Buprenorphine (Subutex)** 6. Sympatholytics: clonidine, propanolol
68
Cocaine HCl methods of administration
No smoking (degrades), snorted, IV, applied to mucous membranes
69
Crack?
- Almost pure cocaine - Crack sound/rock appearance - Higher % abusers bc it's so addicting: rapid peak, euphoria followed by dysphoria - Smoking same feeling as IV - Intense psychological effect due to rapidly increased Cp
70
Cocaine effects
- MI +/- CAD - CP with ST elevation - Paranoid psychosis - Pupils dilated
71
Cocaine tx
- Mild: supportive - Anxiety, agitation, seizures: BZD - Paranoia: haloperidol - Beware of speedball (cocaine & heroin) - Hyperthermia: use cooling, caution w/ thioridazine - Tachy: BB but may aggravate coronary & systemic artery vasoconstriction - Avoid lidocane bc risk of seizures
72
Phencyclidine (PCP) other names
Angel dust, peace pill, hog, sherman, rocket fuel
73
PCP effects
- Anesthesia/Analgesia: dissociative anesthetic - Sensory isolation - Altered perceptions
74
PCP abuse
- Good titration, easy synthesis - Active PO, pulmonary, IV - Analogues: ketamine (Special K) - Adulterant in other marginal products
75
PCP clinical presentation
Blank stare, nystagmus, psychotomimetic effects, strength (no pain), auditory hallucinations, gruesome injuries, PCP psychosis
76
PCP tx
- Enhanced elimination (?) - Decrease sensory environment: quiet! don't try to talk down - Rhabdomyolysis
77
LSD
- Inadvertent ingestion - Window panes - Death rare
78
LSD effects
- Psychotropic: cats afraid of mice, unpleasant rxn (bad trip), aggression - Recreational: synesthesias = hear color, touch music - Flashback
79
LSD tx
- Panic: talk down, reassure, avoid restraints - Gut decontamination **C/I** bc can precipitate psychotic rxns
80
Date rape drugs effects
Sedation, amnesia, respiratory problems
81
Ecstasy, MDMA, MDA effects
Hyperthermia, rhabdomyolysis, hyponatremia, cerebral infarct
82
Methamphetamine effects (long term)
1. Addiction 2. Violent behavior/out of control rages 3. Anxiety 4. Delusions 5. Repetitive motor activity

Poison/Toxicology (3 decks)

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