General methods for treatment

Question 1

who should we really avoid emesis in

Answer 1

someone losing consciousness or substances that can put someone into a coma or cause a seizure. puts patient at risk of aspiration
no gag reflex
corrosive agents

Question 2

problem with activated charcoal studies

Answer 2

patients were all healthy volunteers not like actual people that present to emerg
unethical to make a proper study

Question 3

complications of emesis

Answer 3

aspiration pneumonitis
bleedings
GIT rupture

Question 4

contraindications to gastric lavage

Answer 4

corrosive gents

pertoleum distillate

Question 5

complications of gastric lavage

Answer 5

cardiac arrhythmia
low oxygen
laryngospasm
pharingeal injury
esophageal or gastric perforation

Question 6

gastric lavage technique

Answer 6

largest diameter tube possible
patient in supine on left side with head down below level of the stomach
airway protected with a cuffed endotracheal tube
aspirate gastric contents
instill 250ml aliquots of warm water followed by draining
repeat until clear

Question 7

how does activated charcoal work

Answer 7

physically adsorbs by hydrogen bonding, dipole and van der waals forces
has a large surface area to bind to then
binding decreases systemic absorption, can bind some poisons that have left the stomach

Question 8

activated charcoal contraindications

Answer 8

ingestion of caustic (burn or corrode) substances

presence of ileus or bowel obstruction bc need to be able to eliminate the activated charcoal

Question 9

activated charcoal complications

Answer 9

vomiting
aspiraion pneumonitis 
constipation
GI obstruction 
charcoal empyema - gets into peritoneal cavity

Question 10

activated charcoal technique

Answer 10

administered oral or by gastric tube

30-100g as a slurry in water

Question 11

how does multiple dose activated charcoal work

Answer 11

ensures marked serum to GI lumen concentration gradient pulling more toxin from blood to GI - works for IV drugs

Question 12

what is catharsis

Answer 12

whole bowel irrigation using cathartics (increases defecation)

Question 13

whole bowel irrigation indication

Answer 13

ingestion of iron or zinc salts
ingestion of SR products
ingestion of crack vial
ingestion of drug packets (massive OD)

Question 14

whole bowel irrigation and cathartics contraindications

Answer 14

uncooperative patients
presence of ileus or GI obtruction
GI bleeding or perforation

Question 15

whole bowel irrigation and cathartics complications

Answer 15

abdominal cramping
vomiting
profuse diarrhea
hyperchloremia 
**monitor electrolytes

Question 16

whole bowel irrigation technique

Answer 16

administer large volumes isotonic nonabsorbable polyethylene glycol/electrolyte solution until rectal discharge looks like the fluid administered

Question 17

actions of cathartics

Answer 17

less violent way to move th poison or poison/charcoal complex through the GIT
can help remove poison, decrease absorption

Question 18

examples of cathartics

Answer 18

sorbitol
magnesium citrate
magnesium or sodium sulfate

Question 19

how does dilution work

Answer 19

water or milk fluid admin

Question 20

when is dilution good

Answer 20

first few minutes after ingestion

value in ingestion of corrosive agents

Question 21

contraindications to dilution

Answer 21

coma or convulsions bc there is a risk of vomiting

ingestion of strong acid - reacts with water and stomach can explode

Question 22

ways to enhance elimination

Answer 22

diuresis 
peritoneal dialysis
multiple dose activated charcoal
hemodialysis
hemoperfusion
hemofiltration

Question 23

indications for enhancement of elimination

Answer 23

patients who fail to respond to full supportive care
normal route of elimination of the toxin is impaired ex. renal dysfunction
patients sho the amount of toxin absorbed or plasma concentration indicate high risk of mortality
for patients who have concurrent disease, elderly, infants

Question 24

manipulation of pH for diuresis objective

Answer 24

increase renal clearance

Question 25

which poisons does manipulation of pH work on

Answer 25

poisons that are excreted in urine

Question 26

alkaline diuresis and what it works for

Answer 26

give sodium bicarb iv to increase urinary pH to 7-8 | increased renal excretion of salicylate, isoniazid, phenobarbital

Question 27

acid diuresis and what it works on

Answer 27

give ammoniumchloride iv to reduce urinary pH to 4.5-5.5 weak bases such as amphetamines no evidence of efficacy

Question 28

what is forced diuresis

Answer 28

volume expansion with sodium containing solutions | works is glomerular filtration is an important determinant of excretion

Question 29

riskd of forced diuresis

Answer 29

volume overload manifested by pulmonary and cerebral edema metabolic alkalosis hypokalemia

Question 30

how to do forced diuresis

Answer 30

furosemide iv

Question 31

monitoring of forced diuresis

Answer 31

monitor electrolytes fluid balance acidbase balance response to diuretic

Question 32

which drugs can be eliminated with peritoneal extracorporeal techniques

Answer 32

``` water soluble low MW poorly protein bound low Vd ex alcohol, lithium ```

Question 33

problems with hemodialysis

Answer 33

takes 4-8hrs often not available requires anticoagulation with heparin

Question 34

hemodialysis indications

Answer 34

``` poison dialysable patient deteriorating despite care severe electrolyte problems lethal blood levels prolonged coma risk of renal failure ```

Question 35

hemodialysis complications

Answer 35

``` clotting and leaking of blood from around connections embolus hypotension convulsions arrhythmias infections ```

Question 36

charcoal advantage over dialysis

Answer 36

can remove drugs that are highly protein bound

Question 37

what is charcoal hemoperfusion

Answer 37

cartridge containing a sorbent with a large surface area that gets changed every couple of hourse requires anticoagulation complications similar to hemodialysis

Question 38

how does hemofiltration work

Answer 38

movement of plasma across semipermeable membrane in response to hydrostatic pressure gradient no dialysate on other side of membrane small solutes are transported across the membrane following the water while larger solutes are excluded

Question 39

advantages of hemofiltration

Answer 39

continue therapy for 24hr remove drugs that distribute slowly from tissue binding sites and from the intracellular compartment fast

Question 40

disadvantages of hemofiltration

Answer 40

rate of removal of drugs may not be sufficient to benefit critically ill complex experienced ICU staff required for monitoring clearances achieved are lower than in hemodialysis

Question 41

whats plasmapheresis and exchange transfusion used for

Answer 41

eliminate molecules with large MW | remove plasma proteins

Question 42

problems with plasmapheresis and exchange transfusion

Answer 42

risk of infections and allergic reactions | expensive