General Toxicology Flashcards
(15 cards)
When to suspect a toxicological case
- Sudden deterioration in consciousness in previously healthy patients
- Suddent development of exssive vomiting without history of food poisoning
- History of psychaitric problem (may suggest self-inflicted poisoning)
Mention factors affecting toxic response
- Related to patient: stomach (empty>full in most poisons), age, disease, tolerance, hypersenistivity.
- Related to poison: amount, route of administration (IV is fastest, skin is slowest in most poisons ex OPC, tetraethyl lead and carbolic acid), form of poison, cumulation
Mention 3 measures to maintain patent airway
- Positioning of the patient
- Oropharyngeal tube
- Endotracheal intubation if needed
Mention drugs that cause hypothermia
- CO
- Opiates
- Ethanol
- Oral hypoglycemics/insulin
- Sedative hypnotics
Mention drugs that cause mydriasis
Sympathomimetics
Hallucingoens
Anticholinergics (
Withdrawal from CNS depressants
List manifestations of:
1. Anticholinergic toxidrome
2. Symapthomimetic toxidrome
a. زغلولة الناشفة حبست جوزها أ[و سريع
1. Dilated unreactive pupils (+delirium), dry skin and mumus membranes (>hyperthemia and flushing), urine retention (+decreased peristalsis), glaucoma, tachycardia.
b. MATHS
1. Mydriasis (reactive)
2. Agitation
3. Tachycardia & tachypnea
4. HTN/hyperthermia
5. Seizures, sweating
6. Others: increased peristaslsis
List the manifestations of:
A. Cholinergic toxidrome
B. Opioid toxidrome
A. DUMBLES
1. Diarrhea
2. Urination
3. Miosis
4. Bronchorrhea, bronchospasm, bradycardia
5. Lacrimation
6. Excess salivation
7. Subnormal temperature and Seizures (paralysis and fasciculations
B. Miosis, CNS depression, hypoventilation, hypotension, bradycardia, hypothermia, decreased peristalsis
List general indications of gastric lavage
- When pateint has taken massive overdose o highly toxic substance
- May be done after2 hours only in specific situations such as poisons that are:
I. Eliminated in GIT (opioids and methanol)
II. Form concretions (salicylates and carbamazepine)
III. Have delayed gastric emptying (TCA, atropine, phenothiazine)
IV. Sedative hypnotics (barbiturates)
List contraindications of GL
Absolute: corrosive or foaming substance
Relative:
1. DLOC, seizures and coma
2. Hydrocarbon ingestion
(1&2) may be done if ETT is inserted
3. Shock, arrhythmia, RF
4. History of recent gastric surgery
5. Esophageal varices, active gastric ulceration o hematemsis
List complications of GL
- Bradycardia
- Tachycardia and HTN if patient is conscious
- Hyponatremia if tap water is used especially in children
- Faulty pasage into trachea
- Laryngospasm and cyanosis
- Aspiration of gastric contents
- Mechanical gut injury
List CI of AC
- Corrosives: not effects, masks view on endoscopy, worsens mediastinitis and peritonitis.
- Hydrocarbons: vomiting and apiration
- Intestinal obstruction perforation, ileus
- Some poisons are not absorbed by AC (iron, lithium, lead, mercury, alcohol, hydrocarbons and corrosives)
List indications of MDAC
- Adsoprion of drugs remaining in gut for a long time (SR theophylline CCB, drugs producing concretions)
- Adsorption of drugs having enterohepatic circulation digoxin and TCA
- Drugs diffusing passively from blood to lower GI lumen as theophylline and salicylates
List indications of MDAC
- Adsoprion of drugs remaining in gut for a long time (SR theophylline CCB, drugs producing concretions)
- Adsorption of drugs having enterohepatic circulation digoxin and TCA
- Drugs diffusing passively from blood to lower GI lumen as theophylline and salicylates
Mention indications of alkalinization of urine
- Overdose of salicylates
- Overdose by long-actig barbiturates
- Poisons producing hemolysis and rhabdomyolysis
Mention examples of dialyzable drugs and complications of hemodialysis
Alcohols, phenobarbital, theophylline, lithium and salicylates
CC:
Hypotension, elimination of therapeutically administered drugs, bleeding tendency, air embolism, infection (HIV, hepatitis)
