Lessons 3

Question 1

History of Poison Control Centers

Answer 1

• Jay Arena (1939): Published first case series on Lye poisoning; kickstarted systematic poison data collection.
• Edward Press & Louis Gdalman: Founded the first U.S. poison control center in Chicago (1950s).
  
  • Collected data on 9,000+ products.
  • Provided 24/7 telephone advice to healthcare workers.
• Role: Share poison ingredient info, toxicity risks, and treatment guidelines.

Question 2

Steps to Treat Poisoned Patients

Answer 2

1. Stabilize: Follow ABCs (Airway, Breathing, Circulation).
2. Evaluate: History, physical exam, lab tests, imaging.
3. Prevent Absorption: Use activated charcoal, gastric lavage.
4. Enhance Elimination: Dialysis, urine alkalization.
5. Antidote: Administer specific antidotes (e.g., naloxone for opioids).
6. Supportive Care: Monitor and manage complications (e.g., seizures).

Question 3

Key Challenges in Poison History-Taking

Answer 3

• Patients may lie (e.g., suicide attempts) or be unconscious.
• Sources to Verify History: Family, EMTs, pharmacists, employers.
• Assume Worst-Case Dose: Example: Assume entire pill bottle was ingested unless proven otherwise.

Question 4

Toxidromes (Toxic Syndromes)

Answer 4

• Narcotic: Slow breathing, pinpoint pupils (e.g., opioids).
• Cholinergic: Sweating, vomiting, diarrhea (e.g., pesticides).
• Sympathomimetic: Fast heart rate, high BP (e.g., cocaine).
• Anticholinergic: Dry skin, hallucinations (e.g., antihistamines).

Question 5

Lab Tests for Poisoning

Answer 5

• Anion Gap:
  
  • Formula: [Na⁺] − ([Cl⁻] + [HCO₃⁻]).
  • Normal: ≤12. Elevated? Suggests toxins like methanol, ethylene glycol.
• Osmol Gap:
  
  • Formula: Measured osmolality − Calculated osmolality.
  • Normal: <10 mOsm. Elevated? Indicates alcohol poisoning (e.g., ethanol).

Question 6

Radiographic Exams in Poisoning

Answer 6

• Limited Use: Most pills aren’t visible on X-rays.
• Exceptions:
  
  • Iron tablets (radiopaque).
  • Body Packers: Detect swallowed drug-filled packets (e.g., cocaine).
  • Carbon Monoxide (CO): Brain CT shows damage in basal ganglia.
  • Lead Paint: Seen in abdominal X-rays (common in kids with pica).

Question 7

Key Clinical Tips

Answer 7

• Assume the Worst: Treat based on worst-case exposure if history is unclear.
• Recheck Often: Repeat exams to track poisoning progression.
• Use Toxidromes: Guides treatment when the toxin is unknown.

Question 8

Important Terms

Answer 8

• Methemoglobinemia: Treated with methylene blue (even if toxin isn’t identified).
• Nomograms: Predict poisoning severity (e.g., acetaminophen overdose).