more tox cards

Question 1

Main point on cardiac arrest secondary to poisoning

Answer 1

Prolonged CPR and ECMO may be required

Question 2

What is airway compromise usually due to in the case of poisoning

Answer 2

Hypoventilation
Airway obstruction

Question 3

How to manage hypotension secondary to poisoning

Answer 3

1. IVF- NaCl 0.9% 10-20ml/kg IV over 10-30 min
2. Ionotropes only if non responsive to IVF
   a) adrenaline IV
   b) High dose insulin euglycemia therapy (HIET) = short acting insulin + glucose - monitor BGL and K

Question 4

General advice for antiarrhythmic use in the context of poisoning

Answer 4

Avoid due to pro-arrhythmic FX

Question 5

Mng of QRS widening and instability in the context of poisoning

Answer 5

IV sodium bicarb + hyperventilation via intubation and mech ventilation

Question 6

Mng of QT prolongation in the context of poisoning

Answer 6

Ix underlying electrolyte abnormalities and tx acc- correct Mg, Ca, K

Question 7

Mng of torsades in the context of poisoning

Answer 7

Mag sulphate

Question 8

Mng of hyperthermia in the context of poisoning

Answer 8

1. Active cooling - cold IVF, Ice packs to groin and axillae, cooling mats/blankets
2. small doses of benzos to tx agitation and supress shivering - diazepam and midaolam

Question 9

Options for GI decontaminating in poisonign

Answer 9

Activated charcoal
Whole bowel irrigation

Question 10

When to use activated charcoal for GI decontamination in poisoning

Answer 10

Within two hours of ingestion - if severe can consider > 2 hours
Able to protect airway
Barbiturates, carbamazepine, colchicine, dapsone, phenytoin, theophylline, warfarin

Question 11

When to use whole bowel irrigation for GI decontamination in poisoning

Answer 11

Presents within 4 hours of ingestion or sig toxicity risk (iron, lithium, modified release of verapamil, diltiazem, metformin, K, theophylline)
Pt is alert and cooperative - able to protect airway

Question 12

What is whole bowel irrigation

Answer 12

Large volume of osmotic macrogol laxative given - diarrhea usually within 4 hours

Question 13

Options for enhanced elimination in poisoning

Answer 13

Activated charcoal
Extracorporeal elimination - hemodialysis, hemoperfusion, plasmapheresis
Urinary alkalisination with sodium bicarb for aspirin, salicylates or certain herbicides
Chelating agents

Question 14

Mng of agitation in poisoning if the ingested subtances are unkown

Answer 14

1. verbal de-escalation
2. PO diazepam
3. IV droperidol, IV midazolam

Question 15

Seizure management in poisoning

Answer 15

Considerhypoglycemia
Persistent and recurrent -> IV benzo: midaz, diaz- DO NOT USE PHENYTOIN

Question 16

What are the aspiriation things that can happen and which one is ABX therapy recommended in

Answer 16

Aspiration events
Aspiration pneumonitis
Aspiration pneumonia - ABX

Question 17

RF for aspiration pneumonitis

Answer 17

increasing age
altered conscious state (Glasgow Coma Scale score of less than 15)
vomiting
delayed presentation to hospital (more than 4 hours) following poisoning
seizures
tricyclic antidepressant poisoning (independent of other risk factors)
herbicide, insecticide or hydrocarbon poisonings.

Question 18

Ix for aspiration pneumonitis

Answer 18

CXR
Blood gas

Question 19

Tx for aspiration pneumonitits

Answer 19

Supportive care with oxygen therapy and ventilatory support

Question 20

Clin F of rhabdomyolysis

Answer 20

Myogolbinuria
Muscle pain and tenderness
Muscle swelling and loss of function

Question 21

Ix for rhabdomyolysis

Answer 21

Serum creatine kinase - starts risoing within 12 hours of rhabdo and peaks on day 1 to 3
Serum electrolytes esp potassium and calcium, urea and creatinine
Urine myoglobin - dipstick analysis

Question 22

Tx for rhabdomyolysis

Answer 22

Pressure care
IVF to maintain U/O to 1-2ml/kg/hour
Tx life threatening hyperkalemia
Treat underlying
Monitor for worsening kidney function and compartment syndrome