Overdose or Poisoning Flashcards by Senpai Sama

The term _______ refers to the collection of signs and symptoms that are observed after an exposure to a substance “toxic fingerprint

“toxidrome”

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True/False
In the emergency setting toxicological screening test of blood and urine does not contribute significantly to the evaluation, management, or outcome for most patients.

True

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_______are common overdoses and serum levels are important in the management of the patient.

Acetaminophen and Aspirin

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Thorough physical examination is essential - with a special emphasis on:

(a) Mental status
(b) Pupil size and reactivity
(c) Skin temp
(d) Presence or absence of sweat
(e) Muscular tone
(f) GI motility and mucus membrane moisture

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For the majority of patients resuscitation of the poisoned patient begins with assessment and management of…

airway, breathing and circulation rather than administration of antidotes

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If the pt is contaminated what is priority?

removal of clothing and copious irrigation of the skin

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_____ should be worn at all times for decontamination

PPE

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If altered mental status, obtunded, or coma is present then administer what?

-Naloxone 0.2-2.0mg IV/IM/SQ
-Glucose (dextrose)
-Thiamine (if available)

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Why does naloxone often require re-dosing?

has a duration 30-60 minutes which is a shorter half-life than most opioids

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Hypotension is first treated with..

fluid bolus

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_______ are first line treatment for seizures

Benzodiazepines

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Ocular exposure tx

copious irrigation

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GI decontamination - various methods including

(a) Orogastric lavage
(b) Activated charcoal - most commonly used

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What is the dosing for Activated Charcoal?

1gm/kg

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What is an alternate route of administration of Activated Charcoal?

NG tube

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observation for patients is variable and should be done in consultation with ____ and _______

supervising MO and poison control

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All patients with intentional poisoning/overdoses should be referred for _____ when stable

psychiatric evaluation

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What are the symptoms for Anticholinergic

Dry as a bone, red as a beet, hot as a hare, blind as a bat, mad as a hatter and stuffed as a pipe.

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Anticholinergic Toxidrome is commonly seen in the ED due to high use of what medications

-Antihistamines (primarily diphenhydramine),
-phenothiazines,
-muscle relaxers,
-tricyclic antidepressant (TCA),
-Jimson weed

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Anticholinergic Emergency Care

(a) Mostly supportive
(b) IV, O2, monitor
(c) GI decontamination with Activated charcoal (may be useful even if greater than 1 hour due to delayed GI motility)
(d) Treat hyperthermia and seizures (Benzodiazepines)
(e) If acutely agitated - benzodiazepines
(f) MEDAVICE/MEDEVAC

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These are what type of medication?
Fluoxetine, Sertraline,
Paroxetine, Fluvoxamine, Citalopram and Escitalopram.

SSRI’s

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What is the most adverse effect of SSRI’s?

Serotonin syndrome

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What would you suspect? how would you treat?
Hx of depression tx
(a) Cognitive and behavioral - confusion, agitation, coma, anxiety, hypomania, lethargy, seizures
(b) Autonomic - hyperthermia, diaphoresis, tachycardia, hyper/hypo tension, dilated pupils, salivation
(c) Neuromuscular - myoclonus, hyperreflexia, rigidity, tremor, ataxia, shivering, nystagmus

Serotonin Syndrome
(a) D/C all serotoninergic agents and provide supportive care
(b) MEDEVAC to closest Emergency Department or facility with a higher level of care.
(c) Monitor all patients with muscle rigidity, seizures or hyperthermia for rhabdomyolysis.
(d) For muscle rigidity or seizures administer benzodiazepines.

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Sedative and Hypnotics include what?

barbiturates and benzodiazepines

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_____ depress CNS activity by enhancing the action of Gamma aminobutyric acid (GABA)

Barbiturates

Ingestion of _____ and/or ______ lead to sedation, dizziness, slurred speech, confusion, ataxia. -Respiratory depression is the most common vital sign abnormality in severe overdoses.

Sedative and Hypnotics -barbiturates and benzodiazepines

Sedative and Hypnotics overdoes emergency care

(a) Assess and stabilize ABC's (b) Airways management and ventilator support may be required in the obtunded patient (c) Activated charcoal may decrease absorption and should be administered to the cooperative patient presenting within 1 hour of ingestion (d) Flumazenil/Romazicon - limited role

_______ may decrease absorption and should be administered to the cooperative patient presenting within 1 hour of ingestion

Activated charcoal

What is a is a benzodiazepine antagonist

Flumazenil

What would you suspect? Hx of tx with pain meds (a) CNS depression (b) Miosis (c) Respiratory depression (d) Bradycardia (e) Hypothermia

Opioid overdose

Opioid overdose tx

(a) Airway and ventilator support are most important considerations (b) Activated charcoal - considered if ingestion is less than 1 hour (c) Naloxone (Narcan) - competitive agonist at all opioid receptors

what are the most important considerations when managing an opiod overdose

Airway and ventilator support

What should be considered when treating Opioid dependent patients with overdose

should receive a smaller dose to prevent acute withdrawal

_____ causes sympathetic nervous system activation which causes typical mydriasis, tachycardia, hypertension and diaphoresis

Cocaine

______ - similar effect to cocaine. Block re-uptake of catecholamines, also have effect on serotonin release which causes hallucinogenic effect

Amphetamines

What would you suspect? (a) May demonstrate psychomotor agitation (b) mydriasis (c) diaphoresis (d) tachycardia (e) tachypnea (f) hypertension (g)hyperthermia (h)AMS (i) Watch for seizures and rhabdo (j) May have chest pain, headache, dyspnea or focal neuro complaints

Cocaine, Amphetamines, Stimulants overdose

Cocaine, Amphetamines, Stimulants overdose Mainstay of treatment is.....

adequate sedation and continuous monitoring of vital signs

Cocaine, Amphetamines, Stimulants overdose -Emergency Care (a) Mainstay of treatment is _______________. (b) Monitor for signs of rhabdo, cardiac complications and manage acute agitation. (c) Obtain ____ (d) ________ will often improve tachycardia, hypertension and agitation (e) Active cooling (f) Treat seizures with _______ (g) Treat cardiac chest pain with __________ (h) Call for _______

a) adequate sedation and continuous monitoring of vital signs c) EKG d) Benzodiazepines f) benzodiazepines g) ASA, Nitro, Benzo h) MEDEVAC/MEDAVICE

True/False Beta Blockers are INDICATED in cocaine use induced chest pain

False CONTRAINDICATED (unopposed alpha stimulation)

ASA toxicity causes what?

respiratory alkalosis due to a direct effect on the medullary respiratory center

ASA Clinical diagnosis made in conjunction with acid base status. Ingestion less than: 1) _____ - mild - N/V GI irritation 2) ______moderate - vomiting, tachypnea, tinnitus, sweating 3)______ - severe

1) 150mg/kg - mild - N/V GI irritation 2) 150-300mg/kg moderate - vomiting, tachypnea, tinnitus, sweating 3) > 300mg/kg - severe

What issue? 1) tachypnea 2) tinnitus 3) N/V 4) acid base abnormalities 5) AMS 6) pulmonary edema 7) arrhythmia 8) hypovolemia 9) thrombocytopenia 10) hepatic effects

ASA Toxicity

What medication can be administered for ASA Toxicity, that causes alkalization of urine and increase Salicylate elimination

Sodium Bicarbonate 1- 2mEq/kg

ASA Toxicity Patients may ultimately require what?

hemodialysis

What is the most popular over the counter analgesic in US.

Acetaminophen (APAP)

APAP is rapidly absorbed from the ____ and metabalized in the ____

-GI tract - liver

What stage of APAP Toxicity? first 24 hours - nonspecific. N/V, malaise, anorexia

Stage 1

What stage of APAP Toxicity? day 2-3 - N/V may improve and evidence of toxicity may develop. RUQ pain, elevated bilirubin/jaundice

Stage 2

What stage of APAP Toxicity? day 3-4 - progression to hepatic failure. Lactic acidosis, coagulopathy, renal failure, encephalopathy, N/V

Stage 3 -

what stage of APAP Toxicity? those who survive will begin to recover

Stage 4 -

Toxicity may occur with acute ingestion ______ or ____over 24 hours.

> 140mg/kg or > 7.5 gm

What is the specific antidote for APAP toxicity

NAC (N-acetylcysteine)

NAC (N-acetylcysteine) Can prevent toxicity in administered within how long of ingestion?

8 hours

1) Serum levels should be drawn on all patients with APAP ingestion and levels at ___ hours evaluated. 2) Levels above _______ at 4 hours are considered toxic.

1) 4 2) 150mcg/dl

Toxidrome/clinical features of Insecticides (malathion, parathion) and Nerve agents (VX, sarin)

1) Salivation 2) Lacrimation 3) Urinary incontinence 4) Defecation 5) GI pain/dismotility 6) Emesis

insecticides and Nerve agents Pt usually symptomatic within ____ of dermal exposure to organophosphates. Nerve agents ___

-8 hours - Immediate effect

insecticides and Nerve agents emergency care

(a) Decontamination (b) Monitoring (c) Atropine (d) Pralidoxime -2-PAM. (e) MEDEVAC (f) Seizures - Benzo's (h) Support airway and breathing

Atropine** 1mg in adult. Repeat Q___ min until _____

-Q5m - respiratory secretions improve

True/False Pralidoxime -2-PAM. Can be administered without concurrent Atropine.

False Should NOT

NAC dosage Oral:

NG tube 140mg/kg loading dose, followed by 70mg/kg Q4 hours for 17 additional doses

NAC dosage IV:

150mg/kg loading dose, followed by 50mg/kg over the next 4 hours, then 100mg/kg over next 16 hours. -Ideally initiate loading dose and medevac to higher echelon under consultation with poison control and MO

Naloxone (Narcan) doseage and freq

20-90 minutes 0.4-2 mg

Overdose or Poisoning Flashcards

(62 cards)