peds74

Question 1

antidote for acetominophen poisoning

Answer 1

n-acetylcysteine (NAC); a glutathione precursor; given orally as loading dose and followed every 4 hours for 17 doses; can also use IV NAC; hepatoprotective if given within 8 hrs of ingestion. Still helpful up to 72 hours

Question 2

salicylates found in what?

Answer 2

pepto-bismol, ben-gay, and oil of wintergreen

Question 3

pathophys of salicylate poisoning

Answer 3

directly stimulate respiratory centers; causes hypervent that may overcompensate for metabolic acidosis produced by salicylate, resulting in resp alkalosis

Question 4

how do salicylate poisonings work

Answer 4

uncouple ox-phos, producing lactic acidosis and enhancing ketosis

Question 5

lab findings with salicylic acid poisoning

Answer 5

resp alkalosis with an anion gap metabolic acidosis is the most common; hyperglycemia then hypoglycema; hypokalemia

Question 6

mangement of salicylate poisoning

Answer 6

gastric lavage; activated charcoal; obtain serum salicylate; alkalinization or urine with sodium bicarb; fluids to enhance renal excretion; dialysis may be required

Question 7

stages of acetominophen toxicity

Answer 7

30 mins-24 hours asymptomatic or vom/diarrhea; 24-72 hours GI sx resolve; 72-96 hour hepatic necrosis; 4 days to 2 weeks resolution of sx

Question 8

most common sources of accidental iron poisoning

Answer 8

adult stregnth ferrous sulfate tabs and iron in prenatal vitamins

Question 9

pathophys of iron poisoning

Answer 9

direct damage to GI tract; hepatic injury and necrosis; third spacing and pooling of blood in the vasculature leading to hypotension; interference with oxphos

Question 10

management of iron poisoning

Answer 10

gastric lavage; activated charcoal does NOT bind to iron; hypovolemia should be anticipated and tx; whole bowel irrig; IV deferoxamine

Question 11

determining use of IV deferoxamine in iron poisoning

Answer 11

if serum iron over 500 or if less than 300 and acidosis, hyperglycemia or leuocytosis; severe GI sx; more than 100 mg/kg iron ingested

Question 12

before serum iron level is known, how much deferoxamine do you give?

Answer 12

test dose may be administered; if patients urine turns red or pink, the challenge is considered positive, indicating clinically signif iron ingestion. IV def should be continued

Question 13

clinical features of lead poisoning

Answer 13

abdominal complaints, CNS complaints, peripheral blood smear shows microcytic anemia, basophilic stippling, and RBC precursors; radioopacities on abdom xra

Question 14

dense metaphyseal bands on radiographs of knees and wrists

Answer 14

lead lines due to lead poisoning

Question 15

diagnosis of lead poisoning

Answer 15

elevated lead level or elevated erythrocyte protoporphyrin

Question 16

management of lead poisoning

Answer 16

dimercaprol, british anti-lewisits, or calcium disodium EDTA

Question 17

how does acid ingestion hurt your body

Answer 17

coagulation necrosis that produces superficial damage to the mouth, esoph, and stomach

Question 18

how do alkalis cause damage to the body if ingested?

Answer 18

liquefaction necrosis that produces deep and penetrating damage, most commonly to the mouth and esoph

Question 19

example of acid that is ingested

Answer 19

toilet bowl cleaner

Question 20

example of bases that can be ingested

Answer 20

oven and drain cleaners, bleach, laundry detergent

Question 21

clinical features of ingesting either acidic or basic caustic agent

Answer 21

immediate burning with intense dysphagia, salivation, retrosternal pain, and vomiting; obstructive airway edema; gastric perforation and peritonitis; esoph perforation with mediastinitis

Question 22

management of ingestion of caustic substances

Answer 22

no attempt to neutralize the reaction; ipecac, gastric lavage, and activated charcoal are all contraindic; endoscopy is performed; household bleach requires no tx

Question 23

carbon monoxide poisoning

Answer 23

odorless, tasteless, colorless gas; interferes with oxygen deliv;

Question 24

how does CO interfere with oxygen delivery?

Answer 24

CO displaces oxygen from hgb and binds much stronger than ox; ox-hgb dissociation curve is shifted to the left (tighter binding of ox and impaired release of ox)

Question 25

clinical features of CO poisoning

Answer 25

low levels nonspec sx; high levels are visual and aud changes, confusion

Question 26

classic physical exam findings on phys exam of CO poisoning

Answer 26

cherry red skin (venous blood carries more ox than normal); retinal hemorrhages; tachycardia and tachypnea may be present

Question 27

Co poisoning and little kids

Answer 27

kids less than 8 yo have more sx at lower CO levels; little kids are also more likely to have GI sx than neuro sx

Question 28

delayed permanent neuropsych syndrome

Answer 28

can occur in people with CO poisoning 4 weeks after exposure

Question 29

lab findings in CO poisoning

Answer 29

anion gap met acidosis , low ox sat (even though PaO2 may be normal), and evidence of myocardial ischemia

Question 30

management of CO poisoning

Answer 30

100 percent oxygen; if available, hyperbaric oxygen; hospitalization indic for CO-Hb greater than 25 percent or other things

Question 31

typical animal bite victim

Answer 31

boy during the summer

Question 32

young kids are typically bitten where?

Answer 32

head and neck, whereas older kids on the extremites