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Flashcards in poison Deck (41):
1

An unresponsive patient has lost his or her ________ and is at risk for airway obstruction as well as aspiration

airway reflexes

2

Coma Cocktail
(reversible causes of "coma"

-Opioids: Narcan 0.4 to 2mg IV
-Hypoxia--> 100% O2 nonrebreather
-Hypoglycemia: POC D stick

if these do not reverse the symptoms, then intubation should be performed.

3

Key Historical Data in poison

What was ingested?
How much was ingested?
When was ingested?
Why? (accidental or intentional)?

4

classic presentations of poison are called _________

Toxidromes

5

classic anticholinergic syndrome:

Mad as a hatter (AMS)
Blind as a bat (big-mydriasis)
Hot as Hades
Red as a beat
Dry as a bone

*Rx mostly supportive.

6

Possible toxins with anticholinergic properties include the following

TCA’s
Antihistamines
Overactive bladder medication

7

classic cholinergic syndrome

SLUDGE

-Salivation
-Lacrimation
-Urination
-Diaphoresis
-GI upset/ defecation
-Excessive bradycardia or tachycardia (muscarinic or nicotinic)

8

Cholinergic poisoning Treatment:

Atropine, pralidoxime, decontaminate

9

Sympathomimetic toxidrome

-Tachycardia
-Hypertension
-Mydriasis
-Diaphoresis
-Hyperthermia
-Agitation

10

Sympathomimetic toxidrome poisons

OTC cold agents (containing ephedrine)
cocaine, amphetamines, MDMA
dietary supplements (ephedra)

11

Sympathomimetic toxidrome treatment

-Sedation
-Hydration
-Rx complications--> rhabdomyalysis and hyperthermia

12

Opioid Classic signs:

Apnea
Hypoxia
Unresponsiveness
Flash pulmonary edema (rare)

May appear to require intubation. Administration of Nalaxone can reverse the apnea and obviate the need for intubation

13

Discharge after naloxone

Naloxone will wear off before the opiate so the patient can NOT be discharged without a period of observation.

14

Unlike other toxic ingestions, acute ______ overdose can present asymptomatic and can be missed/ fatal if not tested.

acetaminophen

15

some poisonings--> presence of an anion gap metabolic acidosis is key to diagnosis

Causes of Anion Gap Metabolic Acidosis

M = Methanol
U = Uremia
D = DKA
P = Paraldehyde
I = Iron, Isoniazid
L = Lactate (many causes CO, sepsis, blood loss?)
E = Ethylene Glycol
S = Salicylates

16

Physical exam for poison

vitals
pupil size
skin color and moisture
overall mental status.

17

Decontamination Methods for poison

Activated Charcoal
Whole Bowel Irrigation
Gastric Lavage (rare)

18

Activated Charcoal

-PO to absorb toxins in GI tract (excreted without being digested.)
-Best in 1st hour but still works after that
-Avoid in pts w/ somnolence --> risk of aspiration

19

Charcoal does not bind ___________.

metals (such as iron)
alcohols
hydrocarbons

20

Whole bowel irrigation involves the administration of

osmotically balanced polyethylene glycol electrolyte solution
Flushes GI to prevent the absorption of toxins.

It is used in cases where charcoal is not effective, with certain sustained release products, and in cases of illicit drug packet ingestions (body packers).

21

Whole bowel irrigation used when

-cases where charcoal is not effective
-certain sustained release products
-cases of illicit drug packet ingestions (body packers).

22

Gastric Lavage

Rarely used/ significant risks
good for:
-recently ingest lethal substances
-intubated overdose following recent ingestion

23

Gastric Lavage involves the application of

large bore (36 – 40 French) orogastric tube
flushing the stomach with aliquots of water to obtain pill fragments.

24

Ipecac

- should not be used anymore
-not effective in removing toxin
-reduces effectiveness of better decontamination methods

25

Many patients with potential ingestions may be observed for _______ and then dispositioned if clinically asymptomatic

six hours

dc home or psychiatric facility-provided the ingestion is not an extended release agent

26

it is imperative that an _________ level is checked on all overdose patients

acetaminophen

-measured on Rumak nomogram
- toxic plasma level at four hours is 150.

27

four main stages of an acute acetaminophen overdose.

symptoms usually involve nausea, vomiting in the first two stages.

28

In an acute overdose, acetaminophen is metabolized by

-metabolized into NAPQI which combines with glutathione --> excreted.
-When glutathione is gone, NAPQI--> hepatic toxicity.

29

In an acute overdose, treatment is

-decontamination with repeated doses of activated charcoal,
-antidote N-acetylcysteine (Mucomyst)

30

Unlike the Rumak nomogram of acetaminophen, the _______ is associated with aspirin ingestions

Done nomogram

it is typically not used to determine toxicity and treatment.

31

Patients with an acute overdose of aspirin are usually present

ill appearing
breathing fast
vomiting
confused
sometimes febrile.

32

The toxic effects of aspirin

involve an uncoupling of oxidative phosphorylation.

causes a profound anoin gap metabolic acidosis

33

The general approach to aspirin overdose is

airway managment
gastric decontamination
sodium bicarbonate
hemodialysis

34

In addition to their anticholinergic properties, TCAs cause :

-a direct a-adrenergic blockade
-inhibition of norepi/ 5HT reuptake
-blockade of fast Na channels in myocardial cells

35

Treatment of TCA overdose includes _________ in the asymptomatic patient.

close monitoring for a period of at least six to eight hours

36

Treatment of TCA with QRS widening

Sodium bicarbonate
Seizures -benzo

Newer recommendations for lipid therapy exist in the treatment of severe toxicity.

37

three major alcohols that are considered “toxic”.

metabolic acidosis:
-methanol
-ethylene glycol

no metabolic acidosis
-isopropanol



38

________ alcohol is usually not life threatening and can be managed by supportive care.


Isopropanol

rarely hemodialysis may be required.

39

All alcohols are metabolized by

alcohol dehydrogenase (ADH). Therefore, the initial treatment for methanol and ethylene glycol involves the blockade of ADH.

40

treatment of toxic methanol and ethylene

blockade of ADH w/ ethanol or fomepizole

hemodialysis

Sodium bicarbonate and glucose may also be necessary.

41

isopropanol, methanol, and ethylene glycol sources

Isopropyl- solvents, mouthwashes, rubbing alcohols.

Methanol - windshield fluid.

Ethylene Glycol - antifreeze.