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Flashcards in Poisoning & overdose Deck (54)
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1

What is flumazenil

Benzodiazepine antagonist
Precipiates withdrawal if dependent

2

Uses of flumazenil

May sometimes be used as an alternative to ventilation in children who are naive to benzo's or in COPD to avoid need for ventilation

3

What are the most important things to find out with OD/poisoning

Likely agents involved + coagents
Date and time of ingestion
Quantity
Route of exposure
Single OD/staggered/chronic

4

General examination of person who has ODed

Puncture wounds
Injuries
Self harm

5

Clinical signs of heroin OD

Coma
Constricted pupils
Reduced resp rate
Reduced level of consciousness
Hypotension
Bradycardia
Delayed gastric emptying

6

Clinical signs of ecstasy OD

Delirium
Tachycardia
Agitation
Dilated pupils
Hyperthermia

7

Organophosphate drug
Signs of OD

Malathion
Excessive cholinergic stimulation
Miosis, hypersalivation, vomiting, lacrymation, bradycardia

8

When are samples of ingested substance necessary?

If poisoning is suggested to be from:
• Ethylene glycol
• Iron salts
• Lithium salts
• Methanol
• Paracetamol
• Salicylates (aspirin)
• Theophyline

9

Aims of effective management of poisoning

• Reduce absorption (activated charcoal if within 1 hr, whole bowel irrigation if drug smugglers)
• Give an antidote
• Increase elimination (multiple dose activated charcoal if drug undergoes enterohepatic circulation, urine alkylation for salicylates, dialysis)

10

What is activated charcoal ineffective for?

Alcohol + ionised drugs
-Inorganic acids
-Strong alkalis
-Iron salts
-Lithium salts
-Methanol
-Ethanol
-Ethylene glycol

11

What is used in paracetamol poisoning?

Acetyl-cysteine

12

What is atropine used for?

Treatment of cholinergic excess (malathion poisoning)
To block PNS action of bradycardia (ß-blockers, digoxin)

13

What is used to treat iron poisoning

Desferrioxamine

14

How do you treat digoxin toxicity?

Using digoxin-specific antibdy fragments (Fab fragments)
Bind to digoxin, blocking uptake-> renal excretion

15

Use of fomepizole

Used to manage methanol and ethylene glycol poisoning
Blocks alcohol dehydrogenase, limiting toxic metabolites

16

Management of warfarin poisoning

Vitamin K (Phytomenadione)

17

What is used in ß-blocker toxicity

Glucagon

18

How much paracetamol can cause liver toxicity?

As little as 7g

19

When do you measure plasma-paracetamol level?

4-15hrs after ingestion

20

What factors are associated with a poor prognosis after paracetamol ingestion?

Prolonged prothrombin time
Raised creatinine
Low blood pH

21

When does maximal liver damage occur in an untreated paracetamol OD patient?

72-96hrs post ingestion

22

Pathophysiology of paracetamol liver damage

Metabolism pathways become oversaturated, build up of free radicals
Glutathione depletion
Free radicals cause liver damage

23

When should acetyl-cysteine be administered?

Within 10hrs of ingestion
Only after plasma levels are known (treatment line) (unless late presenation or staggered OD
Course of 21hrs infusion

24

Action of N-acetyl cysteine

Replenishes stores of glutathione

25

What happens if Acetylcyteine gives rash/bronchospasm

Pause infusion
Give antihitamine and bronchodilator
Restart infusion

26

Symptoms of iron overdose

N+V + diarrhoea
Grey/black stools
GI ulceration
GI haemorrhage
Haematemesis
Rectal bleeding
CV collapse

27

Management of iron OD

Admit if >20mg elemental iron/kg
Gastric lavage/aspiration if<1hr post ingestion
Take serum iron level
Desferrioxamine
ABGs, LFTs, Abdo Xray (radio opaque)

28

Management of opioid OD

Fluids
Naloxone infusion

29

Signs of salicylate poisoning

N+V
Dehydration
Deafness/tinnitus
Sweating/vasodilation
Hyperventilation
Tachycardia
Metabolic acidosis

30

How does aspirin cause metabolic acidosis?

Disrupts cellular metabolism by uncoupling oxidative phosphorylation-> metabolic acidosis. (respiratory compensation)