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errors and drugs > Poisonning > Flashcards

Poisonning Flashcards

1
Q

How can be exposed to poisons

A

Oral
Inhaled
Percutaneous - cyanide, organophosphates
Ocular - industrial

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2
Q

Types of poisonning

A

Acute, chronic, acute on chronic
Deliberate or accidental

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3
Q

What is digoxin poisoning time wise?

A

Chronic - elderly too high a dose -> renal failure

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4
Q

Epidemiology of poisoning UK

A

180,000 cases a year
100,000 aditted
300 die
3,500 deaths outside of hospital

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5
Q

What age groups are most comonly affected by poisonings

A

1-5 year olds (male>female)
-accidental, daytime
Adolescents, young adults (male=female)
Deliberate self harm, overdose, evening/night, alcohol ass

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6
Q

Top 10 substances poisonings UK

A

1 - paracetamol (25% all overdoses involve)
2 - ibuprofen
3 - citalopram
zopiclone, fluoxetine, co-codamol, asirin, diazepam, codeine, diclofenac

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7
Q

Most common causes of death from poisoning

A

Paracetamol
TCAs
Opiates - IV heroin, methadone
Carbon monoxide - house fires

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8
Q

ABC assessment in poisoning

A

-AW and gag reflex, coma position
B - RR, O2, ABG
C - pulse, BP, perfusion, IV access, IV fluids for hypotension

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9
Q

What medications esp need to watch for circulatory collapse in

A

Cardiac medications eg B blockers, CCBs
Amphetamines, ecstasy, cocaine, cannabis

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10
Q

What immediate history information need

A

WHEN
WHAT
Mode and duration of exposure
Symptoms

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11
Q

Later information gathering in poisoning

A

WHY
Self harm?
Was it concealed
Consider - timing, precautions aainst discovery, medical help, final acts,

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12
Q

Examination in poisoning

A

Skin colour
Temperature
Pulse rate and rhythm
BP
Coma scale = GCS
Pupils
Muscle tone
Tendon refleces
Resp rate
Needle marks - IVDU, hep, HIV
Blisters
Lacerations, other causes of presentation

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13
Q

What would high temp signify in terms of posionings

A

Cocaine, amphetamine, ecstasy poisnoning

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14
Q

What may bradycardia suggest about a poisoning

A

CCB or digoxin

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15
Q

Hypertension after drug overdose what drug

A

Cocaine

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16
Q

Coma/reduced RR suspect which toxins

A

Benzos, opiates

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17
Q

Meoisis cause

A

Opiates
Organophosphates

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18
Q

What causes dilated pupils

A

Stimulants, anticholinergics, synthetics, cannabis

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19
Q

Routine investigations for overdose presentation

A

FBC, U+Es, LFTs, creatinine, blood glucose, ABG, ECG, CXR

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20
Q

Tests for specific poison concentrations in drug overdose

A

Paracetemol
Salicyclate (aspirin)
CarboxylHb - CO
lithium
iron
Methanol
General urine toxicology screen has limited use

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21
Q

What test for CO poisoning

A

Carboxyl Hb

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22
Q

Management strategies for overdose

A

Support physiology
Prevent absorption
Specific antidote
Chelation
Enhance elimination

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23
Q

What is time frame for gastric deconatmination methods

A

Little evidence useful unless used within one hour (may still use within a few hours)

24
Q

Methods for gastric decontamination

A

Activated charcoal (99%)
Gastric aspiration/lavage
Induced emesis - no longer used - perforation asp etc

25
Q

What patients cant gastric decontamination be used in

A

Unconscious or drowsy unless AW protected <GCS

26
Q

When is gastric lavage/aspiration sued

A

very large and life threatening overdoses
Poisons not absorbed by activated charcoal

27
Q

What should note with gastric lavage

A

More difficult and hazardous in children
Cuffed endotracheal tube in reduced GCS or drowst patients
Rare niw

28
Q

Complications of gastric lavage

A

Gut perforation
Aspiration
Laryngospasm
Water intoxication (hyponatremia)
Dysrhythmias
Pneumothorax
Enhanced early drug absorption

29
Q

Contraindications gastric lavage

A

Hydrocarbon ingestion
Caustic substance - risk of aspriation pneumonitis or perforation

30
Q

What is activated charcoal

A

Charcoal heated in steam air or CO at 600-900 degrees C - increases surface area

31
Q

How does activated charcoal work

A

Adsorbs poison in GI tract by direct contact - reduces absorption

32
Q

What is activated cahrcoal to drug ratio required to be effective

A

Variable - 8:1
Give 10 x dose of poison taken up to 50g

33
Q

How is activated charcoal administered

A

Unpalatable - suspend in flat cola
NG tube - protect with cuffed endotracheal tibe if gag reflex inadequate

34
Q

Complications of activated charcoal

A

Aspiration pneumonitis
Reduced absorption of therapeutic agents eg methionine
Briquette formation -> bowel obstruction

35
Q

Contraindications for activated charcoal

A

Absent bowel sounds - ileus
Impaired gag reflex
Unsafe swallow

36
Q

What poisons is activated charcoal ineffective for

A

Elemental metals/salts - Lithium, iron, boron, salts
Insecticides - malathion, DDT, N-methyl carbamate
Cyanide
Strong acids/alkalis
alcohols
Hydrocarbons

37
Q

Methods to increase drug elimination

A

Multiple dose activated charcoal
Chelation
Urinary alkalinisation
RRTs

38
Q

Renal replacement therapies for overdose

A

Haemodialysis
Haemoperfusion
Haemofiltration
Combined - haemofiltration, MARS

39
Q

How give MultiDACharcoal

A

50g activated charcoal
further 25g every 3 hours

40
Q

What need to give with MDAC

A

Laxative/stool softener to prevent constipation

41
Q

Mechanism of MDAC

A

Reduced elimination half life by interfering with enterohepatic circulation (removes drug onto charcoal)
‘GI dialysis’ - onto charcoal, conc gradient OUT of lumen into GI tract nto charcoal

42
Q

What drugs does MDAC work well for

A

Carbamazepine
Dapsone (antibiotic)
Phenobarbitone
Quinine
Theophylline
May use in - salicyclate, phenytoin

43
Q

When is haemodialysis and haemoperfusion useful

A

small vol of distribution
Low inherent clearance rate (not naturally cleared well by kicneys)
Sufficiently toxic
Small enough to cross dialysis membrane
More free than protein bound
Can bind to activated charcoal - jaemoperfusion

44
Q

Haemodialysis and haemoperfusion

A

Haemodialysis - diffusion gradient allow poison to diffuse across semi permeable membrane
Haemoperfusion - activated charcoal filter directly adsorbes poison

45
Q

Haemofiltration

A

Suction rather than filtration gradient

46
Q

What poisons is haemodialysis (on tis own) used for

A

Toxic alcohols - ethylene glycol, isopropanol, ethanol
Salicyclate - aspirin
Sodium valproate
Lithium
THallium

47
Q

What drugs can be cleared by haemodrialysis OR haemoperfusion

A

eg activated charcoal works
Theophylline
Phenytoin
Carbamazepine
Barbituates

48
Q

Paracetemol antidote

A

Acetylcysteine
Methionine (glutathione repleters)

49
Q

Ethylene glycol, methanol antidotes

A

ethanol, fomepizole
Aim to slow down metabolism - metabolites are toxic
Competitive antagonist

50
Q

Flumexanil side effects

A

Mainly seizures

51
Q

What are chelating agents or fixing agents used to treat

A

Iron, heavy metals, cyanide

52
Q

Chelating agents

A

Desferrioxamine, dimercaprol, edetate (dicobalt or Na Ca), hydroxycalbamin

53
Q

Antidote for dapsone

A

Methylene blue

54
Q

Organophosphates atnidote

A

Pralidoxime

55
Q

Digoxin antidote

A

Digibind

56
Q

Snake bites antidote

A

Zagreb antivenom

errors and drugs (8 decks)

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