Soins intensifs

Question 1

Intoxication TCA ?

Answer 1

**TOXIDROME ANTICHOLINERGIQUE **
Cardio : TV/FV (QRSélargi), hypoTA
SNC : AÉC, delirium, convulsions = benzo. et/ou IET selon GSC
sec, rétentions, MYDRIASE, hypertermie

Question 2

Intoxication Salicylate?

Question 3

ECG intoxication TCA ?

Answer 3

QRS large (+100)
onde R en aVR
onde S en D1 et aVL
Type 1 Brugada
(RBBB, downslope ST
depression V1-V3)

** BIC si arrythmie ventriculaire, hypoTA, QRS +100, acidose (pH 7,50-7,55)

Question 4

Trouvailles précoces et tardives de l’intox. au salicylate ?

Answer 4

précoce (1-2h) : hyperventilation
tardif :

Question 5

Trouvailles précoces et tardives de l’intox. au salicylate ?

Answer 5

précoce (1-2h) : hyperventilation, tinnitus, No/Vo, Fièvre
tardif : Convulsion/coma, OAP, arrytmie, thrombopénie, IRA, acidose métabolique à AG
(donc si acidose respiratoire : R/O co-ingestion, atteinte SNC, OAP)

Question 6

Indication dialyse en intoxication aux salicylates ?

Answer 6

– Levels >7.2mmol/L (toxique à 2,9-3,6 de base…)
– Hypoxemia requiring supplemental O2
– A change in mental status
– Renal failure (and level >6.5mmol/L)
– Progressive deterioration of vital signs
– Severe acid –base or electrolyte imbalance despite appropriate treatment (pH <7.2)
– Hepatic compromise with coagulopathy
– Volume overload preventing admin of sodium bicarb

Question 7

Stades intoxication au tylenol ?

Answer 7

Stage I (0.5 - 24 hrs) – nausea, vomiting, diaphoresis, pallor, lethargy, malaise, or
asymptomatic
* Stage II (24-72 hrs) – RUQ pain, jaundice, oliguria, rise in ALT & AST
* Stage III (72 – 96 hrs) – jaundice, confusion (hepatic encephalopathy), marked
elevation in AST & ALT, prolonged INR/PTT, bili > 68, hypoglycemia, lactic acidosis,
hyperammonemia, bleeding diathesis, renal failure
* Stage IV (96 hrs – 14 days) – recovery phase where hepatic necrosis may develop

Question 8

Charbon activé ?

Answer 8

1g/Kg ou max 50g si ingestion dans les 2-4h post-ingestion (tylenol, salicylate, TCA)
attention aux C-I

Question 9

critères pour cesser la perf de NAC ?

Answer 9

INR < 1.3, ALT < 100 U/L, acetaminophen < 132

Question 10

Stade intox éthylène glycol

Answer 10

The three stages include the following: Stage 1 (the neurological stage) occurs within 30 minutes to 12 hours after ingestion. Stage 2 (the cardiopulmonary stage) occurs between 12 and 24 hours after ingestion. Stage 3 (the renal stage) occurs between 24 and 72 hours after ingestion.