Tox General Flashcards
(51 cards)
Where are poison control centers generally located?
One in every state –> KY’s is in Louisville
What is the average time to presentation for a toxicology ingestion in adults and in children?
Adults: 3.5 hours
Pediatrics: 1.5 hours
What patient population accounts for the most toxic ingestions?
Children under 17 account for the most ingestions but only 10% of the fatalities
T/F: Most pediatric fatalities from toxic ingestions occur under the age of 4.
False: Fatalities in children under the age of 6 are uncommon
T/F: Toxic ingestions in children have been increasing recently.
False: ingestions have been declining since the 1960s
Differentiate generally pediatric ingestions from adult ingestions
Peds: ingestions are single, known, and promptly recognized
Adults: ingestions are multiple, intentional, unknown, and with a delayed presentation
What are the four most commonly ingested products in children?
Plants
Cleaning products
Cough/cold preps
Perfumes/colognes
What accounts for most toxic ingestions in geriatric patients?
Chronic overmedication (polypharmacy)
What route of administration accounts for the most toxic exposures
Ingestion
What is the basic approach to determining how best to treat a tox patient?
Identify the substance, amount, and route of exposure –> assume the worst case scenario
If a toxin is unknown, how might a provider identify the toxin?
Using toxidromes –> constellation of S/S associated with what a drug does in toxicity
Differentiate between a quantitative and qualitative tox screen.
Quantitative: tells you how much is present
Qualitative: tells you whether or not substance is present
When would one use a qualitative screen instead of a quantitative screen?
Qualitative screens may be faster in reporting results
What drugs can a tox screen usually look for?
Any drug, but you must specify what you want the lab to look for
What are five general treatment principles for managing toxic exposures.
Provide supportive care Prevent absorption Enhance elimination Interrupt or alter metabolism Provide specific antidotes
When would you want to interrupt or alter metabolism?
When the drug is not toxic but it’s metabolite is
What drugs are included in the standard toxicology treatment cocktail?
Thiamine, 100mg IV
D5W, 50ml IV
Naloxone, 2-8 mg IV
Flumazenil, 0.2mg IV
Why is the standard toxicology management cocktail no longer hot?
Because flumazenil decreases seizure threshold and many toxins can cause seizures
What is the mechanism of action of syrup of ipecac?
Plant derivative containing emetine and cephalin which irritate the stomach and stimulate the vomit control center in the brain –> induces vomiting.
Why is syrup of ipecac not hot anymore? (2 reasons)
It is not effective if substance is post pyloric
Risk of aspiration since most toxins cause decreased level of consciousness or seizures
What are 5 relative contraindications to ipecac?
- Seizure inducing drugs
- Rapid coma inducing drugs
- Pregnancy –> vomiting causes bradycardia and may decrease blood flow to the fetus
- Hydrocarbons –> substance is generally only toxic if they are aspirated
- Severe bradycardia
What are 3 absolute contraindications to ipecac?
Children < 6 months
Seizing or comatose patients
Corrosive substances
What is another term for gastric lavage?
Pumping the stomach
Differentiate the gastric lavage procedure in children from adults?
In adults you may use free water. In kids, you must use saline so as not to cause hyponatremia and decrease seizure threshold.
