Toxic emergencies

Question 1

who do you contact if there has been a poisoning event?

Answer 1

poison control center- national networks (good to provide this phone number to parents)

Question 2

routes of exposure?

Answer 2

ingestion, inhalation, skin surface irritation, injection (animal bites/stings, IV drugs)

Question 3

what should you NOT do with a toxic exposure?

Answer 3

give q cathartic or inducing vomiting and diarrhea. (often found that these do no work or can cause more harm–i.e. aspiration)

Question 4

what are some acceptable general tx options?

Answer 4

Gastric lavage and activated charcoal may be utilized.

Enhance elimination of the toxin by use of hydration and poison or drug antidotes when possible.

Question 5

antidote for acetomenophen?

Answer 5

N-Acetylcysteine

Question 6

antidote for cyanide?

Answer 6

amyl nitrate, then sodium nitrate, then sodium thiosulfate

Question 7

antidote for lead?

Answer 7

edetate calcium disodium or dimercaptosuccinic acid (DMSA)

Question 8

antidote for atropine?

Answer 8

physostigmine

Question 9

antidote for benzodiazepines?

Answer 9

flumazenil

Question 10

How do you treat suicidal patients?

Answer 10

Document, do they have a plan, are there meds/guns in the house…etc. Involve law enforcement, medical direction, know local procedures for protective custody. (legal obligation)

Question 11

What other substance do you ask about during an assessment of ingested toxin?

Answer 11

Alcohol involvement.

Question 12

What do you avoid ingesting with unknown toxic exposure?

Answer 12

food– may cause vomiting

Question 13

what vitamin deficiency is seen in alcoholics?

Answer 13

Thiamine (B1) , often added to IV fluids in this population.

Question 14

which two substances may have fatal withdrawal sequelae?

Answer 14

alcohol and benzodiazepines

Question 15

signs and symptoms of carbon-monoxide?

Answer 15

HA, N/V, confusion or altered mental status, tachypnea [dec O2 carrying capacity]

Question 16

signs and symptoms of Anticholinergic toxicity

Answer 16

dry skin/mucous membranes, thirst, dysphagia, dilated pupils, tachycardia, rash, confusion,/delirium

Question 17

signs and symptoms of organophosphate toxicity (acetylcholinasterase inhibitors)

Answer 17

SLUDGE

salivation, lacrimation, urination, defecation, GI distress, Emesis

Question 18

antidote for organophosphates?

Answer 18

atropine

Question 19

Signs and symptoms of narcotic toxicity?

Answer 19

CNS depression, **pinpoint pupils, slow respiration, hypotension

Question 20

signs and symptoms of metal fume fever?

Answer 20

chills, fever, N/V, ms pain, throat dryness, HA, fatigue

Question 21

Signs and symptoms of cyanide poisoning?

Answer 21

a burning sensation in the mouth and throat, headache, confusion, combativeness, hypertension and tachycardia

Question 22

what is dangerous about cyanide?

Answer 22

rapidly acting toxin (can be ingested, inhaled and absorbed through the skin)

Question 23

what is the number one side effect of hypertensive drugs?

Answer 23

hypotension! overshooting with meds.

Question 24

what is the number one side-effect of cardiac drugs?

Answer 24

dysrhythmias

Question 25

Signs and symptoms of caustic substances (chemical or thermal burns)?

Answer 25

Hoarseness, stridor, or shortness of breath Shock from bleeding, vomiting. pain in the lips, tongue, throat, drooling, difficulty swallowing

Question 26

Signs and symptoms of salicylate toxicity? (salicylism) -w/ASA

Answer 26

tachypnea, abdominal pain, vomiting, tinnitus, pulmonary edema, ARDS hyperthermia, confusion, lethargy, coma, dysrhythmias, cardiac failure and respiratory arrest. we urinate more and hyperventilate with asa overdose (body trying to decrease acid)

Question 27

What causes Reye's syndrome?

Answer 27

Giving aspirin to children aspirin for a viral fever.

Question 28

What is often a cause for liver failure?

Answer 28

acetominophen/tylenol overdose

Question 29

what molecule is the most hepato-toxic molecule (from break down of acetominophine)?

Answer 29

NAPQI: N-acetyl-p-benzoquinone-imine.

Question 30

why is mixing tylenol and alcohol dangerous?

Answer 30

more rapid breakdown of tylenol to NAPQI and depletion of glutithione stores --> toxicity.

Question 31

At what stage does peak acteominophen toxicity occur?

Answer 31

STAGE 3: 72 to 96 hours: AST may exceed 20k.

Question 32

When is NAC the most effective as an antidote for tylenol?

Answer 32

asap or within 8 hours. | given IV

Question 33

why is NAC an antidote for acetominophen?

Answer 33

NAC is a precursor of glutathione and increases glutathione availability to bind to NAPQI (toxic breakdown moledule of acetominophin)

Question 34

Signs and symptoms of overdose of an NSAIDs?

Answer 34

abdominal pain, nausea, vomiting, drowsiness, headache, tinnitus, dyspnea, wheezing, pulmonary edema, swelling of extremities, rash and itching.

Question 35

samters triad?

Answer 35

consists of asthma, recurrent sinus disease with nasal polyps, and a sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs).

Question 36

what warning do all antidepressants have?

Answer 36

black box warning: increased suicidal ideation especially in adolescents.

Question 37

What is notable about tricyclic anti-depressants?

Answer 37

have a narrow therapeutic index.

Question 38

TCA toxicity signs and symptoms?

Answer 38

have an anti-histamine like effects: Dry mouth, blurred vision, urinary retention, constipation (have been used to prevent bed wetting in children- not a great drug choice obviously)

Question 39

what is notable bronchodilator used for asthma and COPD has a narrow therapeutic index?

Answer 39

theophylline (theodur)

Question 40

Serotonin syndrome? **

Answer 40

agitation, anxiety, confusion, insomnia, headache, coma, salivation, diarrhea, abdominal cramps, cutaneous piloerection, flushed skin, hyperthermia, rigidity, shivering, incoordinationand myoclonic jerks.

Question 41

what should people taking MAOi's avoid?

Answer 41

foods with tyramine- dried fruits, aged cheeses...etc

Question 42

what 2 conditions can be induced by lithium?

Answer 42

hypothyroidism or diabetes insipidus (nephrogenic) - often irreversible

Question 43

when is activated charcoal not indicated?

Answer 43

with iron, lead, mercury (or metal) overdose

Question 44

what are the signs and symptoms of iron overdose?

Answer 44

vomiting (possible hematemesis), diarrhea, abdominal pain, shock, liver failure, bowel scarring and obstruction, metabolic acidosis.