Toxicology 1: Introduction Flashcards
Who has most ingestions?
Children under 17
but only 10% are fatal (accidental)
Childhood ingestions are usually ___ , ____, and ____
Single
Known
Promptly recognized
What are most commonly ingested products in children?
1) Plants
2) Cleaning products
3) Cough / cold preps
4) Perfume / colognes
In adolescents and adults, toxic ingestions usually represent ___ or ____
Substance abuse
Suicide attempts
Adult/adolescent ingestions are usually ___, ____, ___, and with ___
Multiple substances
Intentional
Unknown
Delayed recognition
Most common potential route of toxic exposure?
Ingestion, then dermal
What is the basic approach to the patient?
- Substance
- Amount
- Route of ingestion
With children, if toxin is unknown what do you do?
identify all meds (including OTC) and household products in the vicinity and those taken by caretakers and relatives
What is a toxidrome?
a constellation of signs and symptoms deferrable to a single drug overdose
Does a toxic screen cover all the drugs?
NO!
What are the 5 methods of treatment principles?
- Provide supportive care
- Prevent absorption
- Enhance elimination
- Interrupt or alter metabolism
- Provide specific antidotes
If you want to get rid of an acidic toxin, what do you do?
Alkalinize the urine
Acid + Base = hydrophilic = goes to kidney to be peed out
Why alter metabolism?
if metabolite is extremely toxic, such as anti freeze
What is initial management for toxic overdose?
Airway
Breathing
Circulation
Drugs
What is the adult tox drug cocktail?
- Thiamine (avoid wernickes encephalopathy)
- D5W (for hypoglycemia)
- Naloxone (for narcotic OD)
- Flumazenil (for Benzos)
How does ipecac work?
Local gastric irritant and stimulator of chemo trigger zone
Who benefits from ipecac?
Alert patients without contraindications
When is ipecac useful?
Within 4-6 hours of ingestion
What are the 5 relative ipecac contraindications?
- Seizure inducing drugs
- Hydrocarbons (gasoline, grease)
- Rapid coma inducing drugs
- Pregnancy
- Severe bradycardia
What is the absolute contraindications for ipecac?
Children under 6 months
Seizing or comatose patients
Corrosive substances (drain-o)
What is gastric lavage?
Put water in, pull water out
How do you gastric lavage with children?
Use saline (risk of hyponatremia with kids)
What is the absolute contraindication for gastric lavage?
Unprotected airway
What is the relative contraindication for gastric lavage?
Hydrocarbons and corrosives
