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Flashcards in Toxicology Deck (56):
1

what must be considered when dealing with toxic pt?

dose (manifestations may be related to how much they took)
route
intentional/unintentional
time elapsed (how long has it been since you took this?)

2

snorting

insluphation

3

toxidromes

toxic substance

4

AMS

altered mental status (frightened, agitated, delerium)
-overdose should always be in the differential when a pt presents with this

5

differential of AMS

AEIOUTIPS
alcohol/acidosis
electrolytes/epilepsy
infection (sepsis, elderly)
opiates/overdose
uremia (kidney failure)
trauma/toxicity/tumor
insulin (hypoglycemic/hyperglycemic)
psych
stroke

6

steps to manage patient

ABC -airway (protect it proactively)
D-decontamination (remove garments)
E-easily correctable issues (hypoglycemia, hypoxia, hypotension, hypo/hyperthermia)

7

what is the most common OTC overdose?

acetaminophen

8

what organ does acetaminophen affect?

liver
encephalopothy

9

what is the max dose in people of acetaminophen?

4gms (adults)
90mg/kg (children)

10

toxicity is assoc with what dose of acetaminophen

150mg/kg

11

what is the first stage of acetaminophen overdose?

stage 1: asymptomatic, anorexia, nausea/vomiting, LFTs (liver enzymes) rise in the first 24 hours

12

what is the 2nd stage of acetaminophen overdose?

18-24 hrs post ingestion
RUQ pain
continued rise in LFTs and aPTT
oliguria (urine output drops)
tachycardia
hypotension

13

what is the 3rd stage of acetaminophen overdose?

72-96 hrs post ingestion
continued abdominal pain
hepatic necrosis and encephalopathy (due to rising ammonia levels because liver can't break down nitrogenous wastes of protein synthesis)
jaundice
GI bleeding
LFTs peak, ammonia and bilirubin continue to rise

14

what is the 4th stage of acetaminophen overdose?

4dys -2weeks
resolution of hepatic abnormalities of liver failure
LFTs come down

15

what lab studies will you order with acetaminophen overdose?

CBC
CMP
arterial blood gasses (ABG)
acetaminophen level (recheck every 4 hrs)
U/A
RUQ ultrasound (grossly enlarged gallbladder?)
CT of the head (with evidence of encephalopathy)
EKG (for baseline)

16

what are examples of salicylates?

aspirin
pepto-bismol
oil of wintergreen

17

what drug is taking the place of aspirin as a common overdose drug?

anti-depressants

18

what is the early presentation of aspirin OD?

early (1-2 hrs post ingestion)
-tinnitus
-vertigo
-Nausea/Vomiting/Diarrhea
-hyperpyrexia
-coma

19

what is the later presentation of aspirin OD?

hypernea
blood gas abnormalities
-respiratory alkalosis (CO2 is leaving the body)
-metabolic acidosis
-cerebral edema (AMS)
(cleared in the liver and kidney)

20

what labs do you order for aspirin OD?

salicylate levels
CBC
CMP
LFT
ABG (blood gasses)
UA
(protein will go up, spill blood in the urine)

21

what are the normal/abnormal levels of salicylate?

110 mg/dL severe toxicity

22

what are exampels of opioids

codeine
morphine
hydrocodone
oxycodone
heroine

23

what is the presentation of opioid OD?

respiratory depression
pinpoint pupils (lost light reaction-no dilation)

24

when are the peak effects of opioid with IVs?

10 min with IV route

25

when are the peak effects of opioid with insufflation?

10-15 min

26

when are the peak effects of opioid with IM administration? (intermuscular)

30-45 min

27

when are the peak effects of opioid with oral ingestion?

90 min

28

when are the peak effects of opioid with dermal application?

2-4 hours

29

what labs should you order with opioid OD?

CBC
CMP
ABG
toxicity screen-often times qualitative (opioids, canabis, salycilates, acetaminophen)
abdominal film (body packers)

30

what is the peak effect of cocaine via inhalation?

1-5 min

31

what is the peak effect of cocaine via IV?

3-5 min

32

what is the peak effect of cocaine via nasal?

15 min

33

what is the peak effect of cocaine via oral?

60 min

34

what is mild presentation of cocaine OD?

euphoria
agitation
tachycardia
hypertension

35

what is moderate presentation of cocaine OD?

stroke
renal ischemia
seizures
ventricular dysrhythmias
apnea
cyanosis
hyperthermia
coma
death

36

what are the physiologic affects of cocaine

vasoconstrictor
cardiotoxic
long term use = constrictive cardiomyopathy

37

what labs would you order with cocaine OD?

CBC
CMP
UA
EKG (baseline)
tox screen

38

what are examples of benzodiazepines

valium
xanax
ativan
klonopin
librium (older, not used as much)
tranxene (older, not used as much)
-extremely addictive, designed for short, acute,use

39

presentation of benzo OD?

coma with normal vital signs
nystagmus (horizontal typically)
hallucinations
slurred speech
ataxia (stumble, clumsy gait)
AMS
agitation
Respiratory depression

40

what labs would you order with benzo OD?

CBC
ABG
tox screen (if suspect multiple ingestion)
no set test to identify benzos in blood or urine

41

what are examples of antidepressants?

tricyclics
-elavil
-pamelor
-tofranil
-vivactyl

42

presentation antidepressant OD?

CNS sedation
confusion
delirium
hallucinations
cardiac arrhythmias (widened QT interval-ventricular dysrythmias )

43

what labs would you order for antidepressant OD?

EKG
tox screen (nothing else involved)
TCA levels (qualitative only)
salicylate levels
acetaminophen levels

44

ethanol

ETOH

45

BAC of 0.01-0.1 presents with

euphoria
mild coordination deficits
attention and cognition

46

BAC of 0.1-0.2 presents with

coordination deficits and psychomotor skills, decreased attention, slurred speech, ataxia, impaired judgment and mood variability

47

BAC of 0.2-0.3 presents with

lack of coordination, incoherent thoughts, confusion and nausea and vomiting

48

BAC of >0.3 presents with

stupor and loss of consciousness
coma
respiratory depression and death

49

what is a common complication of vomiting while drunk?

aspiration

50

things to consider with ETOH

BAC may not correlate with S & S
watch out for respiratory depression

51

labs for ETOH

ETOH level
ABGs
tox screen (if something else is going on)

52

why is carbon monoxide dangerous?

it has a greater affinity for hemoglobin compared to oxygen (300 times greater)

53

presentation of acute CO poisoning

headache (most common)
malaise
nausea
dizziness
can be misdiagnosed as ETOH intoxication
chest pain (AMI)

54

presentation of long term CO poisoning

cognitive deficits
personality changes
movement disorders (ataxia that doesn't resolve)and
focal neurological deficits

55

what social group has higher levels of CO?

smokers

56

labs for CO poisoning?

Pulse ox is NOT reliable, cannot distinguish between O2 and carboxyhemaglobin
ABGs (smokers may have 10-15% baseline)

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