Toxicology

Question 1

First thing we do

Answer 1

ABCDE

Question 2

Airway assessment

Answer 2

Is airway protected
Is airway at Risk
What’s the GCS
Any clues (smell,colour,tablet residue,burns)

Question 3

Breathing assessment

Answer 3

Rate
Pattern
Efficacy
Added sounds

Question 4

Circulation

Answer 4

Pulse
No
CRT
IV access
Signs of ivda

Question 5

Agent used for GI decontamination

And dose

Answer 5

Activated charcoal

1g/1kg

Question 6

Multiple doses of carbon can

Answer 6

Enhance removal of already absorbed substances

Question 7

Whole bowel irrigation used for

Answer 7

Heavy metals (iron)
Body stuffers/packers

Sustained release pills

1L/hour until material is recovered or effluent is clear

Question 8

Paracetamol

Answer 8

Commonest ingested toxin in UK for intentional OD

Rarely taken alone

Question 9

Paracetamol OD

Answer 9

Damage tit he liver

6g total potentially fatal

Question 10

Features of paracetamol OD

Answer 10

Extremely common- nausea and vomiting

After 2/3 days : hepatic necrosis, right subcostal pain, tenderness, recurrence of nausea, vomiting and jaundice

Question 11

If caught within one hour of Od

Answer 11

Activated charcoal

Question 12

If under 8 hours

Answer 12

Treat and wait for blood levels

Question 13

Staggered overdose

Answer 13

4 hours after last ingestion in staggered OD take blood measure and paracetamol level INT +LFTS

Question 14

When does patient not need treatment in staggered overdose

Answer 14

If paracetamol is below 10 and
INT 1.3 or less AND
ALT normal AND
Patient has no symptoms of liver damage/abdo pain/jaundice/vomiting

Question 15

Opiate features

Answer 15

Drowsy or unconscious patient

Dysfunctional breathing

Decreased RR

Question 16

Naloxone half life

Answer 16

Is short, repeated doses may be required

Question 17

If not in respiratory failure with good sats

Answer 17

You don’t have to give naloxone just observe

Question 18

Aspirin overdose

Features

Answer 18

Hyperventilation
Sweating
Tremors
Tinnitus
Nausea/vomiting

Question 19

Aspirin OD management

Answer 19

ABCDE
Bloods
Salicylate level at 4 hours

>700 potentially lethal 
U+Es 
Glucose 
ABG
Bicarbonate 

Activated charcoal

Question 20

Management aspirin Od

Answer 20

Levels above 700 consider haemodialysis

Question 21

Cocaine effect

Answer 21

Local anaesthetic and CNS stimulant

Question 22

Clinical features of cocaine use

Answer 22

Feeling of euphoria followed by dysphasia, irritability and hypersomnia

Question 23

Cocaine overdose

Answer 23

Signs of hyperadrenerifx state: agitation, anxiety,dilated pupils, twitches/tremors, hallucinations

Question 24

Treatment for cocaine use

Answer 24

Benzodiazepine for severe agitation, seizures (avoid antipsychotics)

Alpha/beta blockers (labetolol)

Maybe GTN