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Toxidromes Flashcards

(45 cards)

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1
Q

What are the changes that you expect to see in opioid poisoning?

A
  • Bradycardia\Bradypnea
  • Decreased bowel movement
  • Pinpoint pupils
  • coma
  • normal to low temperature
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2
Q

What is the antidote of opioid oversdose

A

Naloxone

If there’s respiratory depression

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3
Q

What are the anticholinergics that you’re aware of?

A
  • Antidepressant
  • Anti-Parkinson
  • Anti-psychotic
  • Anti-spasmodic & Anti-vertigo
  • Muscle relaxants
  • Jimson weed
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4
Q

What do you expect to see in anticholinergic toxicity?

A
  • Dry as a desert
  • Hot as a desert
  • Red due to desert
  • Dilated to look through the desert
  • Tachycardia & Absent bowel sounds
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5
Q

What is the antidote for anti-cholinergic toxicity?

A

Phyostigmine

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6
Q

What do you expect to see in cholinergic toxicity?

A 
Leaking from every orifice
SLUDGE-B 
- Salivation 
- lacrimation 
- urination 
- deification
- Gastric upset 
- Emesis 
- Bradycardia, Bronchospasm, Bronchorrea
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7
Q

What is the antidote for Cholinergic overdose

A

Atropine

Pralidoxime

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8
Q

What is the goal of atropine treatment in cholinergic overdose?

A

Drying the patient of secretions, no maximmum dose! Continue until dry

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9
Q

What is the dose of cholinergic toxicity?

A

2mg - double every 5 minutes - until reach dryness

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10
Q

What do you expect to see in sympathomimetic toxidrome?

A
  • agitated, delirium, seizure
  • dilated pupils
  • tachycardia, high BP
  • hot & sweating

[No change in bowel]

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11
Q

What is the antidote of sympathomimetic?

A

Benzodiazepines

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12
Q

Give examples of sedative hypnotics?

A
  • Barbiturate
  • Benzodiazepine
  • Sleep medications (Zolpidem & melatonin)
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13
Q

what is the antidote of benzo overdose

A

Fluma-Zenil

Given to avoid intractable seizure due to withdrawal in iatrogenic overdose

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14
Q

What are the differential diagnosis of high gap acidosis?

A

A CAT MUDPILES

  • Asprin
  • Carbamezapine
  • Alcohol
  • Toluene
  • Methanol\Metformin
  • Uremia
  • DKA
  • Paraldehyde
  • Isoniazed\Iron
  • Lactic aciosids
  • Ethylene glycol
  • Salicylate
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15
Q

How to get the toxin outside the patients body?

A
  • Decontaminate
  • Enhance elimination
  • invasive methods
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16
Q

What are the dermal, Opthalmic, and the GI decontamination methods?

A
  • Dermal: Water\soap - diphtotrene (chemical)
  • Ophthalmic: water - 0.9% normal saline
  • GI: activated charcoal, MDAC, Lavage, WBI
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17
Q

How to dermal decontamination?

A

1- Remove all attire (cloth, jewls)

2- Choose decontamination solution (water\soap - Diphoterine)

3- 5-15 minutes of decontamination

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18
Q

How to dermal decontaminate an open wound

A

Provide an additional 10-15 minutes of decontimation

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19
Q

How to provide ophthalmic decontamination?

Study These Flashcards
A

1- provide ophthalmic anesthetic

2- 1 to 2 L of normal saline\BSS\ LR

3- aim to reach ocular PH of 7-7.2

4- monitor at 15-20 minutes intervals to insure no further particles present.

20
Q

What are the indications for single-dose activated charcoal?

Study These Flashcards
A

1- given within 1hr of ingestion

2- ingestion of toxic amount of poison

21
Q

What are the contraindications of single-dose activated charcoal?

Study These Flashcards
A

1- unprotected airway\or\ high risk for aspiration.

2- un-intact GI tract

22
Q

What are the complications of SDAC?

Study These Flashcards
A

1- Vomiting\Aspiration

2- Corneal abrasion if there’s direct contact

23
Q

What are the poisonous indications of MDAC?

Study These Flashcards
A

Ingestion of
(QPDTC) كبدتس!

  • Carbamazepine
  • Dapsone
  • Phenobarbital
  • Quinine
  • Theophylline
24
Q

What is the role of MDAC?

Study These Flashcards
A
  • Prevents absorption\reabsorption

- Enhance elimination of xenobiotics

25
What is the dose of MDAC?
- 12g\h | - 25g Q4-6hrs
26
What are the complications of MDAC?
- aspiration | - GI OBSTRUCTION
27
What are the substances that are not adsorbable by activated charcoal?
PHAILS! - Pesticide\potassium - Hydrocarbons - Acid\alkali\alcohol - Iron - Lithium - Solvents
28
What is the device used in gastric lavage?
Ewald tube - Adults: 30-38Fr - Children: 24-48Fr
29
How to preform gastric lavage?
1- keep in left lateral decubitus position 2- insert ewald tube and confirm placement 3- lavage with warm saline 250cc 4- repeat
30
What are the contraindications to gastric lavage?
1- compromised airway 2- high risk patient of perforation\ hemorrhage \cogulopathy 3- corrosive or hydrocarbons
31
What are the complications of gastric lavage?
- perforation - aspiration - electrolyte imbalance - Laryngospasm- hypoxia - dysrhythmia
32
What are the drugs that benefit from using WBI for decontamination
- enteric coated drugs - sustained release drugs - high and high doses of iron - packets of illicit drugs - salicylate - lithum - lead or metals
33
What are the contraindications of WBI?
- perforation - compromised airway - GI bleeding & hemodynamically instability - intractable vomiting
34
What are the complications of WBI?
- N&V - cramps & bloating - aspiration
35
What are the methods usually used for enhanced elimination
1- urine alkalinization 2- hemodyalsis 3- charcoal hemoperfusion
36
What are the options for invasive decontamination
1- Endoscopy | 2- Surgical laparotomy
37
In which situation would endoscopy be beneficial at as an invasive procedure?
Removal of button batteries
38
In which situation would surgical laparotomy be beneficial at as an invasive procedure?
- bowel obstruction | - packer leakage
39
What are the diagnostic studies to order in case of toxicity?
1- EKG 2- LABS 3- Chemistry 4- B-HCG 5- CBC 6- Urine drug screen 7- serum osomlality 8- acetaminophen & salicylate
40
What labs would you order in toxicity suspicion
- Digoxin - ETOH - Lithium - Lead - Phenobarb - Depakote - Theophylline - Phenytoin (As indicated)
41
What are the chemistry labs to order
- electrolyte | - anion gap
42
In toxic alcohol, what important diagnostic study to order?
Serum osmolality
43
How to investigate for paracetamol toxicity?
1- wait for 4 hours after ingestion 2- obtain Paracetamol levels 3- plot on nomogram to decide the antidote 4- if antidote indicate d give within 8 hours of ingestion
44
What is the antidote for paracetamol toxicity?
NAC | N-acetyle cystine
45
What are the radio-opaque substance on imagine?
BET-A-CHIP - Barium - Enteric coated drug - TCA - Antihistamine - Calcium, condom, chloral hydrates - Heavy metals - Iodine\iron - Potassium\phenothiazide

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