week 3 Flashcards
(21 cards)
Toxidromes
Anticholinergic
blind as a bat (mydriasis) mad as a hatter (altered mental status) hot as Hades (hyperthermic) red as a beet (flushing) dry as a bone (no sweating) bowel/ bladder increase their tone (urinary retention, decreased bowel sounds) heart runs alone (tachycardia)
Sympathomimetic
Toxidromes
Hypertension tachycardia diaphoresis mydriasis hyperthermia CNS excitation Delirium
Sedative/Hypnotic
Toxidromes
Drowsy slurred speech nystagmus hypotension ataxia coma respiratory depression
activated charcoal dose
Ratio of 10:1 of AC:toxin
Cholinergic
Toxidromes
DUMBBELLS Diarrhea/Diaphoresis Urination Miosis Bradycardia Bronchorrhea Emesis Lacrimation Low BP Salivation
An _____ is a must in all unknown toxic exposures
EKG
____________ are the mainstay of treatment in the patient suspected of a sympathomimetic ingestion/toxicity.
Benzodiazepines
How do you know a button battery is in airway or esophagus?
Vocal cords make a coin slot- will be skinny edge to front
coin face on- probably esophagus
Is a button battery in the stomach or further an issue?
usually this is fine- should pass easily
Normal transit time for food in GI tract
24 hours for food
foreign objects should pass within 1 week
Can you use OSM gap to rule out toxic ETOH?
per Dr. Seifert: NO, he doesn’t even order this test
Possible Toxic ETOH could have normal osm
4 Agents that block alcohol dehydrogenase
the enzyme that metabolizes ETOH
Disulfiram/ Antabuse
Degreasing agents
Sulfonurea
Metronidazol
Blood alcohol level clearning time
ex BAL 100
clearance = 20 /hour
ex:
100 / 20= 5 hours
300/20= 15 hours
ETOH dose response
for standard drinker
< 30= no effect 30-50= fun 50-80= sedation 80-150= obvious intoxication 350-500= lethal
coroners will attribute death to ETOH if BAL is over 250 no matter the tolerance
Ibuprofen MOA
COX-2 inhibitor
OD= GI irritation, delayed AKI, a-gap acidosis
ABCD of tox Bradycardic/ hypotension
A- a2 agonist
B- beta blocker
C- ca channel blocker
D- digoxin
a2 agonist
Bradycardic/ hypotension
S/S: sleepy, decreased bowel sounds
RX: IV fluids, +/- Atropine
Beta Blocker
Bradycardic/ hypotension
S/S: cap refill sluggish
RX:
0.1 mg/kg Glucagon ( +/- 10 mg for adult)
insulin
lipid emulsion bolus
Digoxin
Bradycardic/ hypotension
S/S: increased K+, Salvador Dali mustache EKG
protip: K=5.5 is 50% mortality w/ dig
RX:
Digoxin immune fab antidote,
ca channel blocker
Bradycardic/ hypotension
S/S: Increased blood sugar, brisk cap refill
RX:
calcium gluconate, goal ionizing ca++ ~ 2
insulin
Warrick’s approach to Bradycardic/ hypotension Tox in EDRU
Pressors Calcium Gluconate Glucagon vs insulin Methylene Blue ECMO Lipid
