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36 Cards in this Set
- Front
- Back
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causes of miosis (poisonings) |
COPS cholinergics, clonidine opiates, organophosphates phencyclidine (PCP), phenothiazine, pilocarpine sedatives (barbiturates) |
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causes of mydriasis (poisonings) |
AAAS anticholinergics (atropine) anntihistamines antidepressants (cyclic) sympathomimetics (amphetamine, cocaine, LSD) |
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causes of diaphoretic skin (poisonings) |
SOAP sympathomimetics organophosphates aspirin (salicylates) PCP (phencyclidine) |
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causes of red skin (poisonings) |
carbon monoxide boric acid |
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prolonged QRS = ___ ingestion |
tricyclic |
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what ingestions cause an anion gap? |
MUDPILES methanol, uremia, DKA, phenols, iron, INH, lactate, ethanol, ethylene glycol, salicyclates |
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when is activated charcoal contraindicated? |
GI obstruction/perforation, unprotected airway, ingestion of caustic or hydrocarbon
ineffective: electrolytes, emtals, iron, cyanide, alcohols, lithium, camphor, phosphorus |
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when do tylenol levels peak? |
4 hours after ingestion |
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when do symptoms peak after tylenol poisoning? |
48-96 hours; AST >20k, prolonged PT, death from hepatic failure or coagulopathy |
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symptoms of anticholinergic ingestion |
dry as a bone: decreased sweating and UOP red as a beet: flushing blind as a bat: mydriasis mad as a hatter: agitation, seizures hot as a hare: hyperthermia |
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s/sx of carbamazepine ingestion |
sx 6-24 hours after; drowsiness, vomiting, ataxia, slurred speech, nystagmus, CNS depression
test 2-4 hours after |
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clonidine ingestion symptoms |
occur within 1 hour mimic opioid toxicity (CNS and respiratory depression with pinpoint pupils) |
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when is ibuprofen toxic? |
dose of >400mg/kg; can cause seizures and coma |
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when is iron toxic? |
20mg/kg mild 40mg/kg moderate >60mg/kg severe |
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phases of iron toxicity |
GI stage (30min-6h) - n/v/d/abd pain, hematemesis, bloody diarrhea
stability 6-24h
systemic toxicity 12-24h - hypovolemic shock, CV collapse, metabolic acidosis with AG, hepatic failure, jaundice, coagulation disruption worsens GI bleeding
GI/pyloric scarring (2-6wk) |
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toxic level of iron |
>500 mcg/dl |
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treatment of iron toxicity |
IV deferoxamine (if >500mcg/dl)
no gastric lavage or activated charcoal |
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symptoms of opioid ingestion |
coma, respiratory depression, pinpoint pupils |
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phenothiazine ingestion/overdose |
promethazine, prochlorperazine, chlorpromazine
anticholinergic effects, cogweel rigidity, long QT interval, dystonic reaction
treat with charcol
treat dystonia with diphenydramine IV/IM |
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why is bicarbonate given during therapy for treatment of salicylate ingestion? |
to enhance elimination by alkalinizing the urine to pH >8 |
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acute findings of calicylate ingestion |
GI (n/v) respiratory (hypernea -> respiratory alkalosis) if severe, CNS sx (agitation, confusion, coma)
can also cause fever, tinnitus, electrolyte imbalance, metabolic acidosis with positive anion gap |
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electrolyte abnormalities in theophylline ingestion |
increased glucose and calcium, decreased potassium and phosphate, metabolic acidosis |
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symptoms of TCA ingestion |
CCCA coma Convulsions cardiac dysrhythmias (tachycardia, widened QRS, prolonged QT) acidosis |
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treatment of TCA ingestion |
do not induce emesis (aspiration)
activated charcoal, sodium bicarb to alkalize serum to prevent dysrhtyhmias lidocaine if dysrhythmic ECG monitoring |
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symptoms of CO poisoning |
headache, malaise, nausea, "flu" symtpoms, cherry red skin |
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alkaline agents and characteristics |
bleeach, ammonia, oven and drain cleaners, dishwasher detergent, ahir relaxers, lye
tasteless
severe, deep, liquefaction necrosis; scar tissue with strictures |
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acidic agents and characteristics |
toilet bowl cleaner, grout cleaner, rust remover, automitive battery liquids, metal cleaners
bitter taste
coagulation necrosis (superficial), may lead to thick eschar formation, severe gastritis, metabolic acidosis, acute renal failure |
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management of caustic substance ingestion |
upper endoscopy if symptomatic or with visible burns in the mouth
do not neutralize, induce emesis, gastric lavage, or activated charcoal |
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symptoms and treatment of methanol ingestion |
methanol = windshield washer fluid, antifreeze, canned heat, fuel; metabolized to formic acid
visual complaints (blurry vision and photophobia = snowstorm, optic nerve damage leading to blindness abdominal pain metabolic acidosis
IV fomepizole; do not lavage/charcoal |
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ethylene glycol ingestion symptoms and treatment |
in antifreeze, radiator fluid, coolants; tastes sweet
CNS manifestations, coma, cardiac/respiratory problems, renal failure; metabolic acidosis
fomepizole, sodium bicarb |
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mechanism of organophosphate toxicity |
inhibit cholinesterase enzymes, form permanent bonds over 1-3 days, can take weeks-months for enzyme regeneration |
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symptoms of organophosphate ingestion |
cholinergic toxidrome (DUMBELS)
diarrhea urination miosis bronchorrhea/bronchospasm emesis lacrimation salivation |
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treatment of organophosphate ingestion |
ABC's atropine prAlidoxime (hydrolyzes thE bond before becomes permanent, doesn't cross BBB) |
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when to order CT in head injury? |
LOC > 1 minute seizure after event persistent/progressive vomiting underlying condition predisposing to intracranial injury
depressed mental status, focal neuro signs, signs of skull fracture (stepoff, battle sigh, hemotympanum, driange of CSF as rhinorrhea, raccoons eyes), irritability, bulging fontanelle, suspicion of abuse |
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burn surface area |
>14yo: head/neck 9%, each UE 9%, trunk front 18%, trunk back 18%, each LE 18%
<10yo: child's pam = 0.5-1% BSA |
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treatment 3rd degree burn |
ringers lactate 4ml/kg/percent of total BSA in first 24 hours; 50% in first 8 hours |
