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22 Cards in this Set
- Front
- Back
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What are important features of an OD history?
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-Collateral history
-Determine accessible medications by acquiring bottles from residence, searching patient, contacting pharmacy -Pill count |
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What antidotes can be given safely on initial presentation to the ED?
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Hypoglycemia = dextrose
Opioids = naloxone Hypoxia = oxygen |
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Vital signs
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HR, RR, BP, SpO2, Temperature, Glucose
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Outline the toxicological exam from head to toe
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Head trauma
Pupils Mucous membranes Secretions Unusual odors Breath sounds Bowel sounds Track marks Reflexes Rigidity Clonus Rectal/vaginal exam if body packing/stuffing suspected |
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Describe the anticholinergic toxidrome
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Blind as a bat (mydriasis)
Mad as a hatter (delirium) Red as a beet (flushed) Hot as Hades (mild temp elevation) Dry as a bone (mouth and skin) The bowel and bladder lose their tone (no bowel sounds, urinary retention) And the heart runs alone (tachycardia) |
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Describe the cholinergic toxidrome
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SLUDGE and the killer B's
Salivation Lacrimation Urination Diarrhea Gastrointestinal distress Emesis Bronchorrhea, Bronchospasm, Bradycardia |
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Describe the sympathomimetic toxidrome
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Tachycardia
Hypertension Dilated pupils Agitation Diaphoresis Delirium Fever |
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Describe the sedative/hypnotic toxidrome
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Respiratory depression
Miosis Hypotension Bradycardia Hypothermia Decreased bowel sounds Hyporeflexia |
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Common anticholinergic agents
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The anti's = antihistamines, antiparkinsonians, antipsychotics, antidepressants, antispasmodics
Sarin gas Atropine-like = atropine, scopolamine, mydriatics, plants (ie - jimson weed) |
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Common sympathomimetic agents
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Classics = cocaine, amphetamine, methamphetamine
Decongestants = ephedrine, pseudoephedrine Caffeine & theophylline |
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Common Opioids/Sedatives
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Narcotics
Clonidine Barbiturates Benzodiazepines Ethanol |
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Common cholinergic agents
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Pesticides - organophosphates and carbamates
Physostigmine Mushrooms |
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Why is the urinary tox screen useless?
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1 - Doesn't test for many important toxins
2 - False negatives too soon after exposure (not in urine yet) 3 - False positives if drugs detected are not responsible for presentation 4 - Expensive 5 - Results do not come back fast enough 6 - Clinical management should be guided by clinical findings |
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When is the urinary tox screen useful?
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1 - necessary for medical clearance / psychiatry
2 - confirm substance for a body packer 3 - assess for child abuse 4 - unknown illness |
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What is the standard toxicology lab work-up?
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CBC, full electrolyte panel, urea, creatinine, glucose, liver enzymes, liver function tests, CK, serum osmolarity, ethanol, acetaminophen, salicylates, urinalysis
+/- lithium/digoxin/valproate/methanol/ethylene glycol levels</div> |
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Is there evidence for the efficacy of activated charcoal?
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No. AC has not been found to improve outcomes in either undifferentiated OD patients or specific OD
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When should activated charcoal be considered?
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Early (~1-2 hours)
Toxic ingestion beyond the requirement for supportive care Ingestion amenable to absorption No contraindications |
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What agents are NOT absorbed by activated charcoal?
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PHAILS
Pesticides Hydrocarbons Acids/Alkalis/Alcohols Iron Lead/Lithium Solvents |
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When should whole-bowel irrigation be used?
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No proven outcome benefit
Severe, recent ingestion of a highly toxic substance, sustained release, body packers, or drugs not absorbed by charcoal Consult with toxicology |
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Orders for whole-bowel irrigation
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NG tube
PEG 1-2L/h until rectal effluent is clear |
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When should gastric lavage be considered?
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Rarely
Has not be shown to have a benefit. Within 1h after ingestion of a highly toxic substance that has no antidote and is not absorbed by charcoal |
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Orders for gastric lavage
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Large orogastric tube (30-F)
Patient angled 30 degrees to the left in trendelenburg Inject and draw out 300-500mL boluses of fluid |
