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50 Cards in this Set
- Front
- Back
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Tricyclic Anti-depressent OD
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-RX for depression
-sodium blocker, cardiotoxic -ability to crash fast -get a baseline EKG S/S -seizure -wide QRS, watch for growing width TX -sodium bicarb |
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Digioxin OD
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-used to control A-FIb, slow down rate
-OD due to narrow therapeutic range -many different arrhythmias possible -FAB = antidote in hospital TX -supportive care -activated charcoal |
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Beta Blocker OD
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TX
-activated charcoal -glucose MD order |
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Calcium Channel blocker OD
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-low BP, dilated arterioles
TX -activated charcoal |
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MAOI OD
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S/S
-CNS Depression -signs of OD do not occur until 6-24 hours after ingestion TX -activated charcoal |
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Non-steroidal Anti-inflammatory drugs
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-IB profen, ASA, Acetaminophen
-ASA may cause painful stomach ulcer -Ibuprofen may cause stomach ulcer S/S -metabolic acidosis -GI irritation |
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Acetaminophen
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140 mg/kg = lethal
16-24 hours window to save liver 325mg regular strength 500mg extra strength 100 kg pt = 14000 mg (30 pills X 500 mg = 15,000 mg OD!!!) S/S -none noticable TX -mucomyst in hospital |
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S/S of organophosphate or carbamate poisoning
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cardiovascular system
-bradycardia -variable blood pressure (usually hypotension) Respiratory system -bronchoconstriction -dsypnea -Rhinorrhea -wheezing GI system -blurred vision -cramps -defacation -emesis -increased bowel sounds -lacrimation -miosis -rapidly changing pupil size Central Nervous System -anxiety -coma -convulsions -dizziness -respiratory depression musculoskeletal system -fasiculations -flaccid paralysis Skin -diaphoresis Other -salivation -urination |
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OP respiratory support
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-first symptoms to appear.
-increased secretions -bronchoconstriction |
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OP drug admin
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Atropine
-competitive antagonist with ACH Pralidoxime -used with significant exposure -muscular twitching and weakness Diazepam/Lorazepam -seizure control |
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OP EKG
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First Phase
-Sinus Tachycardia Second Phase -sinus bradycardia -AV block -ST segment and T wave abnormalities |
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General Drug OD management
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1) scene safe
2) ABCs 3) HX of event, psych HX 4) ID the substance 5) perform a full focused physical exam 6) IV, Labs, Narcan 7) activated charcoal 8) rapid transport |
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stimulants
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-amphetamines
-cocaine -methaphetamine -methylphenidate -nicotine |
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hallucinogens and other compounds
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-LSD
-Mescaline -Phenycyclidine and analogs -Psilocybin -amphetamines variants (MDMA) -marijuana -hashish -tetrahydrocannabinol -anabolic steroids |
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opiods and morphine derivatives
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-coedine
-heroin -methadone -morphine -opium -oxycodone |
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depressants
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-ETOH
-barbituates -benzodiazepines -methaqualone |
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Opiod OD
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-heroin 90%
-CNS depressant & respiratory depression S/S -euphoria -arousable somnolence (nodding) -nausea -pin point pupils (except meperidine) -coma -seizures TX -narcan -be careful of withdrawl symptoms (use smaller doses) |
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S/S of opiod withdrawl
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-abdominal cramps
-anorexia -cold sweats or chills -diaphoresis -diarrhea -fever -general malaise -gooseflesh -insomnia -irritability -N/V -pulmonary edema -severe agitation -ventricular arrhythmias -tachycardia -tremors |
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sedative-hypnotic overdose
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"downers" benzies most common
-diazepam (valium) -lorazepam (ativan) -alprazolam (xanax) Barbituates -phenobarb -amobarb -secobarbi S/S -excessive drowsiness -staggering gait -paradoxical excitability -comatose C R/D -hypotension -shock -constricted pupils or fixed and dilated TX -airway management -ventilatory management -flumazenil, romazacon, CONTRAINDICATED IN PTS WHO ARE PRONE TO SEIZURE AND THOSE WITH TCA OD |
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stimulant overdose
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-belong to the sympathetic family, similar to epinephrine
-typically a crash follows S/S -tachycardia -increased BP -tachypnea -agitation -dilated pupils -tremors -disorganized behavior CRASH -depressed -suicidal -incoherent -near coma |
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cocaine
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IN/SQ/IM/IV
peak effect 15-60 min half life of 1-2.5 hours speedballing = injection of cocaine and heroin crack cocaine = mixing cocaine with an alkaline solution and then adding a solvent such as ether. Ether dissolves resulting in pure cocaine, which is smoked 1200mg is lethal TX -supportive care -benzodiazepines |
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Phenycyclidine OD
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"PCP"
-horse tranquilizer -orally, intranasally, IV/IM, smoked -liquid, tab or powder form Low Dose Toxicity (less then 10 mg) -resemble drunkeness -euphoria -confusion -disorientation -agitation -sudden rage -blank stare -stumbling gate -death by behavior (no pain sensory) -seizure High Dose Toxicity (more then 10 mg) -coma hours-days -unresponsive to painful stimuli -respiratory depression -hypertension -tachycardia may be present -hypertensive crisis, causing cardiac failure, hypetensive encephalopathy, seizures and intracerebral hemorrhage TX -manage respiratory & cardiac arrest -manage status epilepticus |
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Phenycyclidine Psychosis
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true emergency, may mimic schizophrenia
-acute onset -last from several days to weeks S/S -catatonic & unresponsive to bizzare and violent -agitated and suspicious -auditory hallucinations & paranoia TX -antipsychotic drugs |
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Hallucinogen overdose
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LSD, mescaline, peyote, shrooms, nutmeg, mace, X, MDEA eve
S/S -respiratory depression -CNS depression (rare) TX -supportive care -minimal sensory stimulation -calming measures -transport |
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TCA OD
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work by blocking the uptake of noreppie and seratonin, chemically different from safer SSRIs
OD results form the sodium channel blockade of the myocardium common drugs -amitryptiline -desipramine -imipramine -nortryptiline S/S -dry mouth -blurred vision -confusion -inability to concentrate -visual hallucinations severe S/S -delerium -depressed respirations -hypertension -hypotension -hyperthermia -hypothermia -seizure & coma cardiac effects -tachycardia to bradycardia -dysrhythmias & AV block -prolonged QRS -GCS less then 8 S/S -supportive care -rapid transport -tachycardia with wide QRS greater then 100ms is early tox -sodium bicarb (MD order) |
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5 signs of major tricyclic antidepressent OD
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cardiac dysrhythmias
coma GI disturbances hypotension or hypertension respiratory depression |
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meth labs
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-amber stains on walls, furniture, counters
-equipment that has a red or amber color -two large round bottom flasks with stoppers connected by a hose -pyrex-type meatloaf container -various measuring and funnel devices -heat source |
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Lithium
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common mood-stabalizing drug for bipolar disorders
-narrow therapuetic range OD common -increases reuptake or noreppie & interferes with adenosine monophosphate S/S -muscle weakness -slurred speech -severe trembling -blurred vision -confusion -seizures -apnea -coma TX -ABCs -control of seizure activity |
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digioxin
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direct and indirect effects on SA & AV nodes, ability to hal impulses in the SA node, depress conduction in AV node
-increases automaticity -PVCs -any dysrhythmia S/S -N -anorexia -fatigue -visual disturbances -GI -ophthamalogical -nuerologic symptoms TX -activated charcoal -ACLS -ANTIDOTE = FAB |
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beta blockers
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impaired SA/AV node function leading to bradycardia and AV blocks
-occasionally longer QRS S/S -CNS/respiratory depression -hypotension -seizures TX -activated charcoal -drugs to manage hypotension & dysrhtmias -glucagon |
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calcium channel blockers OD
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myocardial depression and peripheral vasodilation with negative inotrophic, chronotrophic, dromotrophic and vasotrophic effects
S/S -hypotension -bradycardia -AV blocks -Sinus arrest -N/V -CNS/respiratory depression TX -antidysrhythmics -vasopressors -activated charcoal |
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monoamine oxidase inhibiters
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block the breakdown of monoamines like noreppie, dopamine, seratonin
S/S -6-24 hours after ingestion -effects last for sever days -CNS depression, nueromuscular and CV manifestations TX -sypportive -ABCs -cardiac meds -rapid transport -activated charcoal |
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NSAIDS
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block production of prostaglandins which cause inflammation and trrigger transmission of pain signals to the brain
common drugs = diflusinal, fenoproen, ibprofen, naproxen |
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Ibprofen OD
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chronic acute ingestion more then 300mg/kg
S/S -mild GI -CNS disturbance usually resolve after 24 hours TX -activated charcoal |
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Digioxin
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Digioxin
-A-Fib -Atrial Tachy -bigeminal and multifocal PVCs -1st and 2nd degree AV blocks -Sinus brady -V-Tach/V-Fib |
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Beta Blockers
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-bradycardia
-hypotension -respiratory arrest -seizures -unconsciousness -VT/VF (rare) |
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Calcium Channel Blockers
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-acute respiratory distress syndrome
-aystole -AV dissasociation -coma -confusion -hypotension -lactic acidosis -mild hyperglycemia/hyperkalemia -pulmonary edema -respiratory depression -sinus arrest -sinus bradycardia -slurred speech |
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salicylate OD
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ASA/cold preparations/oil of wintergreenpropoxyphene
-direct CNS stimulation -inhibition of kreb's cycle CNS -increase rate and depth of respiration -compensatory elimination of biarb ions by the kidneys, this produces compensatory metabolic acidosis -confusion, lethargy, convulsions, respiratory arrest, coma, brain death can occur GI irritation -N/V -hematemesis -pylorospasm (delay gastric emptying) Glucose metabolism -interference with glucose uptake by the cells cauuse a buildup of serum glucose -hypoglycemia in CNS tissue, severe cerebral edema Fluid & electrolyte imba -occur via GI fluids, emesis, and renal clearance Neurological -tinnitus -lethargy -hallucination, seizure & coma coagulation -increased risk for hemorrage disorders |
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salicylate TX
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-activated charcoal
-IV glucose -sodium bicarb (MD order) |
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acetaminophen
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"tylenol'
-analgesic and anti-pyretic -damage unless treated within 16-24 hours -30 standard sized pills can wipe a liver -treatment must be started within 8 hours |
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stages of acetaminophen poisoning
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Stage I: GI irritability (0-24 hours)
-anorexia -diaphoresis -general malaise -N/V -pallor Stage II: Abnormal Lab Findings (24-48 hours) -abd pain and tenderness in the right abdominal quadrant -resolution of stage 1 symptoms Stage III: Hepatic Damage (72-96 hours) -dysrhythmias -hepatotoxicity with significant increase in hepatic enzymes -hypoglycemia -jaundice -lethargy -vomting Stage IV: recovery (4-14 days) or progressive hepatic failure -resolution of hepatic dysfunction -lack of permanent effects in patients who recover -25 percent mortality if hepatotoxic range |
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4 stages of alcoholism
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Stage 1
-developing a tolerance Stage 2 -memory loss Stage 3 -loss of control Stage 4 -binges (5-7 days, no recollection) |
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Beer
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generally 3.2%
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Wine
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generally 12-14%
fortified wine MD 20/20 20% |
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Blood Alcohol Content
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body can metabolize 20 mg/dl/hr
100mg/dl = .10 100/20 = 5 hours increased ETOH -prolonged reflexes -drunks want to hug or fight |
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Dietary replacement
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-ETOH will replace food cravings
-lack of protein causes arrhythmias -acetone breath due to muscle wasting |
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Wernike-Korsakoff Syndrome
WERNICKE |
Wenicke encephalopathy
-temporary -confabulation filling in facts -reversible -patient may pretend to recognize you TX -100mg thiamine B1 (neccessary for glucose metabolization) -D50 if hypoglycemic |
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Wenike-Korsakoff Syndrome
KORSAKOFF |
Korsakoff - Psychosis
-permanent -severe memory impairment -irreversible -"wandering" |
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4 reactions to ETOH (withdrawl)
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Minor Reaction 6-8 hours
Hallucinations 12-36 hours Withdrawl seizures 7-48 hours Delirium Tremens (DT's) 72-96 hours 15% DIE Orthostatic BP's is the reason for most calls for transports from support facilities |
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Disulfiram-Ethanol Reaction "Antabuse"
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-required to take a medication that causes the patient to be violently ill if the drink etoh
-many drink anyway and throw up everywhere |
