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45 Cards in this Set

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  • Back
If the poisoning is affecting the skin, remove the clothing & wash the skin thoroughly unless a ______ is the cause of the poisoning
dry powder
WHat are the indications for Gastric Lavage? When is it most effective? Who should it only be used on?
Coma or impending Coma

within 1 hour of ingestion

Older children
What is the current treatment of choice to prevent absorption of poisoning when the patient is present in the ER? What is it ineffective against?
Activated Charcoal

Cyanides, Metals, Na, K, Cl, acids, bases
Describe the pathophysiology of Acetaminophen overdose
causes N-acetyl-p-benzoquinoeimine metabolite that produces hepatotoxicity in the absence or depletion of GLUTATHIONE
What are the toxic doses of Acetaminophen poisoning?
In children < 12 = 150 mg/kg

Single ingestion of 7.5 g is considered to be a minimum toxic dose in adolescents & adults
What are the 4 stages of Acetaminophen poisoning?
Stage 1: first 24 hrs after ingestion, pt develops N/V & diaphoresis

Stage 2: next 24-48, clinical improvement. Serum Glutamic-oxaloacetic transaminase, serum Glutamate pyruvate transaminase, bilirubin, & prothrombin increase. Pt develops RUQ pain

Stage 3: from 72-96 h after ingestion, pt has peak liver funtion abnormalities. GI symptoms may again develop

Stage 4: from 4 days - 2 wks, pt's hepatic problems resolve. There are no sequelae 3 months - 1 yr later. However, <1% will develop fulminant hepatic necrosis
What is the diagnostic tests for Acetaminophen overdose?
Absorption may be delayed 4 h in overdose; therefore a plasma level of Acetaminophen should be measure >4h after ingestion. The Rumack-Matthew nomogram should be used to plot the level of acetaminophen
What is the antidote for Acetaminophen poisoning? At what drug level should it be used? Within how long after ingestion should it be used?

>150 microgram/ml

within 8 h of ingestion but can be given up to 16 h after ingestion
-given orally
What things should be monitored in patients within the toxic range of Acetaminophen nomogram?
1. Liver enzymes
2. Bilirubin levels
3. Prothrombin time
Describe the pathophys of Salicylate poisoning
Uncouple oxidative phosphorylation & increase the metabolic rate resulting in tachypnea, fever, & hypoglycemia

Krebs cycle is also inhibited, causing a metabolic acidosis

Damage to hepatocytes causing liver toxicity
Describe the 3 phases of Salicylate poisoning
Phase 1: pt has RESPIRATORY ALKALOSIS from direct stimulation of the respiratory center, & K+ & NaHCO3 are excreted in the urin. Lasts ~ 12 h
-may simulate DKA

Phase 2: As alkalosis continues, a "paradoxical aciduria" occurs ~12-24 h after salicylate ingestoin. May lead to Hypokalemia.

Phase 3: Metabolic Acidosis, Dehydration, & Hypokalemia appear 4-6 h after ingestion in an infant, 24 h in adolescent.
-Metabolic acidosis results from Lactic Acidosis
-Hyperpnea in this phase is secondary to acidosis rather than to stimulation of respiratory centers
Describe the pt's serum Salicylate level & the level of toxicity
< 35 mg/dL = Asymptomatic

35-70 = mild to moderate toxicity

70-100 = severe toxicity

>100 = potentially fatal
What can be used to enhance the excretion of Salicylate?
Bicarbonate = raises urine pH to 7.0-7.5
What are some of the causes of death from Salicylate ingestion?
Respiratory failure
Cerebral edema
CV collapse
How does one diagnose Carbon Monoxide poisoning?
Carboxyhemoglobin level as well as ABG analysis

Pts with severe CO poisoning may have muscle breakdown...UA for Myoglobin should be obtained

**presence or absence of the classic Cherry-red skin is of no diagnostic value
What is the treatment for CO poisoning?
Remove pt from environment

100% oxygen or Hyperbaric oxygen until Carboxyhemoglobin level is <5%. UOP should be >1 ml/kg/h
What are some complications of CO poisoning? (3)
1. Memory loss
2. Behavior changes
3. Blindness
What some examples of Acids & Alkalis?
Acids = metals, toilet bowel cleaners, & batteries

Bases = purex, Drano, dishwashing detergent, Red Devil lye, Liquid Plummer
What is the presentation in pts who present with ingestion of Acids or Alkali?
Burns of the mucous membranes may be visualized

Pt may drool & refuse to swallow secondary to pain

Esophageal stricture may be found

Acids may be responsible for delayed gastric emptying from pylorus scarring
What is the treatment for Acid/Alkali ingestion?
removed by flushing copiously with water

Emesis & gastric lavage = CONTRAINDICATED
What is the presentation of Cocaine use?
CNS stimulation = restlessness, excitement, agitation, increased motor activity, increased RR, HTN

Chest pain secondary to myocardial injury
What are hydrocarbons found in?
Fuels, solvents, household cleaners, & polishes.
What is the presentation of Hydrocarbon ingestion?
Cough, emesis, & fever; however, symptoms may be delayed for 6 h.

Chemical pneumonitis may result from aspiration
What are some complications of Hydrocarbon ingestion?
Pneumothorax, pleural effusions, & secondary bacterial infections
A young boy who is visiting his grandfather's farm is brought to the ER center by ambulance. The grandfather says that the child had been playing in a newly fertilized field when he developed drooling, tearing, & emesis. At present the pt is areflexive & had defecated & urinated in his trousers. The pt appears lethargic.
Organophosphate poisoning
What are organophosphates?
Acetylcholinesterase inhibitors
What are the muscarinic symptoms of Organophosphate poisoning? Nicotinic symptoms
Salivation, lacrimation, urination, defecation, GI cramping, & emesis

Cramps, fasciculations, twitching, weakness, & areflexia, & paralysis of voluntary muscles including respiration
What is the treatment for Organophosphate poisoning?
Atropine for Muscarinic symptoms

Pralidoxime for Nicotonic symptoms
What is the most common cause of death from poisoning in childhood?
Iron poisoning
What are the 4 stages of Iron poisoning?
Stage 1: occurs 30min-6 h after ingestion, w/ symptoms of N/V/D & abdominal pain. Hemorrhagic gastroenteritis may be present in more serious iron ingestion

Stage 2: occurs 6-12h after ingestion, & relative clinical improvement may be mistaken for recovery (honeymoon phase)

Stage 3: occurs 24-48h after ingestion = sever poisoning, progressive Circulatory collapse (shock), hepatorenal failure, bleeding, metabolic acidosis, & coma

Stage 4: 1-2 month after ingestion & causes GI scarring & obstruction, as well as pyloric stenosis
What is a side effect of giving Deferoxamine for Iron poisoning?
Urine turns "vin rose" when free iron binds with deferoxamine. Treatment should
What are the complications of lead poisoning?
Encephalopathy can occur 3-6 wks after ingesting lead
What is the treatment for Antihistamine poisoning?
Activated charcoal unless Sustained-release antihistamines are ingested

Whole-bowel irrigation for Sustained-release

**seizures should be controlled
What are the possible complications of Antihistamine poisoning?
Death may result from uncontrolled seizures leading to coma & cardiopulmonary arrest
What are the manifestations of Barbiturate poisoning?
Constricted pupils
poor coordination
Respiratory depression
A 3 yo arrives with his parents after ingesting his brother's seizure medication. The patient has constricted pupils & appears to be in coma
What is the treatment strategy for Barbiturate ingestion?
Gastric lavage & multiple doses of activated charcoal may be used to decontaminate the GI system

IV fluids and forced diuresis & alkalinization should be used for long-acting barbiturate intoxication
What are the complications of Barbiturate toxicity?
Early deaths usually result of shock or cardiopulmonary arrest.

Later deaths are usually the result of pulmonary complictions such as aspiration pneumonia or pulmonary edema
A 3 yo presents after taking her brothers medicine. She is noted to be drowsy, & on ECG has QRS widening & QT prolongation
What are the symptoms of TCA poisoning?

What is the diagnostic test?
Drowsiness, delerium, hallucination, disorientation, seizures, coma, HTN, later hypotension, & arrhythmias

QRS widening & QT prolongation
What is the treatment strategy for TCA poisoning?
Activated charcoal to prevent further absorption

Sodium Bicarbonate to treat & prevent dysrhythmias
-Lidocaine is given to those not responding to NaHCO3
What are the most important life-threatening complications of TCA poisoning?