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45 Cards in this Set
- Front
- Back
If the poisoning is affecting the skin, remove the clothing & wash the skin thoroughly unless a ______ is the cause of the poisoning
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dry powder
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WHat are the indications for Gastric Lavage? When is it most effective? Who should it only be used on?
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Coma or impending Coma
within 1 hour of ingestion Older children |
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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?
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Activated Charcoal
Cyanides, Metals, Na, K, Cl, acids, bases |
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Describe the pathophysiology of Acetaminophen overdose
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causes N-acetyl-p-benzoquinoeimine metabolite that produces hepatotoxicity in the absence or depletion of GLUTATHIONE
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What are the toxic doses of Acetaminophen poisoning?
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In children < 12 = 150 mg/kg
Single ingestion of 7.5 g is considered to be a minimum toxic dose in adolescents & adults |
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What are the 4 stages of Acetaminophen poisoning?
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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 |
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What is the diagnostic tests for Acetaminophen overdose?
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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
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What is the antidote for Acetaminophen poisoning? At what drug level should it be used? Within how long after ingestion should it be used?
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N-acetylcysteine
>150 microgram/ml within 8 h of ingestion but can be given up to 16 h after ingestion -given orally |
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What things should be monitored in patients within the toxic range of Acetaminophen nomogram?
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1. Liver enzymes
2. Bilirubin levels 3. Prothrombin time |
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Describe the pathophys of Salicylate poisoning
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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 |
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Describe the 3 phases of Salicylate poisoning
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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 |
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Describe the pt's serum Salicylate level & the level of toxicity
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< 35 mg/dL = Asymptomatic
35-70 = mild to moderate toxicity 70-100 = severe toxicity >100 = potentially fatal |
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What can be used to enhance the excretion of Salicylate?
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Bicarbonate = raises urine pH to 7.0-7.5
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What are some of the causes of death from Salicylate ingestion?
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Respiratory failure
Cerebral edema Hemorrhage CV collapse |
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How does one diagnose Carbon Monoxide poisoning?
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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 |
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What is the treatment for CO poisoning?
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Remove pt from environment
100% oxygen or Hyperbaric oxygen until Carboxyhemoglobin level is <5%. UOP should be >1 ml/kg/h |
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What are some complications of CO poisoning? (3)
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1. Memory loss
2. Behavior changes 3. Blindness |
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What some examples of Acids & Alkalis?
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Acids = metals, toilet bowel cleaners, & batteries
Bases = purex, Drano, dishwashing detergent, Red Devil lye, Liquid Plummer |
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What is the presentation in pts who present with ingestion of Acids or Alkali?
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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 |
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What is the treatment for Acid/Alkali ingestion?
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removed by flushing copiously with water
Emesis & gastric lavage = CONTRAINDICATED |
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What is the presentation of Cocaine use?
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CNS stimulation = restlessness, excitement, agitation, increased motor activity, increased RR, HTN
Chest pain secondary to myocardial injury |
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What are hydrocarbons found in?
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Fuels, solvents, household cleaners, & polishes.
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What is the presentation of Hydrocarbon ingestion?
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Cough, emesis, & fever; however, symptoms may be delayed for 6 h.
Chemical pneumonitis may result from aspiration |
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What are some complications of Hydrocarbon ingestion?
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Pneumothorax, pleural effusions, & secondary bacterial infections
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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.
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Organophosphate poisoning
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What are organophosphates?
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Acetylcholinesterase inhibitors
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What are the muscarinic symptoms of Organophosphate poisoning? Nicotinic symptoms
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Salivation, lacrimation, urination, defecation, GI cramping, & emesis
Cramps, fasciculations, twitching, weakness, & areflexia, & paralysis of voluntary muscles including respiration |
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What is the treatment for Organophosphate poisoning?
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Atropine for Muscarinic symptoms
Pralidoxime for Nicotonic symptoms |
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What is the most common cause of death from poisoning in childhood?
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Iron poisoning
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What are the 4 stages of Iron poisoning?
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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 |
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What is a side effect of giving Deferoxamine for Iron poisoning?
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Urine turns "vin rose" when free iron binds with deferoxamine. Treatment should
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What are the complications of lead poisoning?
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Encephalopathy can occur 3-6 wks after ingesting lead
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What is the treatment for Antihistamine poisoning?
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Activated charcoal unless Sustained-release antihistamines are ingested
Whole-bowel irrigation for Sustained-release **seizures should be controlled |
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What are the possible complications of Antihistamine poisoning?
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Death may result from uncontrolled seizures leading to coma & cardiopulmonary arrest
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What are the manifestations of Barbiturate poisoning?
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Constricted pupils
confusion hypotension poor coordination Respiratory depression Coma |
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A 3 yo arrives with his parents after ingesting his brother's seizure medication. The patient has constricted pupils & appears to be in coma
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Barbiturate
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What is the treatment strategy for Barbiturate ingestion?
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ABC's
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 |
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What are the complications of Barbiturate toxicity?
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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 |
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A 3 yo presents after taking her brothers medicine. She is noted to be drowsy, & on ECG has QRS widening & QT prolongation
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TCA's
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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 |
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What is the treatment strategy for TCA poisoning?
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Activated charcoal to prevent further absorption
Sodium Bicarbonate to treat & prevent dysrhythmias -Lidocaine is given to those not responding to NaHCO3 |
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What are the most important life-threatening complications of TCA poisoning?
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Seizures
Arrhythmias |
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