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21 Cards in this Set

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  • Back
Snake Bites (Crotalidae envenomation)
give 6 vials crofab as initial dose
* is use >10 vials 50-90% will have serum sickness reactions
1. aliphatic hydrocarbons (long chain hydrocarbons, like gasoline)
2. aromatic hydrocarbons (e.g. benzene, toluene)
3. halogenated hydrocarbons (eg, Freon)
4. ethers (1st inhalant anesthetic-chloroform)
5. alkyl nitrites (room deodorizers)
6. ketones (acetone-nail polish remover)

Mechanism: rapidly absorbed through the alveoli, are lipid soluble and thus quickly enter the CNS- all increase GABA

Clincally- mainly CNS depression, but many sudden death syndromes associated cardiac epi surge (V-Tach)
street names: Georgia Home Boy, Soap or Salty water, Grievous Body Harm, Easy Lay, Liquid E

*popular use as a date-rape

commonly leading to overdose and coma due to usage with EtOH (metabilized by Alcohol dehydrogenase)

Clinical Presentation: Clinical Presentation: ataxia, confusion, hallucinations, coma, amnesia, respiratory depression, salivation, vomiting, incontinence (of urine and stool), hypotonia, myoclonic jerking, and then coma
*The hallmark is that within 4-6 hours, they change back to normal with a dramatic awakening
Withdrawal- GHB and sedative-hypnotic withdrawals are certainly lethal! Severe hypertension, then hypotension, severe hypothermia, renal failure, rhabdomyolysis, seizures, and severe agitation sequelae
Carbon Monoxide
leading cause of poisoning death worldwide- usually from heater malfunction

CO binds competitively to the oxygen binding sites of a variety of heme proteins and forms carboxyHgB (carboxyhemoglobin). It impairs transport of O2 and causes you to switch to anaerobic respiration. This shifts your curve to the left so the Hb will not release O2 but will have higher affinity for it

Clinically- diarrhea, fatigue, malaise, vomiting, ataxia, ischemia, coma, seizures, weakness, dizziness, chest pain, dyspnea, tachypnea- vague and easily mistaken for viral infection
Inhibits Kreb Cycle- ATP production
3 ways the body handles it-
1. Liver enzyme rhodanese
2. Endogenous B12 stores binding
3. RBC binding (no mitochondria)

Clinically- gasp for air, almond odor, blood pressure will increase, tachycardic, leading to pulmonary edema, cherry red, anxiety, confusion, coma, seizures, and death

Dx & Tx- lactic acidosis- Amyl Nitrite Sodium thiosulfate and Sodium Nitrite
Terrorism Agents
1. Cyanide (CN)
2. Nerve Agents (organophosphates): Taban (GA), Sarin (GB), Soman (GD), VX
3. Vesicants- Blister agents: Sulfur mustards, Nitrogen mustards and Arsenicals
4. Choking Agents- Cl gas and phosgene
5. Industrial Agents: hydrofluoric acid, methemoglobin inducing agents, arsine
6. Ricin
Nerve Gases

Sx- SLUDGE= Salivation, Lacrimation, Urination, Diarrhea, Gastric distress, Emesis

Peripheral Nervous System
If muscarinic receptors are stimulated, use DUMBBELLS
Diarrhea, Urination, Miosis, Bradycardia, Bronchorrhea, Bronchospasm, Emesis, Lacrimation, Salivation,, Secretion, Sweating
*Tx= Atropine (post-synaptic muscarinic receptors)

If Nicotinic receptors are stimulated, use MTWHF, days of the week
Mydriasis, Tachycardia, Weakness, Hypertension,, Hyperglycemia , Fasciculations
*Tx- Oximes (pralidoxime/2-PAM and obidoxime) works on both

PreTx = Pyridostigmine (binds AChE)
Vesicants- Blister agents
Sulfur mustards, Nitrogen mustards and Arsenicals

Skin Effects, eyes (corneal ulcerations, temporary blindness), respiratory (burns in back of throat, into bronchial tree), systemic (N/V, hypotension, leukopenia), death (2nd to infection), carcinogenic

Treatment for Mustard Agents
Immediate decontamination (wash off within a few minutes)- No antidote

Treatment for Arsenic- British Antilewisite (BAL) is an antidote
Choking Agents
affect the airway- chlorine gas and phosgene

develop a cough, bronchospasm and pulmonary edema

Tx= supportive care
Industrial Agents
hydrofluoric acid, methemoglobin inducing agents, arsine

profound hypocalcemia which can be fatal

Tx- methylene blue (10 cc, 1% solution)
Aerosol exposure: weakness, fever, cough chest pain, dyspnea, latent period of 8 hours, death 36-72 hours

Oral exposure: severe GI effects, GI hemorrhage, DV collapse, DIC, multi-organ failure

Treatment: supportive care, activated charcoal for oral exposure, Vaccine, ELISA testing for quick testing
Sympatholytic Toxidrome
CNS depression
Respiratory depression

Opioids, Benzo’s, Alcohol
Major site of poisonings
90% occur in the home
Fatalities in poisoning
1 Antidepressants
2 Analgesics
3 Sedative/hypnotics
4 Street drugs
5 Cardiovascular drugs
6 Alcohols
7 Fumes
8 Chemicals
9 Asthma medications
10 Cleaning products * most common exposure
Cholanergic and Nicotinic Toxidrome
Bradycardia, bronchorrhea

Organophosphates, carbamates
Sympathamimetic Toxidrome
Bowel sounds present

Cocaine, amphetamines
High Anion Gap Poisoning
Methanol, Ethylene glycol

[Na + K] – [Cl + HCO3] = ~16

Methanol, Uremia, DKA & AKA, Paraldehyde, Iron, INH, Lactate, Ethylene Glycol, Salicylates
Syrup of Ipecac (SOI)
Emetic (Questionable utility)
* for use at home (NOT the ER)

No efficacy beyond 1 hour
Gastric Lavage (GL)
Clinical benefit proven for serious ingestions within one hour
Activated Charcoal (AC)
Proven to reduce death and arrythmias if given as Multiple Dose

Porous organic compound

Adequate for the majority of ingestions

moderate ingestion, awake patients
Tricyclic Antidepressants Overdose
Wide QRS
Wide pupils

Tx- Sodium Bicarb