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21 Cards in this Set
- Front
- Back
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Snake Bites (Crotalidae envenomation)
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give 6 vials crofab as initial dose
* is use >10 vials 50-90% will have serum sickness reactions |
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INHALANTS OF ABUSE
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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) |
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GHB-gamma-hydroxybutyrate
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street names: Georgia Home Boy, Soap or Salty water, Grievous Body Harm, Easy Lay, Liquid E
*popular use as a date-rape drug 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 |
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Carbon Monoxide
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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 |
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Cyanide
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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 |
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Terrorism Agents
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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 |
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Nerve Gases
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organophosphates
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) |
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Vesicants- Blister agents
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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 |
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Choking Agents
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affect the airway- chlorine gas and phosgene
develop a cough, bronchospasm and pulmonary edema Tx= supportive care |
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Industrial Agents
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hydrofluoric acid, methemoglobin inducing agents, arsine
profound hypocalcemia which can be fatal Tx- methylene blue (10 cc, 1% solution) |
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Ricin
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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 |
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Sympatholytic Toxidrome
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CNS depression
Respiratory depression Miosis Bradycardia Opioids, Benzo’s, Alcohol |
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Major site of poisonings
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90% occur in the home
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Fatalities in poisoning
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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 |
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Cholanergic and Nicotinic Toxidrome
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Diarrhea
Urination Miosis Bradycardia, bronchorrhea Emesis Lacrimation Salivation Organophosphates, carbamates |
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Sympathamimetic Toxidrome
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Tachycardia
Hypertension Agitation Convulsions Mydriasis Bowel sounds present DIAPHORETIC skin Cocaine, amphetamines |
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High Anion Gap Poisoning
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Methanol, Ethylene glycol
[Na + K] – [Cl + HCO3] = ~16 MUDPILES Methanol, Uremia, DKA & AKA, Paraldehyde, Iron, INH, Lactate, Ethylene Glycol, Salicylates |
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Syrup of Ipecac (SOI)
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Emetic (Questionable utility)
* for use at home (NOT the ER) No efficacy beyond 1 hour |
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Gastric Lavage (GL)
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Clinical benefit proven for serious ingestions within one hour
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Activated Charcoal (AC)
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Proven to reduce death and arrythmias if given as Multiple Dose
Porous organic compound Adequate for the majority of ingestions moderate ingestion, awake patients |
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Tricyclic Antidepressants Overdose
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Wide QRS
Tachycardic Seizure Wide pupils Tx- Sodium Bicarb |
