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45 Cards in this Set

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Define toxidrome
a specific cluster of symptoms that occurs after patients are exposed to a poisonous agent; a toxic syndrome
Define Poison
any substance taken into the body by ingestion, inhalation, injection or absorption that interferes with normal physiological functions; term implies an excessive degree of dosage as almost any substance can be poisonous in sufficient doses
Define cathartic agent
an active purgative, producing bowel movements
List five routes of exposure to poisons, identify the most common one:
1. Inhalation 2. insufflation 3. ingestion (tast or swalling most common) 4. Cutaneous and mucous membrane exposure 5. injuection
List the basic elements of an exposure Hx
# of persons exposed, type of ex, amount/dose, route, intent, obtain corroborating info, how pt found, empty bottles, etc., smells, occupation or hobbies of pt., notes
Identify the four emperic antidotes that should be administered within the first few minutes of a tixic pt's arrival
1. O2 2. Naloxone 3. D50W - 50ml for adults, 1g/kg glucose for kids 4. 100 mg thiamine in adults
List the poisons that may result in the following abnormal physical findings: Hypertension
alcohol withdrawl, Amphetamines, Anticholinergic, Caffeine, Cocaine, Methaqualine, Serotonin syndrome, Theophylline, Tricylic antidepressants, Monoamine oxidase inhibitor overdose (MAOI), Phencyclidine, Sedative hypnotic withdrawl, Phenylpropanolamine, Nicotine
List the poisons that may result in the following abnormal physical findings: Hypotension
Baclofen, B blockers, Calcium-channel blockers, Clonidine, Ethanol, Phenothiazines, Opioids, Organophosphates, Meprobamate, Barbiturates, Ethchlorvynol, Glutethamide, Salicylates, Hydrocarbons, Toxic alcohols, Iron
List the poisons that may result in the following abnormal physical findings: Tachycardia
Alcohol withdrawl, Amphetamines, Anticholinergic, Baclofen, Caffeine, Cocaine, Methaqualine, Serotonin syndrome, Theophylline, Tricyclic antidepressants, Ethanol, Phenothiazines, Monoamine oxidase inhibitor overdose, Phencyclidine, Phenylopropanolamine, Salicylates, Nicotine, Hydrocarbons, Toxic alcohols, Iron
List the poisons that may result in the following abnormal physical findings: Bradycardia
Beta-blockers, Calcium-channel blockers, Clonidine, Opioids, Organophosphates, Barbiturates, Ethchlorvynol
List the poisons that may result in the following abnormal physical findings: Hyperventilation
Alcohol withdrawl, Amphetamines, Anticholinergic, Caffeine, Cocaine, Serotonin syndrome, Theophylline, Monoamine oxidase inhibitor overdose, Sedative hypnotic withdrawl, Phenylpropanolamine, Salicylates, Nicotine, Hydrocarbons, Toxic alcohols, Iron
List the poisons that may result in the following abnormal physical findings: Hypoventilation
Baclofen, Methaqualine, Tricyclic antidepressants, Clonidine, Ethanol, Phenothiazines, Opioids, Organophosphates, Meprobamate, Phencyclidine, Barbiturates, Ethchlorvynol, Glutethamide
List the poisons that may result in the following abnormal physical findings: Hyperthermia
Alcohol withdrawl, Amphetamines, Anticholinergic, Cocaine, Serotonin syndrome, Phencyclidine, Sedative hypnotic withdrawl, Salicylates
List the poisons that may result in the following abnormal physical findings: Hypothermia
Baclofen, Clonidine, Phenothiazines, Opiods, Monoamine oxidase inhibitor overdose, Barbiturates
List the poisons that may result in the following abnormal physical findings: Red Colored Skin
Vancomycin, carbon monoxide, boric acid
List the poisons that may result in the following abnormal physical findings: Blue Colored Skin
Anything causing deoxyhemoglobin or methemoglobin
List the poisons that may result in the following abnormal physical findings: Mydriasis
Sympathomimetic, Anticholinergic
List the poisons that may result in the following abnormal physical findings: Myosis
Opioid
Describe what a toxidrome is based on
physiologically based abnormalities of vital signs, appearance, skin, eyes, mucous mem, lung heart, abd, neuro exam known to occur with specific class of substances & typically helpful in establishing a dx when exposure not well defined. Grouped according to drug class or physiologic effect
Identify two representative agents from each toxidrome , the most common symptoms they present with and a potential intervention: Opioid:
heroin, morphine. CNS depression, miosis, respiratory depression. Intervention: ventilation or naloxone
Identify two representative agents from each toxidrome , the most common symptoms they present with and a potential intervention: Sympathomimetic:
cocaine, amphetamine. Psychomotor agitation, mydriasis, diaphoresis, tachycardia, hypertn, hyperthermia. Intervention: cooling, sedation with benzo’s, hydration
Identify two representative agents from each toxidrome , the most common symptoms they present with and a potential intervention: Cholinergic:
organophosphate insecticides, carbamate insecticides. Salivation, lacrimation, diaphoresis, n/v, urination, defecation, fasciculations, weakness, bronchorrhea. Intervention: airway protection, ventilation, atropine, pralidoxime
Identify two representative agents from each toxidrome , the most common symptoms they present with and a potential intervention: Anticholilnergic:
scopolamine, atropine. Altered mental status, mydriasis, dry flushed skin, urinary retention,k decreased bowel sounds, hyperthermia, dry mucous membranes. Intervention: physostigmine, sedation with benzo’s, cooling, supportive care
Identify two representative agents from each toxidrome , the most common symptoms they present with and a potential intervention: Hypoglycemia:
sulfonylureas, insulin. Altered mental status, diaphoresis, tachycardia, hypertension. Intervention: glucose containing solution IV, po feedings if able, frequent blood su\gars, octreotide
Explain the goal of GI decontamination:
general goal is to bind toxins within the gut lumen to make them unavailable for absorption or have their elimination enhanced from the gut
List the three main choices for GI decontamination:
a.Removal of the toxin from the stomach via the mouth
b.Binding it inside the gut lumen
c.Mechanically flushing it through the GI tract
What is the goal of the following treatments for poisonings
multiple dose activated charcoal therapy (MDAC), urinary alkalinization, hemodialysis, hemoperfusion
For Syrup of Ipecac identify how long it takes to produce emisis
90% vomit within 20 minutes of first dose; second dose may be given after 30 minutes—97% of patients vomit after the second dose
For syrup of Ipecac know the indications for using it:
limited; recent ingestion of substance not expected to compromise airway or lead to altered mental status, hemodynamic derangement, seizure; recent ingestion of pill known not to fit into holes of OG tube; or substance known not to adsorb to activated charcoal
For syrup of Ipecac know the contraindications for using it:
ingestions that have potential to alter mental status; active or prior vomiting; caustic ingestion; toxin with more pulmonary than GI toxicity (e.g. hydrocarbons); and ingestions of toxins that have the potential for inducing seizures
List other treatments that ipecac can interfere with
delays the time to administration of oral antidotes such as N-acetylcysteine by 1 to 6.5 hours
Discuss activated charcoal in regard to the following: How it works:
by adsorbing the toxin within the gut lumen, makes the toxin less available for absorption into the tissues. Enhances elimination by creating a gradient (GI dialysis). Also binds substances excreted in bile
Discuss activated charcoal in regard to the following: Benefits:
Decontaminates the gut without requiring invasive procedures. Proven safe, rapid
Discuss activated charcoal in regard to the following: Route of administration:
given in a slurry of water or juice by mouth or through an NG tube
Discuss activated charcoal in regard to the following: Contraindications to its use:
should not be given if esophageal or gastric perforation are suspected, or if emergency endoscopy might be needed (e.g. as in caustic ingestion)
Discuss activated charcoal in regard to the following: Indications for its use:
ingestion of any drug known to adsorb to it or after an unknown ingestion by patients with protected airways.
Discuss the following in regard to whole bowel irrigation (WBI): Its therapeutic purpose:
produces rapid catharsis by mechanically forcing ingested substances through the bowel at a rapid rate
Discuss the following in regard to whole bowel irrigation (WBI): Indications for use:
ingestion of potentially toxic doses of substances known not to adsorb to activated charcoal, such as heavy metals, body packers, iron, lithium, sustained or delayed release formulations and substances with potential for bezoar formation
Discuss the following in regard to whole bowel irrigation (WBI): Contraindications for use:
patients with preceding diarrhea; ingestions that are expected to result in significant diarrhea and patients with absent bowel sounds or with obstructions
Discuss the following in regard to whole bowel irrigation (WBI): Most commonly used agent and its route of administration:
polyethylene glycol in an osmotically balanced electrolyte solution by mouth or via NG tube
List the drug class and clinical indications for the following antidotes: Naloxone:
opioid antagonist. Indicated for reversal of opioid-induced respiratory depression, mental status changes, miosis and analgesia
List the drug class and clinical indications for the following antidotes: Atropine:
anticholinergic. Indicated for treatment of poisoning with organophosporous compounds and carbamates
List the drug class and clinical indications for the following antidotes: Dextrose:
Indicated for treatment of hypoglycemia secondary to overdose of hypoglycemic agents (e.g. sulfonylureas, insulin, etc)
What is the main risk of naloxone use?
May precipitate opioid withdrawal syndrome
TOXICOLOGY
TOXICOLOGY