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39 Cards in this Set
- Front
- Back
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What is in a Chem 7?
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- Sodium
- Chlorine - Potassium - Bicarb - BUN - Creatinine - Glucose |
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Describe the following for metabolic acidosis:
- pH - PO2 - PCO2 - HCO3 |
Ph: low (<7.35)
PO2: Normal PCO2: Normal HCO3: low (<18) |
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Describe the following for Respiratory acidosis:
- pH - PO2 - PCO2 - HCO3 |
pH: low (<7.35)
PO2: low (<90) PCO2: high (>45) HCO3: Normal |
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Describe the following for metabolic alkalosis:
- pH - PO2 - PCO2 - HCO3 |
pH: high (>7.45)
PO2: normal PCO2: normal HCO3: high (>24) |
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Describe the following for respiratory alkalosis:
- pH - PO2 - PCO2 - HCO3 |
pH: low <7.35
PO2: high >100 PCO2: low <35 HCO3: Normal |
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When are quantitative lab assessments of toxins valuable?
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- when they have antidotes (APAP, Carboxyhemoglobin, methemoglobin, digoxin, metals, iron)
- When pt needs dialysis (ethylene glycol, methanol, lithium, salicylate, theophyline) |
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When is qualitative ID of toxins used?
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- Urine tox screen
- Radioopaque compounds (xray) |
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What should you remember for patients with altered mentation with regards to treatment algorhythm?
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DONT: Dextrose, Oxygen, Naloxone, Thiamine
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What are indications of general GI decontamination?
Condraindications? |
Indications:
- risk of serious toxicity (aka death) - recent ingestion - it can be performed safely - no better alternative Contraindications: - rapid onset of seizures - rapid CNS depression - alkaline corrosives (and maybe acids) - loss of gag reflex |
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An addition to the general contraindications for Emesis is what?
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- ingestion of sharp objects
- pts with hemorrhagic diagnosis |
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On of the primary methods of inducing emesis is? Name the medication, onset, desired effect, and side effects.
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Syrup of Ipecac
- Onset: 15-20mins - Desired effect: emesis - Side effects: diarrhea, drowsiness, arrhythmia, neuropathy, weakness |
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Describe the process of lavage.
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Use saline to flush via OG or NG tube to clear fluid return.
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Indications and contraindicaitons of lavage are the same as general except what?
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- Can be used in CNS depression in intubated patients with cuffed ETT
- Can be used in seizure pts who are intubated and seizures controlled - Contraindicated in pts with underlying esophagus or stomach pathology |
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Adverse effects of lavage include what?
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- aspiration
- esophageal/gastric bruising - electrolyte imbalance - EKG changes - hypoxia - esophageal rupture |
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What compounds will not bind with activated charcoal?
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- Low molecular weight, charged compounds (cyanide, bromide, K, ethanol, methanol, iron, lithium, alkaline corrosives, mineral acids)
- Highly concentrated solutions (gasoline, kerosine, alcohol) |
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Activated charcoal is usually given with another substance called a ____ which does what?
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- cathartics: increase GI motility to promote movement of bound AC through GI
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Adverse reactions to activated charcoal include:
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- vomiting
- constipation - aspiration - GI obstruction - charcoal empyema - GI perforation |
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When is whole bowel irrigation indicated?
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- substances not absorbed by AC
- very large ingestions - significant GI hemorrhage - intestinal obstruction - unprotected airways - hemodynamic instability |
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What solution is used to facilitate whole bowel irrigation?
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Golytely
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What are some methods for "enhancing elimination"? When is it indicated?
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Indication: impaired normal elimination, severe presentation, progressive deterioration despite care, significant toxicity expected (death).
Methods: multiple does activated charcoal, ion trapping, hemodialysis, forced diuresis, exchange transfusions |
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Which toxic ingestions would be cause for repeated activated charcoal administration?
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- theophylline
- carbamazepine - phenobarbitol |
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When is repeat activated charcoal contraindicated? what adverse effects are there?
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- Ileus, Intestinal obstruction, unprotected airway = contraindications
- ADR: pulmonary aspiration, consitpation, electrolyte imbalance. |
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What is Ion Trapping? Give an example.
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Change of pH of urine to ionize poison and prevent reabsorption.
In weak acid toxicity (salicylate, phenobarbitol), give bicarb to get a pH >7 |
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___ are drugs used to treat heavy metal exposure
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Chelators
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The medication Dimercaprol is used to treat what?
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Hypertension and tachycardia in OD of As, Hg, Pb, Cd
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The medication Penicillamine is used to treat what?
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allergic rxn to Cu, Pb, Hg, As
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The medication DMSA is used to treat what?
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Gas & abdominal pain in OD of Pb, As, or Hg
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The medication EDTA is used to treat what?
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Nephrotoxicity in OD of Pb
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The medicaiton Deferoxamine is used to treat what?
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HypOtension, anaphylactoid rxn, ARDS in Iron toxicity.
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A patient was bitten by a rattlesnake. What should you administer?
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Crotalidae Antivenin
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A patient was bitten by a black widow, what should you administer?
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Lactrodectus Antivenin
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A patinet was bitten by a coral snake. What should you give?
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Elapidae Antivenin
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A pt has contracted botulism (type A, B, or E), what shouldyou give?
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Trivalent botulinum
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A patient has overdosed on digoxin, what do you give?
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Digoxin Immune Fab
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What is the antidotes to APAP OD and how does it work?
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N-acetylcysteine (NAC), prevents NAPQI binding at hepatocyte
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What is the antidote to Opioid toxicity? How does it work?
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Naloxone (opioid receptor)
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What is the antidote to benzodiazepine toxicity? How does it work?
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Flumazenil - benzo receptor antagonist
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What is the antidote to organophosphate/ pesticide poisoning? How does it work?
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Atropine - muscarinic receptor antagonist
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What is the antidote to methanol or ethylene glycol toxicity? How does it work?
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Fomepizole - blocks metabolite formation.
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