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Flashcards in Poisoning Deck (39):
1

Name 5 medications with delayed reaction

Aspirin, paracetamol, iron, TCAs, co-phenotrope

2

When should O2 be given at the highest conc possibl?

In carbon monoxide poisoning and irritant gases

3

What happens if BP drops to below 70?

Irreversible brain damage, renal tubular necrosis

4

Which 3 classes of drug are more likely to cause cardiac conduction defects?

TCAs, antipsychotics, antihistamines

5

Management of hyperthermia

Remove all unnecessary clothing, fan, sponge with tepid water

6

What might cause hyperthermia?

CNS stimulants
Serotonin syndrome
Children taking antimuscarinics

7

What might cause hypothermia?

After deeply unconscious for hours
eg OD barbiturates or phenothiazines
(eg secobarbital or prochlorperazine)

8

Management of methaemoglobinaemia?

Methylthioninium chloride if hypoxic despite O2 or conc >30%

9

When is activated charcoal useful?

To prevent absorption if drug taken very recently (up to 1hr post ingestion)
To enhance elimination of drugs such as carbamazepine, dapsone, phenobarbital, quinine, theophylline

10

When should activated charcoal be avoided?

Petroleum distillates, corrosive substances, alcohols, malathion, cyanides and metal salts (including iron and lithium)

11

When is haemodialysis used in poisoning?

Ethylene glycol
Lithium
Methanol
Phenobarbital
Salicylates
Sodium valproate

12

What is done in salicylate poisoning?

Activated charcoal if within 1hr and >125mg/kg ingested
Haemodialysis considered (if>700mg/litre)
Alkalinisation of urine (IV bicarbonate)

13

When is gastric lavage indicated?

Only in severe cases of poisoning where activated charcoal cannot be used
Iron and Lithium

14

What are the features of salicylate poisoning?

Hyperventilation (respiratory alkalosis)
Followed by metabolic acidosis
Tinnitus
Deafness
Vasodilation
Sweating

15

When is salicylate poisoning severe?

> 500mg/L conc
Metabolic acidosis

16

When should activated charcoal be given in salicylate poisoning?

Within 1hr of ingesting >125mg/kg aspirin

17

Features of opioid OD

Coma, resp depression, pin point pupils,

18

Antidote to opioids?

Naloxone hydrochloride
IV infusion and monitoring

19

Danger of paracetamol OD?

Severe hepatocellular necrosis
Renal tubular necrosis
Liver damage maximal 3-4days post ingestion
Encephalopathy, haemorrhage, hypoglycaemia, cerebral oedema, death

20

Management of paracetamol poisoning

Hospital if >75mg/kg
Treat if >150mg/kg in less than 1hr
Acetyl cysteine protect liver if infused up to 24hrs post ingestion. Most effective for 8hrs post ingestion (augments glutathione levels)

21

When do you measure a paracetamol level?

4 hrs post ingestion
Use a graph w/the treatment line

22

Name 11 features of TCA OD

Dry mouth
Coma & convulsions
Hypotension
Hypothermia
Hyperreflexia
Respiratory failure
Conduction defects & arrhythmias
Dilated pupils
Urinary retention

23

Name 8 features of SSRI OD

Agitation
Tremor
Nystagmus
Drowsiness
Sinus tachycardia
Convulsions
n&v

24

What is serotonin syndrome?

Neuropsychiatric effects
Neuromuscular hyperactivity
Autonomic instability
Hyperthermia
Rhabdomyolysis
Renal failure
Coagulopathies

25

What is the antagonist to bezodiazepines?

Flumazenil

26

In massive beta blocker OD what is needed?

Atropine to treat bradycardia
IV glucagon if still in cardiogenic shock
If still, IV isoprenaline or pacemaker

27

Features of CCB OD

N+v+d
Agitation, confusion, coma
Metabolic acidosis and hyperglycaemia
Hypotension (cardiac depression)

28

Management of CCB OD

Activated charcoal within 1 hr
Calcium chloride/gluconate
Atropine

29

Management of iron OD

IV desferrioxamine mesilate (chelates iron)

30

Management of lithium OD

Haemodialysis
Increase urine output (fluids)
Supportive care (electrolytes, convulsions ec)
Gastric lavage?

31

Features of lithium OD

Apathy, restlessness
Ataxia, weakness, dysarthria, muscle twitching
Excess of 2mmol/L = poisoning

32

Stimulant OD?

Early stage (mania)-> lorazepam/diazepam
Late stage (exhaustion hyperthermia)=> tepid sponging, anticonvulsants, ventilation

33

Effects of cocaine

Agitation, dilated pupils, tachycardia, hypertension, hallucinations, hyperthermia, hypertonia, and hyperreflexia; cardiac effects include chest pain, myocardial infarction, and arrhythmias.

34

Serious SE of ecstasy

Delirium, coma, convulsions, ventricular arrhythmias, hyperthermia, rhabdomyolysis, acute renal failure, acute hepatitis, disseminated intravascular coagulation, adult respiratory distress syndrome, hyperreflexia, hypotension and intracerebral haemorrhage
Self induced water intoxication

35

Management of theophylline OD

Repeated activated charcoal
Ondansetron for vomiting
KCl for hypokalaemia
Lorazepam for convulsions
Diazepam for sedation
If not asthmatic: B-blocker

36

Management of cyanide poisoning

O2
Dicobalt edetate if strong clinical suspicion of severe cyanide poisoning
Hydroxocobalamin for smoke inhalation victims

37

Management of ethylene glycol or methanol OD

Fomepizole
Ethanol

38

Management of carbon monoxide poisoning

Clear airway
100% O2
NIV?
Cerebral oedema-> mannitol
? hyperbaric O2 chamber

39

Management of organophosphate poisoning

Atropine
Pralidoxime chloride