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Flashcards in TOX Deck (148)
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1

When should poisoning be on the ddx

• Patient with ALOC – no obvious cause
• Inexplicable vital signs
• Inexplicable lab tests, EKG
• Symptoms look like a toxidrome
• Multiple patients w/ same sx’s

2

focused Hx with poisoning should focus on

Known, suspected or reported ingestion/exposure?
1. Anticipate: What class of substance was ingested? What does it (they) do?

3

mngmt of poisoning should involve

v. REVERSE with antidote, if possible
vi. REMOVE residual poison, if possible
vii. NEUTRALIZE circulating poison
viii. ENHANCE ELIMINATION of the poison

4

poison control number

1-800-411-8080

5

initial mangement of tox pt

ii. Breathing - O2 Sat, RR – effectively ventilating?
iii. Circulation – BP low or high?
iv. Cardiac rhythm? Tachy? Brady? Wide or narrow? Is it changing?
v. D & E is for Disability/Decontamination/Exposure

6

why is considering who called 911 important

did the person who ingested this want to be saved

7

other important hx question

when was it taken
why
etoh or alcohol
PMH
has this ever happened before

8

physical exam

i. Vital signs
ii. Cardiac rhythm – do they have a dysrhythmia?
iii. Level of consciousness, gag reflex
iv. Pupils - size and reactivity
v. Skin signs – sweaty, dry, hot, rash, track marks
vi. Bowel sounds – hyper-, hypoactive, are they present at all?
vii. Bladder distention
viii. Breath/body odor
ix. Evidence of trauma, focal

9

bowel sounds

toxidrome predictable of medicines

10

management of tox

• D-stick, EKG, Upreg right away
• IV access, monitor, O2
• Acetaminophen (APAP) level
• Chem, CBC, UA, Blood
EtOH, Utox

11

why do you want to get a cmp

anion gap, electrolytes, renal, LFT’s),

12

get drug levels

• Digoxin
• Dilantin (ataxia; OD of Dilantin will make you not able to walk; they have a broad based ataxia like “drunk walking”), Carbamazepine, Valproic Acid
• Lithium


“Comprehensive” drug screens not helpful – take too long

13

• “Coma Cocktail”

• 50 cc of 50% glucose IV: (“Amp of D50”)
• Naloxone (Narcan®

14

• Naloxone (Narcan®)

reverses an opioid OD immediately. Narcan lasts about 45 mins. So if their OD is with a longer acting agent then they will come back for the 45 mins, the narcan wears off and they will go down again. Put soft restraints b/c they will wake up UNHAPPY, combative, and irritable

• 0.8-2 mg IN, IM, IV

15

when would you get a KUB

• KUB for select, ingested radiopaque substances

16

special labs you may need to order

• Calcium, Magnesium
• Total CK (rhabdomyolysis)
• PT/INR (hepatotoxic, coumadin)
• Serum osmolarity/osmolar gap

17

methods of removal

decontamination
• HAZMAT, protection for HCP
• Forced emesis**
• Surgical removal

18

Forced emesis**

b/c concerned about airway complications and esophageal rupture so don’t use this method

Rare: no syrup of ipecac

19

how do you neutralize

• 1 gm / kg administered orally
• Repeat dosing for some drugs
• Give with cathartic (Sorbitol)
• Can be given pre-hospital
• Not always useful, can be dangerous
Antidote: known ingestion/exposure

20

ENHANCE ELIMINATIONhis look like and what do we use

• Whole bowel irrigation
• Go-Lytely
• Dialysis, Hemofiltration
• Enhance urinary excretion


usually reserved for people who have ingested packets of drugs

21

i. Opiates tx

naloxone

22

ii. Acetaminophen tx

– N-acetylcysteine
1. NAC, Mucomyst

23

iii. Digoxin

– Digibind Fab-fragments

24

iv. Benzos -

flumazenil

25

v. Cyanide

- Lilly kit

26

vi. INH –

– pyridoxine

B6?

27

Carbon Monoxide

vii. Carbon Monoxide – oxygen

28

• Anticholinergics -

physostigmine

29

• Cholinergics

atropine, 2-PAM

30

• Beta blockers

glucagon (increases force and rate of contraction – chronotropic and ionotropic)