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Emergency Medicine > Toxicology > Flashcards

Flashcards in Toxicology Deck (108)
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1

Initial Evaluation for a Toxicology Patient

ABC's
ABGs as soon as practical
Obtain IV access
Treat coma promptly: glucose, naloxone, thiamine
Maintain circulation
Treat seizures
Cardiac monitoring and pulse oximetry
History

2

Train of Overdose Effects

CNS depression
Myosis
Respiratory depression

3

Medications to Treat Seizures in Toxicology Patients

Diazepam
Phenobarbital

4

Options for Decontamination of Ingested Toxins

Emesis
Gastric lavage
Activated charcoal
Whole bowel irrigation

5

Emesis as a Decontamination Option

Requires gag reflex
Limited efficacy if 1+ hour since ingestion
Ipecac + water

6

Contraindications to Inducing Emesis

Caustics
Low-viscosity hydrocarbons: gasoline, kerosene
Rapid-acting convulsants: meth, cocaine, cyclic antidepressants

7

Indications for Gastric Lavage

Serious ingestions when emesis has failed
Patients are lethargic or uncooperative
Gag-reflex markedly depressed
Patients have ingested rapid-acting convulsants

8

Methodology of Gastric Lavage

Large bore NG tube
Tap water or saline at body temp in 250 mL increments
Continue until fluid returns clear and free of pill fragments

9

What poisons does activated charcoal not adsorb?

P: potassium
A: alcohol
I: iron
L: lithium

10

What are some cathartic actions?

Speeds up GI transit time
Screws up electrolytes
Lots more vomiting
Severe abdominal cramp

11

When is a whole bowel irrigation useful?

Sustained release and enteric coated tablets

12

Initial Laboratory Studies in a Toxicology Patient

ABGs
Chem 7
ECG: wide QRS or prolonged QT
CXR: pulmonary edema
Flat plate abdomen??
Urine for toxicology screen
Draw and hold serum toxicology screens

13

What does management of the patient require in toxicology patients?

Understanding of absorption, distribution, elimination

14

Define First-Order Kinetics

Fixed PERCENTAGE of the toxin is removed per unit of time

15

Define Zero-Order Kinetics

Fixed AMOUNT of toxin is removed per unit of time

16

Define Drug Clearance

Volume of plasma that can be cleared of toxin per unit time

17

When is hemodialysis used in patients who have overdosed?

When toxin is relatively water-soluble and not highly protein bound

18

Indications for Hemodialysis in Overdose Patients

M: methanol
E: ethylene glycol
L: lithium
S: salicylate

19

Advantage of Hemoperfusion over Hemodialysis

Drug/toxin in direct contact with adsorbent material

20

What is hemoperfusion commonly associated with?

Thrombocytopenia

21

What does hemoperfusion NOT do?

Correct electrolyte imbalances
Adjust pH

22

When is hemoperfusion useful?

TRI: TCAs
P: paraquat
E: ethchlorvynol
P: phenobarbital
T: theophylline
D: digitoxin

23

Antidote for Acetaminophen

Acetylcysteine

24

MOA of Acetylcysteine

Bind to NAPQI so it can't accumulate

25

Antidote for Anticholinergics

Physostigmine

26

What other uses are there for physostigmine?

Myasthenia graves
Short term memory

27

Antidote for Benzodiazepines

Flumazenil: if infusion too rapid, patient will seize

28

Antidote for Cyanide

Na nitrite
Na thiosulfate

29

Antidote for Methanol/Polyethylene Glycol (anti-freeze)

Ethanol

30

Antidote for Narcotics

Naloxone (Narcan)