Flashcards in Toxicology Deck (108)
Initial Evaluation for a Toxicology Patient
ABGs as soon as practical
Obtain IV access
Treat coma promptly: glucose, naloxone, thiamine
Cardiac monitoring and pulse oximetry
Train of Overdose Effects
Medications to Treat Seizures in Toxicology Patients
Options for Decontamination of Ingested Toxins
Whole bowel irrigation
Emesis as a Decontamination Option
Requires gag reflex
Limited efficacy if 1+ hour since ingestion
Ipecac + water
Contraindications to Inducing Emesis
Low-viscosity hydrocarbons: gasoline, kerosene
Rapid-acting convulsants: meth, cocaine, cyclic antidepressants
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
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
What poisons does activated charcoal not adsorb?
What are some cathartic actions?
Speeds up GI transit time
Screws up electrolytes
Lots more vomiting
Severe abdominal cramp
When is a whole bowel irrigation useful?
Sustained release and enteric coated tablets
Initial Laboratory Studies in a Toxicology Patient
ECG: wide QRS or prolonged QT
CXR: pulmonary edema
Flat plate abdomen??
Urine for toxicology screen
Draw and hold serum toxicology screens
What does management of the patient require in toxicology patients?
Understanding of absorption, distribution, elimination
Define First-Order Kinetics
Fixed PERCENTAGE of the toxin is removed per unit of time
Define Zero-Order Kinetics
Fixed AMOUNT of toxin is removed per unit of time
Define Drug Clearance
Volume of plasma that can be cleared of toxin per unit time
When is hemodialysis used in patients who have overdosed?
When toxin is relatively water-soluble and not highly protein bound
Indications for Hemodialysis in Overdose Patients
E: ethylene glycol
Advantage of Hemoperfusion over Hemodialysis
Drug/toxin in direct contact with adsorbent material
What is hemoperfusion commonly associated with?
What does hemoperfusion NOT do?
Correct electrolyte imbalances
When is hemoperfusion useful?
Antidote for Acetaminophen
MOA of Acetylcysteine
Bind to NAPQI so it can't accumulate
Antidote for Anticholinergics
What other uses are there for physostigmine?
Short term memory
Antidote for Benzodiazepines
Flumazenil: if infusion too rapid, patient will seize
Antidote for Cyanide
Antidote for Methanol/Polyethylene Glycol (anti-freeze)