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Sam: Emergency Medicine > Toxicology -- SD > Flashcards

Toxicology -- SD Flashcards

1
Q

What are considered to be the “bad boys” for overdoses?

A

CCB, TCA, ethylene glycol, and alcohol

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2
Q

What EKG changes are seen in overdoses?

A

Arrhythmias, prolonged QT, widened QRS

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3
Q

What does MUDPILES stand for?

A

Methanol, Uremia, DKA, propylene glycol, isoniazid, lactic acidosis, ethylene glycol/ethanol, salicylates

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4
Q

How do we calculate an anion gap?

A

Sodium - (Bicarb + Chloride)

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5
Q

An anion gap less than _____ is normal

A

12

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6
Q

Patient is delirious, hyperventilating (Kussmal), and is complaining of tinnitus. What is the likely causative agent of OD?

A

Aspirin

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7
Q

At what levels are salicylates considered to be life threatening?

A

> 500mg/kg

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8
Q

How often do we repeat serum salicylate levels?

A

Every 2 hours

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9
Q

After how many hours do people reach their max absorption of salicylates?

A

6 hours

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10
Q

How do maintain a patient’s pH with an aspirin overdose?

A

Bicarb

monitor patient’s urine pH

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11
Q

What metabolic disorder typically accompanies aspirin overdose?

A

Metabolic acidosis

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12
Q

Do you see ECG changes with an aspirin overdose?

A

None

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13
Q

Gastric lavage can be done up to _______ minutes post ingestion

A

60

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14
Q

What is the treatment of choice for aspirin overdoses?

A

Dialysis

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15
Q

What is the max daily dose of tylenol?

A

4 grams in adults

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16
Q

What is the most common cause of acute liver failure?

A

Acetaminophen overdose

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17
Q

Why do children typically fare better from a tylenol overdose?

A

because they have more glutathione in their liver

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18
Q

tylenol overdose – people get sick right away or days later?

A

days later!

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19
Q

What makes a tylenol overdose even worse?

A

alcohol

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20
Q

When do you draw labs for a tylenol overdose?

A

immediately and then 4 hours later

21
Q

True or False, tylenol overdose patients will suffer from metabolic acidosis?

A

False – pH should be normal. If you see acidosis, something else is on board.

22
Q

How soon do we have to give NAC for tylenol overdose? What if the person is pregnant?

A

Within 8 hours

Anytime if the patient is pregnant

23
Q

What are the four criteria you have to meet to get a liver transplant?

A

pH less than 7.3

Grade 3+ encephalopathic

Pt greater than 100

Serum creatinine greater than 3.4

24
Q

This type of toxicity often mimics psychological illness

A

Psychotropic medicatios

25
Q

What two psychotropic medications are considered to be the “bad boys?”

A

lithium and amitriptyline

26
Q

What are symptoms of serotonin syndrome?

A

Agitation, confusion, tremor rigidity, hyperreflexia, ataxia

27
Q

What lab must we check for in psychotropic toxicity?

A

Creatinine kinase – check for rhabdomyolysis

28
Q

How do we treat psychotropic toxicity?

A

Benzo’s!

BP control, fluid for rhabdo, and cooling

29
Q

What dose is a toxic dose in terms of TCA’s?

A

10-20mg/kg

30
Q

When do TCA’s reach peak absorption?

A

1 hour

31
Q

What does SALT stand for? and what toxicity is it connected to?

A

Connected to TCA’s

Stands for shock, AMS, wide QRS, terminal R wave in AVR

32
Q

How do we treat a TCA overdose?

A

Bicarb! Intubation is key in severe OD, serial EKG’s, and seizure precautions

33
Q

what are the take home points of TCA toxicity?

A
  1. Initially asymptomatic – then crash shortly thereafter
  2. Look for classic ECG findings
  3. Tachy (acidotic) –> give bicarb
34
Q

What two opioids that we talked about are extended release?

A

Dilaudid, Methadone

35
Q

How do opioid overdose patients present?

A

Respiratory depression with altered mental status

36
Q

when do you start cardiac issues with an opioid overdose?

A

Only if the patient has been down a long time!

37
Q

If any patient comes into the ED unresponsive, what blood test should we get?

A

Blood sugar!

38
Q

What does narcan promote?

A

aggression

39
Q

What are the take home points from opioid overdose?

A
  1. Opiates last longer than Narcan (sometimes)
  2. Usually all issues involve respiratory
  3. Wake up angry
  4. If still altered – other ingestion vs. anoxic brain injury
40
Q

What is the legal limit for alcohol?

A

0.08 or 80 in the medical world

41
Q

This overdose causes vasodilation and bradycardia

A

Calcium channel blockers (Verapamil)

42
Q

What dose of a CCB do we consider it to be a serious ingestion?

A

greater than 1 gram

43
Q

What formulation of CCB is the most dangerous?

A

Extended release

44
Q

How do we treat a CCB overdose?

A

Calcium chloride, pacing, and pressors

45
Q

Ethylene glycol causes what metabolic disturbance?

A

Severe metabolic acidosis

46
Q

How do ethylene glycol overdoses typically present?

A

Kussmal breathing, altered mental status

47
Q

How do we treat an ethylene glycol overdose?

A

Fluids, bicarb to correct acidosis

48
Q

What is considered to be the treatment of choice for ethylene glycol overdose?

A

Fomepizole – other option is ethanol drip

49
Q

What are the take home points from ethylene glycol overdose?

A
  1. Sick as hell
  2. Severe acidosis
  3. Fomepizole, ethanol drip, dialysis

Sam: Emergency Medicine (12 decks)

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