-
Symptoms of organophosphate toxicity and/or PNS overstimulation
- SLUDGE-M2B:
- Salivation
- Lacrimation
- Urination
- Defecation/Diarrhea
- GI upset
- Emesis
- Muscle spasms
- Miosis
- Bradycardia
-
Antidote for: opioids
naloxone
-
Antidote for: phenothiazines
- diphenhydramine
- benztropine
-
Antidote for: lead
- chelation tx:
- calcium
- EDTA
- dimercaprol (BAL)
- succimer
- penicillamine
-
Presentation of lead poisoning:
- abdominal pain
- anemia
- headache
- memory loss
- cosntipation
- AMS
- renal dysfxn
- chronic: mental retardation, cog dysfxn
-
Presentation of ASA toxicity:
- tinnitus
- metabolic acidosis with anion gap and respiratory alkalosis
- N/V
- AMS
- seizures
- hyperthermia
- encephalopathy
-
Causes of anion gap metabolic acidosis:
- Methanol, Metformin
- Uremia
- DKA
- Propylene glycol, phenformin
- Isoniazid, Iron, Idiopathic
- Lactic acidosis (cyanide)
- Ethalene glycol
- Rabdomyolisis
- Salicylates, Strychnine
- Alcoholic Ketoacidosis
-
Presentation of TCA toxicity:
- EKG: QRS widening, prolonged QT interval
- Anticholinergic effects:
- tachycardia
- mydriasis
- flushed skin
- dry mouth
- AMS
- seizures
-
Antidote for: TCA
bicarbonate
-
Antidote for: ACTN
N-acetylcysteine
-
Antidote for: ASA
bicarbonate
-
Antidote for: carbon monoxide
100% oxygen
-
-
Antidote for: organophosphates
- atropine
- pralidoxime/2-PAM
-
Antidote for: arsenic or mercury
- dimercaprol (BAL)
- succimer
-
Antidote for: benzo's
Flumazenil
-
Antidote for: beta-blockers
glucagon
-
Antidote for: atropine
physostigmine
-
Antidote for: cyanide
- sodium nitrite
- thiosulphate
- hydroxycobalamin
-
Antidote for: heparin
protamine sulfate
-
Antidote for: methanol or ethylene glycol
- fomepizole
- (ethanol infusion)
-
Antidote for: nitrites
methylene blue
-
Antidote for: digoxin
digoxin-specific antibodies
-
Antidote for: iron
deferoxamine
-
Treatment for cocaine overdose
- symptomatic, control HTN:
- alpha-blocker (phentolamine)
- alpha/beta-blocker (labetolol)
(AVOID pure beta-blocker)
-
Presentation of digoxin overdose:
- yellowing of vision
- blurred vision
- N/V/D
- cardiac arrythmias (paroxysmal atrial tachy)
- hyperkalemia
- AMS +/- hallucinations
-
How does an "anticholinergic" toxidrome present and what are the main culprits? Tx?
- present:
- mydriasis
- dry, flushed skin
- dry mucous membranes
- sedation, agitation, hallucinations
- urinary retention
- causes:
- Benedryl
- Phergan
- Jimson Weed
- Scopalamine
Tx = supportive, +/- benzos 2/2 agitation
-
What substances can cause an increased osmolol gap?
- ethanol
- ethylene glycol*
- isopropanol
- methanol*
- acetone
- ketoacidosis*
- renal failure*
- mannitol
- sorbitol
- hyperlipidemia
- hyperproteinemia
* = double gap acidosis
-
With what types of OD would multidose activated charcoal be a good option?
- phenobarbital
- salicylates
- theophyline
- carbamazepine
- digoxin
- phenytoin
-
Antidote for: calcium channel blockers
- calcium
- glucagon
- insulin/glucose
-
What are physiologic criteria for being sent to a trauma center?
- GCS <14
- RR <10 or >29 bpm
- SBP <90 mmHg (or pediatric equivalent)
-
What are anatomic criteria for being sent to a trauma center?
- (injuries only need be suspected)
- flail chest
- >2 long-bone fractures
- amputations proximal to wrist/ankle
- penetrating trauma in head, neck, chest, abd, or proximal extremity (i.e. above knee/elbow)
- limb paralysis
- pelvic fractures
- significant trauma + burns
-
What types/mechanisms of injury should be transferred to trauma center?
- ejection from vehicle
- death of other person in same vehicle
- pedestrian vs vehicle
- high-speed MVC
- falls >20ft
- MVC with rollover
- patient entrapped >20 min
- motorcycle crash >20mph
- separation/ejection from motorcycle
-
What types of patients are at high risk of serious injury with minor injury mechanisms?
- elderly
- very young
- people with coagulopathies
- people reduced physiologic reserve 2/2 chronic disease or acute intoxication
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