Card Set Information
What is a toxidrome?
Lungs, heart, CNS
When is gatric lavage indicated?
when someone downs a bottle of pills in the ED
What should you know before calling poison control?
How to decontaminate the eyes
copious irrigation - 2L NSS
Alkali solution is the worst of the eyes
What are the contraindications of ipecac?
Active or prior vomitting
may alter MS
may cause seizures
Explain orogastric lavage
best means of gastric emtyping
lateral decubitus position - tube placed in stomach
lavage with H20 until contents are clear
What are the indications for orgastic lavage?
Recent ingection (within 1 hour)
Potential life threatening
Contraindications for orgastric lavage
Pills are too large
more harmful to lungs then GI
non life threatening
Complications or Orogastric lavage
perforation of esophagus or stomach
inability to withdrawl tube
Explain activated charcoal
Most appropriate for decontamination of the gut
has a large surface area and binds many drugs to keep them in the GI instead of being absorped into blood
*used approximately 10 times the amount of ingested drug
Indications for AC
Unknown substance ingested
known substance that AC binds
ingection within a couple hours
contraindications of AC use
Lead, Lithium, Iron, ETOH
chance of endoscopy
When is Multi dose AC used?
When LARGE ingestion
toxins that slow GI
sustained release products
enterhepatic, or enteroenteric recirculation
No definitive clinical data supports its use
used with AC always
causes cramping, ab pain, volume depletion
renal failure in children
What is a Whole Bowel irrigation
Use Polyethylene glycol - no electrolyte inbalance
used 2L/hour until fluid is clear
use when ingested drug is life threatening with sustain release
What are TCA and what are clinical features
-antidepressants that cause the most deaths out of any Rx drug
Cause sodium channel blockage and arrythmias(death)
cause confusion, ataxia, slurred speech, ileus, urinary retention, decreased bowel sounds
SVT, VTach, coma, seizures, hypotension, coma
Treatment of TCA ingestions
Lavage (serious enough)
Na Bicarb to get pH to 7.5
Ingestion of Non SSRI and Non TCA
no change in QT
Can cause Serotonin syndrome
LESS dangerous then TCA
Wide theraputic window
Treatment of Non SSRI and Non TCA ingestion
Lavage is NOT indicated
Do not inhibit sodium channels so theres no arrythmia
Cause seizures and serotonin syndrome
give benzo for seizures
Treatment of SSRI ingestion
observe for 8 hrs
admit if lethargy, seizures, tachycardia, signs of serotonin synd.
What is serotonin syndrome?
Seen with a patient already on MAOI and ingests an SSRI or atypical antidepressent
can be seen with combo of two SSRI
What are clinical findings of serotonin syndrome?
Confusion, hypomania, myoclonus, hyperreflexia, diaphoresis, shivering, tremor
*Incoordination, hyperthermia, hypertension
What three drugs should you be careful prescribing SSRI's?
ultram or tramadol
Clinical features of mild-moderate barbituate overdose?
Drowsiness, disinhibition, ataxia, slurred speech, confusion
What are clinical features of severe barbituate intoxication?
Stupor, coma, hypotension, respiratory distress
Treatment of barbituate OD in ED?
Charcoal - maybe MDAC
Long acting barbs
Describe benzo OD
**Hypotn. and Respiratory distress**
Less toxis than Barb OD but presents the same way
Elderly more susecptible
worry about withdrawal more
Treatment of benzo OD in ED?
AC only - no indication for MDAC
Flumazenil - reverse agent but WILL CAUSE SEIZURES
Describe ETOH ingestion according to the numbers
80-100 mg/dl considered legally intoxicated
>500 mg/dl need to go to ICU
Levels drop 20-30 mg/dl per hour
What are the clinical features of Opiod overdose?
TRIAD - 1. Miosis, 2. Respiratory Depression, 3. Coma
also see N/V, hypotension, bradycardia
What is ED management of Opiod ingestions?
Heroin OD will walk out
Worry about Methdone - its long acting and has 24 hr 1/2 life
Clinical features of cocaine/amphetamine ingestions
dysrhythmia, ichemia, cocaine chest pain, seizures, CVA, asthma, ARDS
Tachycardia, tachypnea, HTN, hyperthermia, Rhabdo
what is the treatment of Cocaine and amphetamine ingestion?
ASA, nitrates, benzo for Chest pain
What can cocaine and amphetamine ingestion cause?
HTN crisis - tx w/phentolamine
concaine induced arrythmias - alkalinize the urine
CLinical effects of LCD
Coma, respiratory depression, hyperthermia
Clinical findings of PCP
CNS stimulation or depression
Rhabdo and renal failure
Management of Hallucinogen ingestion in ED?q
If sx last more than 8 hrs-admit
What are sx of moderate toxicity of Salicylates?
Hyperventilation, swelling, Tinnitus
What are sx of severe toxicity from salicylates?
Metabolic acidosis and respiratory alkalosis
seizures, hypoglycemia, N/V
Diagnosis of salicylate intoxication
Blood levels - chronic theraputic 10-30mg/dl
>30mg/dl w/sx is suggestive
>60mg/dl w/acidosis is very persuasive
Treatment of Salicylate ingestions
Whole bowel irrigation for enteric coated prep
give NSS and D5 for hypoglycemia
Describe Stage 1 of Acetaminophen overdose
first 24 hours
few or no symptoms
N/V some GI complains
Describe Stage 2 of Acetaminophen overdose
Most will recover w/o treatment
Describe stage 3 of acetaminophen overdose
Fulminat hepatic failure
Describe stage 4 of Acetaminophen overdose
Those who recover - occurs in a one week period
or you die
Treatment of Acetaminophen ingestions in ED?
get serum levels
What is the general lab workup in overdoses?
Urine toxiocology screen
PT/PTT and LFT
ASA and APAP levels