E. Med

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  1. What is a toxidrome?
    • Vitals
    • General survey
    • Skin
    • Eyes
    • mucous membranes
    • Lungs, heart, CNS
  2. When is gatric lavage indicated?
    when someone downs a bottle of pills in the ED
  3. What should you know before calling poison control?
    • Neuro Exam
    • Vital signs
    • Pupillary reaction
  4. How to decontaminate the eyes
    • copious irrigation - 2L NSS
    • tetracaine
    • check pH

    Alkali solution is the worst of the eyes
  5. What are the contraindications of ipecac?
    • Active or prior vomitting
    • may alter MS
    • may cause seizures
  6. Explain orogastric lavage
    • best means of gastric emtyping
    • lateral decubitus position - tube placed in stomach
    • lavage with H20 until contents are clear
    • Use charcoal
  7. What are the indications for orgastic lavage?
    • Recent ingection (within 1 hour)
    • Potential life threatening
  8. Contraindications for orgastric lavage
    • Pills are too large
    • more harmful to lungs then GI
    • non life threatening
    • Caustics
  9. Complications or Orogastric lavage
    • perforation of esophagus or stomach
    • tracheal insertion
    • aspiration
    • decreased O2
    • inability to withdrawl tube
  10. 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
  11. Indications for AC
    • Unknown substance ingested
    • known substance that AC binds
    • ingection within a couple hours
  12. contraindications of AC use
    • Lead, Lithium, Iron, ETOH
    • esophageal/gastric perf
    • chance of endoscopy
    • obstruction
    • unsecured airway
  13. When is Multi dose AC used?
    • When LARGE ingestion
    • toxins that slow GI
    • sustained release products
    • enterhepatic, or enteroenteric recirculation
  14. Cathartics
    • No definitive clinical data supports its use
    • used with AC always
    • causes cramping, ab pain, volume depletion
    • renal failure in children
  15. 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
  16. 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
  17. Treatment of TCA ingestions
    • Charcoal
    • Lavage (serious enough)
    • Na Bicarb to get pH to 7.5
  18. Ingestion of Non SSRI and Non TCA
    • Cause seizures
    • no change in QT
    • Can cause Serotonin syndrome
    • LESS dangerous then TCA
    • Wide theraputic window
  19. Treatment of Non SSRI and Non TCA ingestion
    • Activated charcoal
    • Lavage is NOT indicated
    • no antidote
  20. SSRI ingestion
    • Do not inhibit sodium channels so theres no arrythmia
    • Cause seizures and serotonin syndrome
    • give benzo for seizures
  21. Treatment of SSRI ingestion
    • Charcoal
    • observe for 8 hrs
    • admit if lethargy, seizures, tachycardia, signs of serotonin synd.
  22. 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
  23. What are clinical findings of serotonin syndrome?
    • Confusion, hypomania, myoclonus, hyperreflexia, diaphoresis, shivering, tremor
    • *Incoordination, hyperthermia, hypertension
  24. What three drugs should you be careful prescribing SSRI's?
    • Demerol
    • dextromethorphan
    • ultram or tramadol
  25. Clinical features of mild-moderate barbituate overdose?
    Drowsiness, disinhibition, ataxia, slurred speech, confusion
  26. What are clinical features of severe barbituate intoxication?
    Stupor, coma, hypotension, respiratory distress
  27. Treatment of barbituate OD in ED?
    • Charcoal - maybe MDAC
    • forced diuresis
    • Long acting barbs
    • dialysis
  28. Describe benzo OD
    • **Hypotn. and Respiratory distress**
    • Less toxis than Barb OD but presents the same way
    • Elderly more susecptible
    • worry about withdrawal more
  29. Treatment of benzo OD in ED?
    • AC only - no indication for MDAC
    • Flumazenil - reverse agent but WILL CAUSE SEIZURES
  30. 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
  31. What are the clinical features of Opiod overdose?
    • TRIAD - 1. Miosis, 2. Respiratory Depression, 3. Coma
    • also see N/V, hypotension, bradycardia
  32. 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
    • give AC
  33. Clinical features of cocaine/amphetamine ingestions
    • dysrhythmia, ichemia, cocaine chest pain, seizures, CVA, asthma, ARDS
    • Tachycardia, tachypnea, HTN, hyperthermia, Rhabdo
  34. what is the treatment of Cocaine and amphetamine ingestion?
    • Benzodiazapines
    • ASA, nitrates, benzo for Chest pain
  35. What can cocaine and amphetamine ingestion cause?
    • HTN crisis - tx w/phentolamine
    • concaine induced arrythmias - alkalinize the urine
  36. CLinical effects of LCD
    Coma, respiratory depression, hyperthermia
  37. Clinical findings of PCP
    • CNS stimulation or depression
    • Rhabdo and renal failure
  38. Management of Hallucinogen ingestion in ED?q
    • Supportive, ABC's
    • Respiratory support
    • Benzos
    • If sx last more than 8 hrs-admit
  39. What are sx of moderate toxicity of Salicylates?
    Hyperventilation, swelling, Tinnitus
  40. What are sx of severe toxicity from salicylates?
    • Metabolic acidosis and respiratory alkalosis
    • seizures, hypoglycemia, N/V
  41. Diagnosis of salicylate intoxication
    • Blood levels - chronic theraputic 10-30mg/dl
    • >30mg/dl w/sx is suggestive
    • >60mg/dl w/acidosis is very persuasive
  42. Treatment of Salicylate ingestions
    • AC
    • Whole bowel irrigation for enteric coated prep
    • give NSS and D5 for hypoglycemia
  43. Describe Stage 1 of Acetaminophen overdose
    • first 24 hours
    • few or no symptoms
    • N/V some GI complains
  44. Describe Stage 2 of Acetaminophen overdose
    • Days 2-3
    • RUQ pain
    • Elevated LFTs
    • Most will recover w/o treatment
  45. Describe stage 3 of acetaminophen overdose
    • Days 3-4
    • Fulminat hepatic failure
    • metabolic acidosis
    • renal failure
    • coagulopathy
    • encephalopathy
  46. Describe stage 4 of Acetaminophen overdose
    • Those who recover - occurs in a one week period
    • complete resolution
    • or you die
  47. Treatment of Acetaminophen ingestions in ED?
    • AC
    • N-acetylcysteine
    • IV form
    • get serum levels
  48. What is the general lab workup in overdoses?
    • Chem 7
    • CBC
    • Urine toxiocology screen
    • ETOH level
    • PT/PTT and LFT
    • ASA and APAP levels
    • EKG

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E. Med
2010-03-01 03:48:13

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