Emed - Toxicology

A specific evaluation of ___ should be done

the gag reflex

Respiratory complications are common in patients with

altered level of consciousness

Common cardiac complications

Bradycardia

Hypotension

Neurological complications are commonly seen with

altered level of consciousness, seizures, behavioral abnormalities

What is the main goal when dealing with toxicology?

Decontamination of the GI tract ***

Think Decontamination

- removal, prevent reabsorption, antidote

Syrup of ipecac

not recommened anymore due to the risk of aspiration

Good for immediate recovery of gastric contents and liquids

Gastric lavage

Catharics

Sorbitol, Magnesium Citrate

Catharics cause

increased GI motility therefore decreased GI absorption

Disadv to catharics

liquid stools/dehydration

most aboprtion already took place

What is whole bowel irrigation

rapidly wash the GI tract

Whole bowel irrigation works well with

enteric coated meds, sustained release or if poorly absorbed by activated charcoal

Activated charcoal is ___ times the surface area of ipecac

100 times

Decontamination treatment of choice

Activated charcoal

Activated charcoal - use within

1 hr of toxic med ingestion

Activated charcoal prevents

absorption

CI of Activated charcoal

Decreased LOC*

Increased risk of bleeding/perf

AMS cocktail

Dextrose

Naloxone

Thiamine

Why is thiamine given in AMS?

To treat and/or avoid Wernicke-Korasakoff* syndrome

D50%... Hm if D10g

5g

EQ**

Benzo OD give

Flumazenil**

Flumazenil CI

h/o seizures

chronic benzo use

co-ingestions that may induce seizures

Sxs of acetaminophen overdose

anorexia, high LFTs, jaundice, liver failure (very hepatotoxic, this is a bad OD)

Tinnitus in an OD think of

Salicylates

Anticholinergic OD

Hot as a hare, red as a beet, dry as a bone, blind as a bat, mad as a hatter

**

Cholinergic OD

SLUDGE. Salivation

Lacrimation

Urination

Defecation

Gastric motility

Emesis

Look over other OD sxs

*

Pin point pupils

Opioid OD

When do u get mydriasis

Anticholinergics, sympathomimetics, Belladonna

What should you test the urine for

Do a urine toxicology screening and serum salicylate and acetaminophem levels to screen for co-ingestions

Urine pregnancy test

Anion gap

= Na - (Cl + HCO3)

Normal is between 9 and 16

MUDPILES

Anion Gap Acidosis

Methanol

Uremia

Diabetic Ketoacidosis

Paraldehyde/Phenformin

INH

Lactic acidosis

Ethylene glycol

Salicylates

Osmolar gap plasma

measured osmolarity - calculated osmolarity (2x NA + glu/18 + BUN/2.8)

normal < 15

ME DIE

Methanol

Ethylene glycol

Diuretics

Isopropyl alcohol

Ethanol

Responsible for more intentional OD related deaths than any other group of meds (non opiate)

TCAs

What are the TCAs

Elavil (amitriptyline), nortriptyline, despiramine

What do TCAs do

Block reuptake of centrally active neurotransmitters

Global widening on EKG

TCA OD...GIVE BICARB***

TX TCA OD

sodium bicarb

Bicarb can cause ___ so may have to supplement ___

hypoK

K

An example of cholinergic posion

Organo-phosphate exposure

Treat Organo-phosphate exposure (SLUDGEM sxs)

ATROPINE** (no max dose when it comes to OD)

Serotonin syndrome

Potentially life-threatening condition from excess serotonin.

3 subtypes of MAOI OD

-actual poisoning from OD (not common)

-Drug-food interaction (Tyramine)

-Drug-drug interaction (SSRIs, TCAs)

Tx MAOI OD

Tx based on sxs

Neuroleptics

Haloperidol/Haldol

Compazine

Thorazine

Zyprexa

Dystonic reactions think

Neuroleptic OD

Sxs of neuroleptic OD

Dystonic reactions

TARTIVE DYSKINESIA**

Akathisia

Parkinnosmism

neuroleptic OD treatment

Benadryl *

Cogentin

Baclofen for TD

Most common used and abused intoxicant in the USA

Alcohol

Alc is a ____

CNS depresssant

What is the killer in Alc OD

Respiratory depression

Isopropanol

Rubbing alcohol

Twice as potent as ETOH

Common for suicide attempts

Isopropanol OD is there AG acidosis

no but positive osmolar gap

Isopropanol if levels are > 500

hemodialysis is needed

Ethylene glycol aka

Antifreeze

Ethylene glycol - very toxic to

liver and kidney

why is Ethylene glycol common

sweet tasting

Test urine in Ethylene glycol OD for

OXYLATE CRYTALS* and flourescence

Ethylene glycol OD tx

Fomepizole***

ETOH antagonist

Hemodialysus for any level with high anion gap and evidence of end organ disease

Best method for removing toxic alc and metabolites

Hemodialysis

Meds able to be passed down ET tube

LEAN

Lido Epi Atropine Narcan

MCC of ED visits due to drug OD (excpet for ETOH)

Cocaine

Cocaine usu DX with

Urine screen

Tx Cocaine OD

Benzos

Dont give in cocaine OD

BB (don't want unopossed alpha)

#1 OD in elderly

ASA

ASA OD sxs

mostly GI AE

Seizures, respiratory arres, PARADOXICAL FEVER

Acidosis, hyperthermia, Vtaach/fib

ARDS

TINNITUS***

Treatment of ASA OD

Charcoal

Fluids

BICARB**

Acetaminophen OD stages

look in notes

Acetomeniophen OD treatment

Mucomyst (NAC) 21 hour IV protocol

Dose 1 = 150mg over 60 min

Dose 2 = 50 mg over 4 hours

Dose 3 = 100 mg over 16 hours

Acetaminophen OD - early admin of NAC within ____ is nearly 100% hepatiprotective

8 hours

Digitalis OD sxs

AV blocks*

Visual distrubances*

#2 OD in elderly

Digitalis

Digitalis antidote

Digibind

Digitalis OD what is CI

Cardiac pacing - fear of Vfib or asystole