Term
| ____ involved patients younger than 18 years of age |
|
Definition
52%
of these 50% are children between 1-5 yo |
|
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Term
| Some authors currently list poisoning as the ___ leading cause of death in the US |
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Definition
|
|
Term
| _____ of all adult poisonings are intentional |
|
Definition
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|
Term
| ____ of poisonings are in the home |
|
Definition
|
|
Term
| A ____ is an event where a living organism is exposed to a chemical that adversely affects the functioning of that organism |
|
Definition
|
|
Term
| poisoning --> exposure to the toxin may be... |
|
Definition
occupational
environmental
recreational
medicinal |
|
|
Term
| poisoning may result from varied portals of entry including: |
|
Definition
inhalation
injection
ingestion
cutaneous and mucous membrane exposure |
|
|
Term
| historically most poisonings are secondary to... |
|
Definition
|
|
Term
|
Definition
ABCs come first
next: B/P, rectal temp, O2 saturation, & hypoglycemia
antidotes |
|
|
Term
| ___ are rarely needed in the early management |
|
Definition
|
|
Term
| the prime exception of antidotes rarely needed in the early management is.... |
|
Definition
|
|
Term
| common causes of an altered mental status |
|
Definition
hypoxia (O2)
opioid toxicity
hypoglycemia
Wernicke's encephalitis (coma cocktail) |
|
|
Term
|
Definition
D-dextrose
O- oxygen
N- narcan
T- thiamine |
|
|
Term
|
Definition
50 ml of D50W in adults
1 gm/kg in children |
|
|
Term
|
Definition
0.1-2.0 mg
consider restraints prior to admin |
|
|
Term
|
Definition
100 mg IV
indicated if you think there is a history of ETOH/malnutrition |
|
|
Term
|
Definition
nNumber of exposed persons and the type, amount, and route of exposure are essential
nPatient’s intent must be ascertained
nClinicians must be aware of the inherent inaccuracies in these types of histories
nPatient’s motivation, potential for secondary gain, and perceived risk of
arrest all may affect the history |
|
|
Term
| toxicology history that should be obtained |
|
Definition
oWhere the patient was found
oEmpty pill bottles or containers nearby
oSmells or unusual materials in the home
oOccupation of the person
oPresence of a suicide note
oAll “home remedies” used |
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|
Term
| Medical history summary for toxicology |
|
Definition
oWhat was taken and how?
oWhen was it taken?
oHow much was taken?
oWhy was it taken?
oIs this a co-ingestion?
oWas this a suicide attempt or gesture?
oWas this your medication or someone else's? |
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|
Term
| Toxicologic PE : comprehensive PE must be performed..... |
|
Definition
| on a fully undressed patient |
|
|
Term
| Toxicologic PE : assess general appearance |
|
Definition
agitation
confusion
obtundation should be noted |
|
|
Term
| Toxicologic PE : skin must be examined for.... |
|
Definition
cyanosis or flushing
excessive diaphoresis or dryness
signs of injury or injection
ulcers or bullae
bruising may be a cluse as to duration of unconsciousness, as well as coagulopathy or trauma |
|
|
Term
| Toxicologic PE : Examine the eyes for: |
|
Definition
pupil size
reactivity
nystagmus
dysconjugate gaze (completely dissociated)
excessive lacrimation (organophosphates)
hypersalivation or excessive dryness should be noted in the oropharynx |
|
|
Term
| Toxicologic PE : baseline & subsequent vital signs |
|
Definition
heart must be assessed for : rhythm, rate, regularity
evaluate lungs for bronchorrhea or wheezing
bowel sounds, urinary retention, abd tenderness or rigidity |
|
|
Term
| extremities must be evaluated for : |
|
Definition
tremor or fasciculation
as well as cranial nerves, reflexes, resting muscle tone, coordination, cognition, and ability to ambulate all must be assessed |
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|
Term
| a collection of S&S that are observed after an exposure to a substance ( a toxic "fingerprint") |
|
Definition
|
|
Term
|
Definition
S- salivation
L - lacrimation
U - urination
D - defecation
G - gastrointestinal (cramping)
E - emesis |
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|
Term
| Anticholinergics toxidromes |
|
Definition
"Alice in Wonderland"
Mad as a hatter
Blind as a bat (lose accommodation)
Red as a beet
Dry as a bone
Hotter than hell |
|
|
Term
| result from antagonization of acetylcholine by numerous medications or plant metabolites |
|
Definition
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|
Term
| Agents which cause seizures toxidromes |
|
Definition
W - withdrawal
I - isoniazid
T - theophylline, tricyclics
H - hypoglycemia, hypoxia
L - lithium
A - anticholinergics
C - cholinergics, camphor, CO
O - organophosphates
P - phenothiazines, PCP, propoxyphene (old)
S - sympathomimetics, Salicylates |
|
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Term
| Agents that cause nystagmus toxidrome |
|
Definition
S - sedative - hypnotics, solvents
A - alcohol
L - lithium
E - ethylene glycol, ethanol
M - methanol
T - tegretol, thiamine depletion
I - isopropranol
P - phenytoin |
|
|
Term
| the patient is removed from the substance and the substance is removed from the patient |
|
Definition
decontamination
can be internally or externally |
|
|
Term
| toxins on the body must be washed off OR toxins within the body must be made unavailable for absorption within the gut |
|
Definition
|
|
Term
| completely undress the patient and wash them with copious amounts of water |
|
Definition
|
|
Term
| Needs to occur PRIOR to the patient entering the ER |
|
Definition
|
|
Term
| decontamination of the eyes |
|
Definition
immediate copious irrigation with NS
very uncomfortable - 2 man procedure
may use tetracaine opth drops for pain |
|
|
Term
| GI decontamination : what are the 3 methods |
|
Definition
removal of the toxin vai the mouth
binding the toxin within the gut
flushing the toxin through the GI tract (change osmolarity of gut so gut can't absorb it - cathartic) |
|
|
Term
|
Definition
syrup of ipecac has virtually no role int he ED
limited role int he home |
|
|
Term
| GI decon : Orogastric lavage |
|
Definition
insert an OG tube
lavage with room temp water until you get back clear water
|
|
|
Term
| what type of water do you use with an orogastric lavage? |
|
Definition
|
|
Term
| Make sure to note ____ with an orogastric lavage? |
|
Definition
pill fragments
most beneficial if ingestion is within 1 hour |
|
|
Term
| GI decon : orogastric lavage can instill... |
|
Definition
| activated charcoal at 1 gm/kg - should be done before removing the tube |
|
|
Term
| for toxin absorption in the gut the most appopriate agent is? |
|
Definition
|
|
Term
| 1st dose of activated charcoal is given with ____ in order to decrease transit time |
|
Definition
cathartic
ie. sorbitol or mag citrate |
|
|
Term
| shown to decrease the transit time for he passage of the charcoal and subsequent absorbed toxin |
|
Definition
|
|
Term
| shouldnt be used in children under 5, substances known to cause diarrhea, intestinal obstruction, or ingestions of a caustic material |
|
Definition
|
|
Term
| installation of large volumes of polyethylene glycol in an osmotically balanced electrolyte solution |
|
Definition
|
|
Term
| _____ forces ingested substances through the bowel at a rapid rate |
|
Definition
|
|
Term
| whole bowel irrigation may require an ..... |
|
Definition
|
|
Term
|
Definition
alkalinization
urinary pH is exploited to manipulate certain toxins
|
|
|
Term
| toxins that are weak acis can be converted from a nonionized state to an ionized state |
|
Definition
alkalinization
"enhanced elimination"
(held within the renal tubules and excreted out of the body via urination) |
|
|
Term
| Is acidification of urine recommended for enhanced elimination? |
|
Definition
| no - probably wont survive |
|
|
Term
| is forced diuresis recommended for enhanced elimination? |
|
Definition
|
|
Term
| effective in eliminating substances that have already been absorbed |
|
Definition
|
|
Term
| hemodialysis is less effective if there is an associated _____ |
|
Definition
large dose ingestion
large molecular weight
OR
toxin is highly protein bound |
|
|
Term
| Putting toxicology all together |
|
Definition
brief to very brief history
safety net - ensure enogh blood for tox screen
ABC's
STAT EKG
STAT PCXR
labs (tox screen, UA, ABG)
imaging as appropriate
NG lavage
Give charcoal (cathartic w/ first dose)
Start MDAC if indicated
consider whole bowel irrigation |
|
|
Term
| Most important thing to remember about treatment of poisoning.... |
|
Definition
|
|
Term
| One of the primary goals in disposition is..... |
|
Definition
| medically clearing of the patient |
|
|
Term
| Disposition - if they are unstable or if they are uable to "medically clear" them consult --> |
|
Definition
|
|
Term
| Disposition - if they have "medically cleared" them and they are stable you must consider.. |
|
Definition
|
|
Term
| Important to remember about disposition |
|
Definition
|
|
Term
| If the incident is truly accidental - who do you consult? |
|
Definition
internal medicine and let them help you provide the correct disposition
example --> their med regimen needs to be re-looked at |
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