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Toxicology Exam I
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Causes deformation of limbs
thalidomide
Accound for most serious/fatal poisoning
suicide attempts
% ICU admission and % psych admissions due to poison
5% ICU
30% psych
Key points of diagnosis
history
physical exam
laboratory values
Initial focus on the exam
vital signs
cardiopulmonary assessment
neurologic assessment
Consumption of acids leads to
coagulation necrosis
consumption of bases leads to
liquifaction necrosis
Elevated ALT is a sign of
liver damage
Elevated lactate dehydrogenase is a sign of
heart attack
Guidelines for management of acute poisoning
airway management
breathing management
circulation management
(ABC)
Activated charcoal
treatment of choice for most ingestions
most effective when given w/in the 1st hour
Contraindications to activated charcoal
pt with altered conscious state
ethanol/glycols
alkalis
acids
petrolum distilates
Examples of drugs that have specific antidotes
Benzodiazepines
alcohol
methamphetamines
Alkali poisons result in
liquifaction necrosis
significant GI ulceration
Alkaline poisons
drain cleaners
oven cleaners
dishwashing liquids/powders
detergents
ammonia
portland cement
Liquid alkali producst are more likely to cause_____ than powders
esophageal burns
Antihistamine poisoning
cough and cold preperations
paracetamol may be in products
Psychostimulants
dexamphetamine
methylphenidate
Recreational drugs
amphetamine
cocaine
ecstacy
Assesment of antihistamine poisoning (symptoms present)
drowsiness
restlessness
tachycardia
palpitations
hypertension
Ephedrine may cause
hypertensive crisis
cerebral hemorrhage
Poisoning with slow release products
beware of delayed onset of poisoning
pt may require repeated doses of activated charcoal
Asymptomatic antihistamine poisoning
does not require treatment if dose is <3x the normal daily dose
Symptomatic antihistamine poisoning
charcoal 1g/kg unless altered conscious state
Symptoms of benzodiazepine poisoning
CNS depression
drowsiness
coma
respiratory depression
hypotension
Management of BZD overdose
charcoal is not usually beneficial
flumazenil is antidote
depresssion state = call EMS
Ethanol poisoning fatality occurs with blood levels ____ or breath level of _____.
>86.8 mmol/L
>0.4
Highest ethanol containing product
mehtylated spirits (95%)
does not contain methanol
Symptoms of EtOH poisoning
n/v
abd. pain
hypoglycemia
Ethanol poisoning management
charcoal is no benefit
check bg in younger children
Petroleum distillates
gases/oils/fuels/white spirit
Main complication with petroleum distillate poisoning
aspiration pneumonitis
risk of aspiration during vomiting outweighs any benefit from removal of the substance
CNS toxicity may be evident
Symptoms of petroleum distillate poison
coughing
choking
respiratory distress
management of petroleum distillate poisoning
charcoal is contraindicated
Salicylate poisoning may result from
aspirin
oil of wintergreen
symptoms of salicylate poisoning
tinnitus
vomiting
hyperventilation
respiratory alkalosis
Patients requiring treatment for salicylate poisoning
acute ingestion 150mg/kg
all symptomatic pt
ingestion of unknown qty
Labs for salicylate poisoning
initial serum salicylate then q2h if symptomatic or extended release product was injested
urea
electrolytes
creatinine
acid/base
glucose
Management of salicylate poisoning
symptomatic pt require urgent medical assesment
Author
Rx2013
ID
66541
Card Set
Toxicology Exam I
Description
clinical toxicolgoy
Updated
2011-02-15T22:55:19Z
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