14843967
Description
Flashcards by Elizabeth Then, updated more than 1 year ago
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Created by Elizabeth Then
over 6 years ago
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| Question | Answer |
| Principles of management | - Triage - Initial stabilisation - Directed history and examination - assessment of toxidromes ongoing care and specific treatments, decontamination or antidotes |
| General management | History - agent and does Risk assessment Time since ingestion Patient factors, intention vs unintentional supportive care monitoring |
| Investigations | BSL, ECG, urine, liver and renal function, radiology |
| General management | decontamination, antidotes, disposition |
| Decontamination | - reduce rate of absorption - bind and remove before it is fully absorbed e.g. activated charcoal |
| Activated charcoal | reversibly absorbs toxins, prevents absorption via GIT tract - needs to be able to maintain airway and prevent aspiration - administer within first house of ingestion - effective for benzos and antidepressants some substances are not removed by charcoal, pesticides, alcohols, hydrocarbons |
| Decontamination - whole bowel lavage | For life threatening ingestions of sustained release of preparations -Polyethylene glycol solution - Until rectal effulent is clear |
| Whole bowel lavage | 1:1 nursing care for at least 6 hours - NGT tube postioned - give charcoal if agent will bind - metoclopramide - position pt - stop irrigation if their is abdomen distention or loss of bowel sounds |
| Enhanced elimination | - increase rate of elimination - methods include: - urinary alkanisation - haemodialysis - haemoperfusion |
| Admit for crit care unit for | - ventilation, advanced supports, resuscitation, extracorporeal elimination, multiorgan support, continous monitoring |
| Useful emergency antidotes | paracetemol - Nacetyl Tricylics - sodium bicarbonate Digoxin - phenytoin methanol - ethanol Beta blockers - glucagon opiotes - naloxone benzos - flumazenil |
| Toxidrome | group of signs and symptoms that commonly occur in poisoning due to specific toxin sympathomimetic toxidrome - sympathetic NS stimulated Anticholinergic - block acetyl choline cholnergic - excessive acetyl choline opioid - sedative/hypontic - induce coma |
| Sympathomimetic | Excessive sympathetic stimulation - excessive alpha and beta stimulation substances include - amphetamine, cocaine, ectasy, caffiene management - airway. fluids. betablockers. temp |
| Anticholinergic toxidrome | antagonise ach block muscarinic receptors substances - tricylics, atropine, anticonvulsants managements - cardiac arrhytmias - prolonged QTs, airway oxygen, iv fluids, benzos for agitation ad seizure management |
| Cholinergic toxidrome | accumulation of excessive levels of ACH inhibit cholinestarase substances - pesticides, mushrooms managements - decontamination, PPE. seizure managements, intubation, ventilation, atropine, iv fluids |
| Opioid toxidrome | opiate induced bind to opioid receptors CNS depression to coma, hypotension duration dependent on half life - naloxone, oxygen, nerve compression injury |
| seative hypotic toxidrome | defined by CNS GABA receptors manifests as a spectrum of mental status changes substances - benzodiazepines management - primary survey, charcoal |
| Non - toxidrome substances | carbon monoxide, paracetemol, antidepressants, ethanol/toxic alcohols |
| Carbon monoxide poisioning | 200 times affinity with hb than 02 forms carboxyhb crosses alveolar cap membrane binds to hamoprotein |
| Carbon monoxide | confirmed with COHB measurement - ABG may demonstrate acidosis - cardiac monitor |
| Paracetemol | rapidly absorbed through GI tract peak plasma concentrations reached within 30-60 minutes NAPQI antidote produces hepatocyte damage and failure - analgesic effect in CNS due to activation of serotonergic pathways |
| N- Acetylcysteine | maintain or replenish glutathione in liver enhance non-toxic metabolism or paracetamol protect liver cells administer within 8-10 hours |
| NAC | adverse reactions allergic type dose dependent |
| SSRI | Replace TCA as first line adverse effects, gi symptoms, headache SSRI SYNDROME - resting tremor, rigidity, abnormal limb and head movements, arrhythmias management - supportive, primary survey,administration of benzodiazepine |
| Ethanol/toxic alchols | - rapid dose related CNS depression - rapid onset CNS effects - leads to metabolic acidosis clinical features - headache, vertigo, blurred vision, nausea, vomiting - antidote - IV ethanol, oral, thiamine, hypocalcaemia will resolve consider haemodialysis |
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