Toxicology

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Flashcards on Toxicology, created by Elizabeth Then on 29/08/2018.
Elizabeth Then
Flashcards by Elizabeth Then, updated more than 1 year ago
Elizabeth Then
Created by Elizabeth Then over 5 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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