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EM Toxi
Emergency Medicine Toxicology
72
Medical
Post-Graduate
01/21/2009

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Cards

Term
Clonidine o/d
Definition
Apnea-> mental status changes->coma
Sz, miosis, bradycardia, hypotension
Term
Complications of EtOH induced chronic liver dz
Definition
Bleed d/o, esophageal varices, portosystemic encephalopathy, hepatorenal sx, spontaneous bacterial peritonitis
Term
ABG in ASA o/d
Definition
Early resp alkalosis-> central resp center shut->metabolic acidosis
Term
Clinical presentation of CN poisoning
Definition
Agitation, Sz, ↓mental status, resp. depression, brady->tahcy->bradycardia, ↑BP->↓BP, pulmonary eema, bitter almond odor/breath, gastritis, cherry red skin -> cyanosis
Term
Poisons that may cause latent GI bleeding
Definition
ASA, iron, coumadin, mercuric salts, alkali/acids caustics, lung acting anticoag, rodenticids
Term
Toxins cause pulmonary edema
Definition
Opioids, ASA, cocaine, ed/hyp, CO, Dig, BB, CCB, chlorine N2O3, organophosphates, ethylene glycol
Term
Drugs to avoid in heterocyclic antidepressants tox
Definition
Phenytoin (↑ V.ectopy), BB & CCB (↓BP), Ipecac (coma), Type 1A (auinidine, procain) & 1C (flecainide), flumazenil, physostigmine (cardiotoxic, asystole
Term
↑anion gap metab acidosis + calcium oxalate crystals in U/A
Definition
Ethylene glycol
Term
Botulism MC initial symptom
Definition
Visual disturbance - abducens (VI) n. palsy
Term
Antidote for organophosphates (SLUDGE)
Definition
❑ Atropine: 2-4 mg IV 5min ❑ 2-PAM if weakness, 25-50 mg/kg/IV up to 1 grm
Term
Antidote to atropine
Definition
physostigmine or pilocarpine
Term
Alcohol w/osmolal gap & anion gap
Definition
EtOH, Isopropyl
Term
Sinus brady in a suspected poisoning
Definition
Dig, cyanide, organophosphates, carbonates?,βB,CCB
Term
Antidote for phenothiazines (neuroleptic durgs w/antiemetic properties and also used in CHF)
Definition
❑ Diphenidramine 50mg ❑ Bentropine 2mg IM
Term
What med ingestion will cause hypoglycemia
Definition
•Oral hypoglycemics •ASA •EtOH •Propranolol
Term
Hydrocarbons aspiration hazard depends on 2 physical properties
Definition
• Low viscosity (most imp. factor)-measures in SSV (saybolt seconds univ.), ↓# = ↑mortality •high volatility
Term
Iron stages poisoning
Definition
[image]
Term
Urine alkalinization indications
Definition
•Barb tox •Salicylate (bolus & drip) •TCA •Chloramphenicol
Term
Urine alkalinization C/I
Definition
NON cardio pulmonary edema
Term
Blood vs urine alkalinization
Definition
[image]
Term
Ethylene glycol & methanol antidote
Definition
Ethanol 10%/D5W 800 mg/kg load, then 1-1.5 ml/kg/hr
Term
A welder w/fever, shaking chills, salivation, HA, cough, resp distress - Dx?
Definition
Metal fume fever - resolves 24-48 hrs
Term
What causes metal fume fever
Definition
Zinc, copper, Mg, carmium, nickel, brass, Fe, manganesse, tin
Term
Complications of ASA tox
Definition
Gastric dilation, ileus, GI hemorrhage, platelet dysfunction
Term
Indications for hemodialysis in ASA toxicity
Definition
• Levels >90-100mg/dL •CNS depression • Rising levels despite tx • Renal, hepatic or pulm failure • Severe cardiac toxicity • Severe acid/base disturbance
Term
Toxidrome of cholinergics
Definition
DUMBLES (or SLUDGE): Dirrhea, Urination, Miosis, Bradycardia, Bronchospasms, Bronchorrhea, Lacrimation, Emesis, Salivation, Seizures. Also, coma resp, failure, muscle fasciculation
Term
Toxins causing latent HTN
Definition
PCP, MAOI, phenylpropanolamine, cacaine, amphetamines
Term
Tx for TCA's w/seizures
Definition
Valium/Ativam, phenobarbs
Term
Rx to avoid in TCA's w/seizures
Definition
❑ Dilantin - ↑incidence of dysrhythmias ❑ Romozicin - ↑ seizures risk ❑ Procainamide - worsen quinidine-like tox ❑ Ipecac - rapid onset seizures & coma
Term
Narcan drip
Definition
❑ 1/2 awakening dose as load, then 2/3 of awakening dose/hr diluted in D5W or NS
Term
Anion gas w/Astra analyzer values
Definition
•Normal Astra 7 mEq; ↑AG=>11mEq/L •Normal test = 12; ↑AG >16
Term
EKG changes in poisoned pt
Definition
• Prolonged QT • Wide QRS • Sinus brady
Term
Opioid intoxications w/out miosis
Definition
Meperidine & lomotril
Term
Toxidromes
Definition
[image]
Term
Fruit-like breath in poisoning
Definition
Nitrites, isopropil alcohol
Term
Bitter almonds breath in poisoning
Definition
Cyanide
Term
Pear-like breath in poisoning
Definition
Chloral hydrate
Term
Rotten eggs breath in poisoning
Definition
Hydrogen sulfide (used in refineries)
Term
Garlic breath in poisoning
Definition
Arsenic, phosphorus, organophosphates, tellurium
Term
Serum osmol formula
Definition
2 Na + Glu/18 + BUN/2.8
Term
DDx in ↑osmolar gap & normal AG
Definition
Ethanol, isopropyl alcohol, glycerol, mannitol, sorbitol, acetone
Term
Toxic metabolite of methanol
Definition
Formic acid -Blind drunk: produces optic papillitis & retinal edema
Term
Fab frag indications in Dig toxicity
Definition
V-Fib, V-Tach, sinus brady, resistant to atropine, K+ >5.5, potentially lethal intox
Term
What specific lab in a suspected organophosphate exposure
Definition
Serum cholinesterase level expected <10% of normal
Term
Si/Sx of carboxyhemoglobin
Definition
HA, N/A, flu-like, syncope, tachypnea, coma, Sz, CV collapse, resp failure
Term
Coma causes
Definition
[image]
Term
Phenytoin toxicity
Definition
[image]
Term
Low anion gap poisoning
Definition
Iodide & bromide
Term
APAP antidote
Definition
N-acetylcysteine 140 mg/kg, then PO 70 mg/kg q4 hrs x 17
Term
DDx is osmolar gap
Definition
Methanol, ethyl alcohol, isopropyl, glycerol, mannitol, ethylene gly, DKA, lactic acidosis
Term
DDx is osmolar gap
Definition
Methanol, ethyl alcohol, isopropyl, glycerol, mannitol, ethylene gly, DKA, lactic acidosis
Term
Tx Methanol toxicity
Definition
Ethanol, HD, Leukovorin 50 mg IV q 4 hrs x 24
Term
When consider whole bowel irrigation
Definition
Lithium, iron, heavy metal, sustained release drugs, body stuffers/packers
Term
Toxic APAP metabol
Definition
• NAPQI • Metabolized by glutathione
Term
Young make with nystagmus & very bizarre, aggressive behavior
Definition
PCP tox
Term
Leading cause of toxin related deaths in USA
Definition
CarboxyHgb
Term
Which poisoning cause latent renal failure
Definition
CCl4, mercuric salts, APA, colchicine, ethylene glycol
Term
Toxic metabolite of isopropyl alcohol ingestion
Definition
Acetone - CNS depre, ↓BP, hemorrhagic gastritis
Term
Charcoal hemoperfusion
Definition
Theo, barbiturates
Term
2 MC sympathomimetics toxins
Definition
Cocaine, amphetamines
Term
Antidote for lead tox
Definition
EDTA, calcium disodium edelate
Term
S/E phenobarbital
Definition
Steven-Johnson Sx, mucocutaneous membrane bullae
Term
CNS complications of opioids
Definition
Traumatic mononeuritis - MC painful weakness; Sz, brain abscess, transverse muelitis
Term
Activated charcoal not useful in?
Definition
Lithium, alkalis, acids, heavy metals, iron
Term
What to avoid in organophosphate poisoning
Definition
Opioid (↓resp depre), physostigmine, succinyl (prolonged paralysis), sympathomimetics
Term
Poisoning assos. w/fever in children
Definition
Anticholinergics, ASA, amphetamines, LSD, phenothiazines, TCA
Term
Antidote for CO
Definition
O2 , hyperbaric
Term
Drugs that ↑ theo levels
Definition
Macrolide, cipro, cimetidine, alopurinol, propranolol, OCP's
Term
Chronic ASA ingestion
Definition
•Usually elderly •Altered MS • Met acidosis > resp alkalosis •non-cariogenic pulmonary edema
Term
Antidote for Fe
Definition
Deferoxamine 15 mg/kg/hr IV
Term
Drugs that ↑1/2 life of phenytoin
Definition
Cimetidine, phenothiazine, INH, disulfram, dicumarol, chloramphenicol
Term
HD in poisoned pt - indications
Definition
Ethylene glycol, EtOH, methanol, lithium w/CNS alteration, ASA if: >100 mg/dL, Sz, CNS changes, evere met acid
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