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basic EM tox

Terms in this set (55)

Acetaminophen reversal
NAC
Benzodiazepine reversal
Flumazenil
why should we be careful to reverse a benzo "OD"?
isolated OD is rarely fatal (patient keeps breathing), but withdrawal precipitated by Flumazenil can be fatal
Opiate reversal
Naloxone (Narcan)
TCA reversal
Bicarb
why do we not reverse TCA with Physostigmine like the other anticholinergics?
physostigmine can precipitate seizure, so bicarb is safer
Beta blocker reversal
Glucagon
Cholinergic (organophosphate) reversal
Pralidoxine (2-pam)
Anticholinergic (atropine, antihistamines, anti-parkinsonians, anti-spasmodics) reversal
Physostigmine
Carbon monoxide reversal
Oxygen
does carbon monoxide poisoning have cyanosis??
NO
can you diagnose carbon monoxide with pulse ox?
NO!!! need ABG
Cyanide reversal
Hydroxycobalamin (Cyanokit), followed by Nitrites, Sodium Thiosulfate
does cyanide poisoning have cyanosis??
NO
which HTN medication can break down and cause cyanide poisoning?
sodium nitroprusside
Iron reversal
Desfuroximine
Pb, Hg, Ag, Au, Zn reversal
Penicillamine
Insulin reversal
Dextrose
Methemoglobinemia reversal
Methylene blue
what meds can cause methemoglobinemia?
UTI meds, anesthetics
does methemoglobinemia poisoning have cyanosis??
YES!!!!
how do we diagnose methemoglobinemia?
ABG
what is the KEY FEATURE of methemoglobinemia?
persistent hypoxemia (80-85%)
Heparin reversal
Protamine
Coumadin reversal
Vitamin K, FFP
lead toxicity treatment
chelation
Sympathomimetic (cocaine, amphetamine) reversal
bicarb
hallucinogens treatment
benzos
what causes serotonin syndrome?
overlapping antidepressants (SSRIs, SNRIs, MAOIs, etc.)
serotonin syndrome triad?
MAN
1. mental status changes
2. autonomic dysfunction
3. neuromuscular dysfunction
serotonin syndrome treatment
benzos
what causes neuroleptic malignant syndrome?
reaction to anti-psychotics
what are the main differences between NMS and serotonin syndrome?
NMS = "lead-pipe rigidity", bradyreflexia
Neuroleptic malignant syndrome (NMS) treatment
dantrolene + beznos
lithium reversal
aggressive IVF, hemodialysis
ASA/salicylate overdose
bicarb, early hemodialysis,
what is the number for poison control?
1-800-222-1222
what is better: blood tox or urine tox? why?
blood tox!! = active concentration of drug, while urine tox = qualitative measures of metabolites suggesting recent use
miosis (pinpoint pupil), hyperactive BS? reversal?
Cholinergics

Pralidoxine
miosis (pinpoint pupils), hypoactive BS? reversal?
Opioids

Naloxone (Narcan)
normal/mydriasis (dilated pupils), high temp, hyperactive BS? reversal?
Sympathomimetics (act like epi/norepi)

Bicarb
normal/mydriasis (dilated pupils), high temp, hypoactive BS? reversal?
Anti-cholinergics

Physostigmine
normal/mydriasis (dilated pupils), low temp, hyperactive BS? reversal?
Hallucinogenics

Benzos
normal/mydriasis (dilated pupils), low temp, hypoactive BS?
Sedatives

Hypnotics
beta blocker toxicity S&S? lab findings? treatment?
Bradycardia + hypotension + AMS

Hypoglycemia + hyperkalemia

Glucagon
calcium channel blocker toxicity S&S? lab findings? treatment?
Bradycardia + preserved AMS

hyperglycemia (THE HALLMARK) + hyperkalemia

HIET (hyperinsulinism euglycemia therapy), atropine + IVF to improve hemodynamics
which is more life-threatening: BB overdose or CCB overdose
CCB
digoxin toxicity S&S? treatment?
EKG changes, paroxysmal atrial tachycardia is most common

Digoxin-specific Fab (Digibind)
what electrolyte abnormality should we look out for w/ digoxin toxicity?
hyperkalemia
what are you considering w/ GI complaints?
iron tox
what are you considering w/ AMS/neuro complaints?
lead tox
ethanol toxicity
the typical drunk
PURE acute alcohol withdrawal (AAWD) treatment
phenobarbital
acute alcohol withdrawal (AAWD) treatment when mixed with something else
benzos
methanol (paint thinner) toxicity
the blind drunk (methanol -> formaldehyde -> blindess)
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