Flashcards
Toxicology
Flashcards do conjunto (25)
- 1Principles of management- Triage
- Initial stabilisation
- Directed history and examination
- assessment of toxidromes
ongoing care and specific treatments, decontamination or antidotes - 2General managementHistory - agent and does
Risk assessment
Time since ingestion
Patient factors, intention vs unintentional
supportive care monitoring - 3InvestigationsBSL, ECG, urine, liver and renal function, radiology
- 4General managementdecontamination, antidotes, disposition
- 5Decontamination- reduce rate of absorption
- bind and remove before it is fully absorbed
e.g. activated charcoal - 6Activated charcoalreversibly 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 - 7Decontamination - whole bowel lavageFor life threatening ingestions of sustained release of preparations
-Polyethylene glycol solution
- Until rectal effulent is clear - 8Whole bowel lavage1:1 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 - 9Enhanced elimination- increase rate of elimination
- methods include:
- urinary alkanisation
- haemodialysis
- haemoperfusion - 10Admit for crit care unit for- ventilation, advanced supports, resuscitation, extracorporeal elimination, multiorgan support, continous monitoring
- 11Useful emergency antidotesparacetemol - Nacetyl
Tricylics - sodium bicarbonate
Digoxin - phenytoin
methanol - ethanol
Beta blockers - glucagon
opiotes - naloxone
benzos - flumazenil - 12Toxidromegroup 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 - 13SympathomimeticExcessive sympathetic stimulation
- excessive alpha and beta stimulation
substances include - amphetamine, cocaine, ectasy, caffiene
management - airway. fluids. betablockers. temp - 14Anticholinergic toxidromeantagonise ach
block muscarinic receptors
substances - tricylics, atropine, anticonvulsants
managements - cardiac arrhytmias - prolonged QTs, airway oxygen, iv fluids, benzos for agitation ad seizure management - 15Cholinergic toxidromeaccumulation of excessive levels of ACH
inhibit cholinestarase
substances - pesticides, mushrooms
managements - decontamination, PPE. seizure managements, intubation, ventilation, atropine, iv fluids - 16Opioid toxidromeopiate induced
bind to opioid receptors
CNS depression to coma, hypotension
duration dependent on half life
- naloxone, oxygen, nerve compression injury - 17seative hypotic toxidromedefined by CNS GABA receptors
manifests as a spectrum of mental status changes
substances - benzodiazepines
management - primary survey, charcoal - 18Non - toxidrome substancescarbon monoxide, paracetemol, antidepressants, ethanol/toxic alcohols
- 19Carbon monoxide poisioning200 times affinity with hb than 02 forms carboxyhb
crosses alveolar cap membrane
binds to hamoprotein - 20Carbon monoxideconfirmed with COHB measurement
- ABG may demonstrate acidosis
- cardiac monitor - 21Paracetemolrapidly 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 - 22N- Acetylcysteinemaintain or replenish glutathione in liver
enhance non-toxic metabolism or paracetamol
protect liver cells
administer within 8-10 hours - 23NACadverse reactions
allergic type
dose dependent - 24SSRIReplace 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 - 25Ethanol/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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- O usuário eliminou as informações de disciplina FlashCards sobre Toxicology, criado por Usuário eliminado em 29-08-2018.
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- Usuário eliminado · ago 2018
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- 29 ago 2018
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- Criado por Elizabeth Then · 29 ago 2018
- Copiado por Elizabeth Then · 29 ago 2018
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