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Questions and Answers

What is the first priority in the treatment of a poisoned patient?

  • Symptomatic treatment
  • Decontamination
  • Clinical stabilization (correct)
  • Enhanced elimination

    • What are the primary objectives in the evaluation stage of suspected poisoning?

  • Administration of antidote
  • Establishment of IV access
  • Continuous ECG and pulse oximetry monitoring
  • Securing the airway and ensuring cardiopulmonary function (correct)

    • When should oxygen be administered to a poisoned patient?

  • When there is evidence of inadequate oxygenation (correct)
  • If the patient has altered mental status
  • Only if the patient is comatose
  • For all poisoned patients regardless of symptoms

    • What should be provided for a poisoned patient with altered mental status and low serum glucose?

    <p>$ ext{C}<em>6 ext{H}</em>{12} ext{O}_6$ (glucose)</p> Signup and view all the answers

    What measures pulse rate and the degree of oxygen saturation of hemoglobin?

    <p>Pulse oximetry</p> Signup and view all the answers

    What is necessary early steps for a poisoned patient who is delirious, stuporous, or comatose?

    <p>Securing the airway and ensuring cardiopulmonary function</p> Signup and view all the answers

    What must be considered for possible administration in patients with altered mental status?

    <p>Oxygen, glucose, thiamine, naloxone( and/or flumazenil)</p> Signup and view all the answers

    What is the typical dose ratio of activated charcoal to toxin?

    <p>10:1 charcoal to toxin ratio</p> Signup and view all the answers

    When is gastric lavage considered contraindicated?

    <p>Corrosive ingestion</p> Signup and view all the answers

    What is the purpose of whole bowel irrigation (WBI)?

    <p>To reduce transit time and limit toxin absorption</p> Signup and view all the answers

    What can alkaline urine enhance the elimination of?

    <p>Acids such as salicylates and phenobarbital</p> Signup and view all the answers

    What is the purpose of cathartics in poison ingestion treatment?

    <p>$To draw water into the gut by establishing an osmotic gradient$</p> Signup and view all the answers

    What is the specific lavage fluid used for iron poisoning?

    <p>Deferioxamine solution</p> Signup and view all the answers

    What is multiple dose activated charcoal (MDAC) useful for?

    <p>Overdose of theophylline, phenobarbital, quinine, dapsone, and carbamazepine.</p> Signup and view all the answers

    What are the contraindications for cathartics?

    <p>Intestinal obstruction and renal insufficiency</p> Signup and view all the answers

    What substances respond well to dialysis?

    <p>Lithium, methanol, and salicylates</p> Signup and view all the answers

    What is the purpose of hemoperfusion?

    <p>To pump blood through an external cartridge containing charcoal or adsorbent</p> Signup and view all the answers

    What is the basis for symptomatic treatment of poisoning?

    <p>Functional antagonism</p> Signup and view all the answers

    How are antidotes classified?

    <p>Chemical, receptor, dispositional, and functional classes</p> Signup and view all the answers

    What are examples of clinically useful antidotes?

    <p>N-acetylcysteine for acetaminophen and naloxone for opiates</p> Signup and view all the answers

    What are the factors affecting dialysis effectiveness?

    <p>Tissue binding, volume of distribution, and molecular weight</p> Signup and view all the answers

    What does dialysis involve?

    <p>Blood circulated through a semi-permeable membrane</p> Signup and view all the answers

    What are examples of diagnostic clues for poisoning?

    <p>Colored emesis, stool, urine, nails, and odors associated with specific toxins</p> Signup and view all the answers

    What is the recommended treatment for patients with suspected opiate use?

    <p>Naloxone</p> Signup and view all the answers

    Which substance may require phenobarbital or dialysis for treating its induced seizures?

    <p>Theophylline</p> Signup and view all the answers

    What do toxidromes aid in selecting?

    <p>Therapeutic steps</p> Signup and view all the answers

    Which toxidrome presents with tachycardia, delirium, and seizures?

    <p>Anticholinergic toxidrome</p> Signup and view all the answers

    What is the characteristic clinical sign of sympathomimetic toxidrome?

    <p>Hyperpyrexia</p> Signup and view all the answers

    What is the primary method used for decontamination to reduce toxin absorption?

    <p>Activated charcoal</p> Signup and view all the answers

    What is the typical dose ratio of activated charcoal to toxin?

    <p>1 gm/kg b.wt.</p> Signup and view all the answers

    When is whole bowel irrigation (WBI) valuable?

    <p>For sustained-release drugs, foreign bodies, and toxins removed by charcoal</p> Signup and view all the answers

    What is the purpose of acid or base load in poison ingestion treatment?

    <p>To change the urinary pH, affecting the charge status of substances in the blood</p> Signup and view all the answers

    What can alkaline urine enhance the elimination of?

    <p>Acids such as salicylates and phenobarbital</p> Signup and view all the answers

    What is the primary purpose of cathartics in poison ingestion treatment?

    <p>To draw water into the gut by establishing an osmotic gradient for intestinal evacuation</p> Signup and view all the answers

    What is ion trapping in poison ingestion treatment?

    <p>A technique to change the charge status of substances in the stomach</p> Signup and view all the answers

    When is gastric lavage contraindicated?

    <p>In patients experiencing seizures</p> Signup and view all the answers

    What is the primary method used for decontamination to reduce toxin absorption?

    <p>Activated charcoal administration</p> Signup and view all the answers

    What is the purpose of hemoperfusion in treating poisoning?

    <p>Removal of toxins by passing blood through an adsorbent cartridge</p> Signup and view all the answers

    When is gastric lavage considered contraindicated in cases of poisoning?

    <p>When the patient has ingested a corrosive substance</p> Signup and view all the answers

    What can alkaline urine enhance the elimination of in cases of poisoning?

    <p>Salicylates</p> Signup and view all the answers

    What are examples of substances responding well to dialysis in cases of poisoning?

    <p>$ ext{Li}$, methanol, and salicylates</p> Signup and view all the answers

    What is the characteristic clinical sign associated with sympathomimetic toxidrome?

    <p>Dilated pupils and diaphoresis</p> Signup and view all the answers

    What are examples of diagnostic clues for poisoning?

    <p>Colored emesis, stool, urine, nails, and odors associated with specific toxins</p> Signup and view all the answers

    What is the purpose of cathartics in poison ingestion treatment?

    <p>To enhance intestinal pressure and motility</p> Signup and view all the answers

    What is necessary early steps for a poisoned patient who is delirious, stuporous, or comatose?

    <p>Ensuring adequate ventilation and oxygenation</p> Signup and view all the answers

    What are the primary objectives of the evaluation stage in suspected poisoning?

    <p>Assessment of vital signs and the effectiveness of respiration and circulation</p> Signup and view all the answers

    What is the first priority in the treatment of a poisoned patient?

    <p>Clinical stabilization</p> Signup and view all the answers

    What is necessary early steps for a poisoned patient who is delirious, stuporous, or comatose?

    <p>Continuous ECG, pulse oximetry, and establishment of IV access</p> Signup and view all the answers

    What should be provided for any poisoned patient with altered mental status if the serum glucose is less than 80 mg/dL or if the glucose level is unknown due to delayed testing?

    <p>$Glucose$</p> Signup and view all the answers

    What must be considered for possible administration in patients with altered mental status?

    <p>$Oxygen$, $Glucose$, $Thiamine$, $Naloxone$, and/or $Flumazenil$</p> Signup and view all the answers

    When should oxygen be administered to a poisoned patient?

    <p>$To any patient with respiratory distress or altered mental status$</p> Signup and view all the answers

    What can alkaline urine enhance the elimination of?

    <p>$Acidic toxins$</p> Signup and view all the answers

    What is the characteristic clinical sign of cholinergic toxidrome?

    <p>Meiosis and tachycardia</p> Signup and view all the answers

    Which decontamination method should be avoided in patients with comatose or seizing conditions?

    <p>Induction of emesis</p> Signup and view all the answers

    Which substance may require phenobarbital or dialysis for treating its induced seizures?

    <p>Theophylline</p> Signup and view all the answers

    What is the primary characteristic of sympathomimetic toxidrome?

    <p>Tachycardia and hypertension</p> Signup and view all the answers

    What is the primary method used for decontamination to reduce toxin absorption?

    <p>Activated charcoal</p> Signup and view all the answers

    What are the clinical signs associated with anticholinergic toxidrome?

    <p>Tachycardia, delirium, and dilated pupils</p> Signup and view all the answers

    Which toxidrome includes hypotension and respiratory depression as primary characteristics?

    <p>Opiate toxidrome</p> Signup and view all the answers

    What is the first priority in the treatment of a poisoned patient?

    <p>Clinical stabilization</p> Signup and view all the answers

    What are the primary objectives in the evaluation stage of suspected poisoning?

    <p>Assessment of vital signs and cardiopulmonary function</p> Signup and view all the answers

    What is necessary early steps for a poisoned patient who is delirious, stuporous, or comatose?

    <p>Continuous ECG monitoring</p> Signup and view all the answers

    When should oxygen be administered to a poisoned patient?

    <p>When there is evidence of inadequate oxygenation</p> Signup and view all the answers

    What should be provided for any poisoned patient with altered mental status if the serum glucose is less than 80 mg/dL or if the glucose level is unknown due to delayed testing?

    <p>Glucose</p> Signup and view all the answers

    What measures pulse rate and the degree of oxygen saturation of hemoglobin?

    <p>Pulse oximetry</p> Signup and view all the answers

    What is considered for possible administration in patients with altered mental status?

    <p>Oxygen and glucose</p> Signup and view all the answers

    What is the primary purpose of hemoperfusion in poisoning treatment?

    <p>To remove toxins from the blood using an external cartridge containing charcoal or adsorbent</p> Signup and view all the answers

    What are examples of substances responding well to dialysis in poisoning cases?

    <p>Lithium, methanol, and salicylates</p> Signup and view all the answers

    What are the contraindications for cathartics in poisoning treatment?

    <p>Intestinal obstruction and renal insufficiency</p> Signup and view all the answers

    What is the primary classification of antidotes based on?

    <p>Chemical, receptor, dispositional, and functional classes</p> Signup and view all the answers

    What are examples of diagnostic clues for poisoning?

    <p>$Colored$ $emesis$, $stool$, $urine$, $nails$, and odors associated with specific toxins</p> Signup and view all the answers

    What factors affect dialysis effectiveness in poisoning treatment?

    <p>$Tissue$ $binding$, $volume$ of distribution, and molecular weight</p> Signup and view all the answers

    What is the primary purpose of symptomatic treatment for poisoning?

    <p>Based on functional antagonism</p> Signup and view all the answers

    What is the primary purpose of antidotes in poisoning treatment?

    <p>Specific medicinal interventions effective for particular toxins</p> Signup and view all the answers

    What are the adverse effects of cathartics in poisoning treatment?

    <p>Dehydration and electrolyte disturbances</p> Signup and view all the answers

    Which method involves flushing the entire GI tract with polyethylene glycol and an added electrolyte lavage solution?

    <p>Whole bowel irrigation (WBI)</p> Signup and view all the answers

    What is the primary purpose of activated charcoal in poison ingestion treatment?

    <p>To prevent toxin absorption into the bloodstream</p> Signup and view all the answers

    What can alkaline urine enhance the elimination of in cases of poisoning?

    <p>Acids such as salicylates</p> Signup and view all the answers

    What is the typical dose ratio of activated charcoal to toxin in poison ingestion treatment?

    <p>$10:1$</p> Signup and view all the answers

    What is the purpose of acid or base load in poison ingestion treatment?

    <p>To change the urinary pH affecting charge status of substances in blood</p> Signup and view all the answers

    What are cathartics primarily used for in poison ingestion treatment?

    <p>To draw water into the gut for intestinal evacuation</p> Signup and view all the answers

    When is multiple dose activated charcoal (MDAC) useful in poison ingestion treatment?

    <p>For sustained-release drugs and foreign bodies not removed by charcoal</p> Signup and view all the answers

    Which toxidrome presents with hypotension, respiratory depression, and meiosis as primary characteristics?

    <p>Opiate toxidrome</p> Signup and view all the answers

    What is the recommended treatment for patients with suspected opiate use?

    <p>Naloxone</p> Signup and view all the answers

    What is the characteristic clinical sign associated with anticholinergic toxidrome?

    <p>Tachycardia</p> Signup and view all the answers

    Which decontamination method can remove around 30% of a toxic substance load within 1 hour of ingestion?

    <p>Emesis induced with syrup of ipecac</p> Signup and view all the answers

    What are the primary characteristics of sedative-hypnotic toxidrome?

    <p>Sedation and coma</p> Signup and view all the answers

    Which substance may require phenobarbital or dialysis for treating its induced seizures?

    <p>Theophylline</p> Signup and view all the answers

    Adverse effects of cathartics are dehydration and electrolyte disturbances

    <p>True</p> Signup and view all the answers

    Dialysis involves blood circulated through a semi-permeable membrane

    <p>True</p> Signup and view all the answers

    Antidotes are specific medicinal interventions effective for all toxins

    <p>False</p> Signup and view all the answers

    Hemoperfusion involves blood pumped through an external cartridge containing charcoal or adsorbent

    <p>True</p> Signup and view all the answers

    Examples of substances responding well to dialysis are lithium, methanol, and salicylates

    <p>True</p> Signup and view all the answers

    Symptomatic treatment for poisoning is based on functional antagonism

    <p>True</p> Signup and view all the answers

    Antidotes can be classified into chemical, receptor, dispositional, and functional classes

    <p>True</p> Signup and view all the answers

    Diagnostic clues for poisoning include colored emesis, stool, urine, nails, and odors associated with specific toxins

    <p>True</p> Signup and view all the answers

    Increased water retention leads to decreased intestinal pressure and motility

    <p>False</p> Signup and view all the answers

    Factors affecting dialysis effectiveness include tissue binding, volume of distribution, and molecular weight

    <p>True</p> Signup and view all the answers

    Study Notes

    Toxicology and Overdose Management

    • Naloxone is recommended for patients with suspected opiate use, while thiamine should be given to malnourished patients receiving glucose.
    • Benzodiazepines are effective in treating seizures caused by overdose, except for theophylline-induced seizures, which may require phenobarbital or dialysis, and isoniazid overdose, which is usually treated with pyridoxine.
    • Medical history in poisoned patients aims to determine the substance, mode, state, quantity, and time of exposure to estimate the patient's mortality risk.
    • Physical examination in poisoned patients should focus on respiratory, pulse, blood pressure, CNS, GI, cardiac, and skin abnormalities. Toxic syndromes categorize these parameters and aid in selecting therapeutic steps.
    • Toxidromes are clinical signs and symptoms associated with exposure to certain toxicologic classes of chemicals. They can help with selecting therapy and initiating treatment faster, but may not be accurate in cases of multiple drug use or delayed presentation.
    • Anticholinergic toxidrome includes tachycardia, delirium, dry skin, urinary retention, seizures, dilated pupils, decreased bowel sounds, coma, raised body temperature, and agitation.
    • Sympathomimetic toxidrome presents with delusions, hyperpyrexia, diaphoresis, hypertension, tachycardia, mydriasis, and seizures, and is caused by substances like cocaine and amphetamine.
    • Opiate toxidrome includes hypotension, respiratory depression, bradycardia, hypothermia, altered mental status, meiosis, and decreased bowel sounds, and is caused by substances like morphine and heroin.
    • Cholinergic toxidrome presents with confusion, agitation, tremors, CNS depression, delirium, coma, seizures, meiosis, tachycardia, and hypertension, and is caused by substances like organophosphate insecticides and carbamate insecticides.
    • Sedative-hypnotic toxidrome is characterized by sedation, delirium, loss of CNS function, confusion, coma, and apnea, and is caused by substances like barbiturates and benzodiazepines.
    • Decontamination methods include induction of emesis, lavage, activated charcoal, and whole bowel irrigation to reduce toxin absorption.
    • Emesis induced with syrup of ipecac can remove around 30% of a toxic substance load within 1 hour of ingestion, but should not be given in certain cases, such as with hydrocarbons, corrosives, or in patients with cardiac disease, comatose patients, or those experiencing seizures.

    Poison Ingestion Treatment Methods

    • Gastric lavage is a method of rinsing the stomach with water or saline solution via a tube inserted through the mouth or nose, and it is effective within 1 hour of ingestion of poison.
    • Contraindications for gastric lavage include corrosive ingestion, hydrocarbons, comatose patients, patients experiencing seizures, and those with hemorrhage in the esophagus or stomach.
    • Specific lavage fluids include thiosulfate solution for CN, calcium gluconate solution for oxalic acid, and deferioxamine solution for iron.
    • Activated charcoal is used as an adsorbent to prevent toxin absorption into the bloodstream, with a typical dose of 10:1 charcoal to toxin ratio or 1 gm/kg b.wt.
    • Multiple dose activated charcoal (MDAC) is useful for overdose of theophylline, phenobarbital, quinine, dapsone, and carbamazepine.
    • Whole bowel irrigation (WBI) involves flushing the entire GI tract with polyethylene glycol (PEG) and an added electrolyte lavage solution (ELS) to reduce transit time and limit toxin absorption.
    • WBI is valuable for sustained-release drugs, foreign bodies, and toxins not removed by charcoal, and it must be employed soon after toxin exposure.
    • Acid or base load can change the urinary pH, affecting the charge status of substances in the blood, a technique known as ion trapping.
    • Alkaline urine enhances the elimination of acids such as salicylates, phenobarbital, chlorpropamide, and others, while acidic urine can speed up the excretion of basic drugs like tricyclic antidepressants or phencyclidine.
    • Cathartics, including laxatives and rapid watery evacuation promoters, can draw water into the gut by establishing an osmotic gradient, and are used for intestinal evacuation.
    • Saline cathartics such as magnesium citrate and magnesium sulfate and sorbitol are usually employed for this purpose.
    • Each method has specific indications, contraindications, and mechanisms, and should be used according to the specific characteristics of the poisoning and the patient's condition.

    Toxicology and Overdose Management

    • Naloxone is recommended for patients with suspected opiate use, while thiamine should be given to malnourished patients receiving glucose.
    • Benzodiazepines are effective in treating seizures caused by overdose, except for theophylline-induced seizures, which may require phenobarbital or dialysis, and isoniazid overdose, which is usually treated with pyridoxine.
    • Medical history in poisoned patients aims to determine the substance, mode, state, quantity, and time of exposure to estimate the patient's mortality risk.
    • Physical examination in poisoned patients should focus on respiratory, pulse, blood pressure, CNS, GI, cardiac, and skin abnormalities. Toxic syndromes categorize these parameters and aid in selecting therapeutic steps.
    • Toxidromes are clinical signs and symptoms associated with exposure to certain toxicologic classes of chemicals. They can help with selecting therapy and initiating treatment faster, but may not be accurate in cases of multiple drug use or delayed presentation.
    • Anticholinergic toxidrome includes tachycardia, delirium, dry skin, urinary retention, seizures, dilated pupils, decreased bowel sounds, coma, raised body temperature, and agitation.
    • Sympathomimetic toxidrome presents with delusions, hyperpyrexia, diaphoresis, hypertension, tachycardia, mydriasis, and seizures, and is caused by substances like cocaine and amphetamine.
    • Opiate toxidrome includes hypotension, respiratory depression, bradycardia, hypothermia, altered mental status, meiosis, and decreased bowel sounds, and is caused by substances like morphine and heroin.
    • Cholinergic toxidrome presents with confusion, agitation, tremors, CNS depression, delirium, coma, seizures, meiosis, tachycardia, and hypertension, and is caused by substances like organophosphate insecticides and carbamate insecticides.
    • Sedative-hypnotic toxidrome is characterized by sedation, delirium, loss of CNS function, confusion, coma, and apnea, and is caused by substances like barbiturates and benzodiazepines.
    • Decontamination methods include induction of emesis, lavage, activated charcoal, and whole bowel irrigation to reduce toxin absorption.
    • Emesis induced with syrup of ipecac can remove around 30% of a toxic substance load within 1 hour of ingestion, but should not be given in certain cases, such as with hydrocarbons, corrosives, or in patients with cardiac disease, comatose patients, or those experiencing seizures.

    Toxicology and Overdose Management

    • Naloxone is recommended for patients with suspected opiate use, while thiamine should be given to malnourished patients receiving glucose.
    • Benzodiazepines are effective in treating seizures caused by overdose, except for theophylline-induced seizures, which may require phenobarbital or dialysis, and isoniazid overdose, which is usually treated with pyridoxine.
    • Medical history in poisoned patients aims to determine the substance, mode, state, quantity, and time of exposure to estimate the patient's mortality risk.
    • Physical examination in poisoned patients should focus on respiratory, pulse, blood pressure, CNS, GI, cardiac, and skin abnormalities. Toxic syndromes categorize these parameters and aid in selecting therapeutic steps.
    • Toxidromes are clinical signs and symptoms associated with exposure to certain toxicologic classes of chemicals. They can help with selecting therapy and initiating treatment faster, but may not be accurate in cases of multiple drug use or delayed presentation.
    • Anticholinergic toxidrome includes tachycardia, delirium, dry skin, urinary retention, seizures, dilated pupils, decreased bowel sounds, coma, raised body temperature, and agitation.
    • Sympathomimetic toxidrome presents with delusions, hyperpyrexia, diaphoresis, hypertension, tachycardia, mydriasis, and seizures, and is caused by substances like cocaine and amphetamine.
    • Opiate toxidrome includes hypotension, respiratory depression, bradycardia, hypothermia, altered mental status, meiosis, and decreased bowel sounds, and is caused by substances like morphine and heroin.
    • Cholinergic toxidrome presents with confusion, agitation, tremors, CNS depression, delirium, coma, seizures, meiosis, tachycardia, and hypertension, and is caused by substances like organophosphate insecticides and carbamate insecticides.
    • Sedative-hypnotic toxidrome is characterized by sedation, delirium, loss of CNS function, confusion, coma, and apnea, and is caused by substances like barbiturates and benzodiazepines.
    • Decontamination methods include induction of emesis, lavage, activated charcoal, and whole bowel irrigation to reduce toxin absorption.
    • Emesis induced with syrup of ipecac can remove around 30% of a toxic substance load within 1 hour of ingestion, but should not be given in certain cases, such as with hydrocarbons, corrosives, or in patients with cardiac disease, comatose patients, or those experiencing seizures.

    Toxicology and Antidotes Overview

    • Increased water retention leads to increased intestinal pressure and motility
    • Adverse effects of cathartics are dehydration and electrolyte disturbances
    • Contraindications for cathartics include intestinal obstruction and renal insufficiency
    • Dialysis involves blood circulated through a semi-permeable membrane
    • Factors affecting dialysis effectiveness include tissue binding, volume of distribution, and molecular weight
    • Examples of substances responding well to dialysis are lithium, methanol, and salicylates
    • Hemoperfusion involves blood pumped through an external cartridge containing charcoal or adsorbent
    • Symptomatic treatment for poisoning is based on functional antagonism
    • Antidotes are specific medicinal interventions effective for particular toxins
    • Antidotes can be classified into chemical, receptor, dispositional, and functional classes
    • Examples of clinically useful antidotes include N-acetylcysteine for acetaminophen and naloxone for opiates
    • Diagnostic clues for poisoning include colored emesis, stool, urine, nails, and odors associated with specific toxins

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