98 Questions
What is the first priority in the treatment of a poisoned patient?
Clinical stabilization
What are the primary objectives in the evaluation stage of suspected poisoning?
Securing the airway and ensuring cardiopulmonary function
When should oxygen be administered to a poisoned patient?
When there is evidence of inadequate oxygenation
What should be provided for a poisoned patient with altered mental status and low serum glucose?
$ ext{C}6 ext{H}{12} ext{O}_6$ (glucose)
What measures pulse rate and the degree of oxygen saturation of hemoglobin?
Pulse oximetry
What is necessary early steps for a poisoned patient who is delirious, stuporous, or comatose?
Securing the airway and ensuring cardiopulmonary function
What must be considered for possible administration in patients with altered mental status?
Oxygen, glucose, thiamine, naloxone( and/or flumazenil)
What is the typical dose ratio of activated charcoal to toxin?
10:1 charcoal to toxin ratio
When is gastric lavage considered contraindicated?
Corrosive ingestion
What is the purpose of whole bowel irrigation (WBI)?
To reduce transit time and limit toxin absorption
What can alkaline urine enhance the elimination of?
Acids such as salicylates and phenobarbital
What is the purpose of cathartics in poison ingestion treatment?
$To draw water into the gut by establishing an osmotic gradient$
What is the specific lavage fluid used for iron poisoning?
Deferioxamine solution
What is multiple dose activated charcoal (MDAC) useful for?
Overdose of theophylline, phenobarbital, quinine, dapsone, and carbamazepine.
What are the contraindications for cathartics?
Intestinal obstruction and renal insufficiency
What substances respond well to dialysis?
Lithium, methanol, and salicylates
What is the purpose of hemoperfusion?
To pump blood through an external cartridge containing charcoal or adsorbent
What is the basis for symptomatic treatment of poisoning?
Functional antagonism
How are antidotes classified?
Chemical, receptor, dispositional, and functional classes
What are examples of clinically useful antidotes?
N-acetylcysteine for acetaminophen and naloxone for opiates
What are the factors affecting dialysis effectiveness?
Tissue binding, volume of distribution, and molecular weight
What does dialysis involve?
Blood circulated through a semi-permeable membrane
What are examples of diagnostic clues for poisoning?
Colored emesis, stool, urine, nails, and odors associated with specific toxins
What is the recommended treatment for patients with suspected opiate use?
Naloxone
Which substance may require phenobarbital or dialysis for treating its induced seizures?
Theophylline
What do toxidromes aid in selecting?
Therapeutic steps
Which toxidrome presents with tachycardia, delirium, and seizures?
Anticholinergic toxidrome
What is the characteristic clinical sign of sympathomimetic toxidrome?
Hyperpyrexia
What is the primary method used for decontamination to reduce toxin absorption?
Activated charcoal
What is the typical dose ratio of activated charcoal to toxin?
1 gm/kg b.wt.
When is whole bowel irrigation (WBI) valuable?
For sustained-release drugs, foreign bodies, and toxins removed by charcoal
What is the purpose of acid or base load in poison ingestion treatment?
To change the urinary pH, affecting the charge status of substances in the blood
What can alkaline urine enhance the elimination of?
Acids such as salicylates and phenobarbital
What is the primary purpose of cathartics in poison ingestion treatment?
To draw water into the gut by establishing an osmotic gradient for intestinal evacuation
What is ion trapping in poison ingestion treatment?
A technique to change the charge status of substances in the stomach
When is gastric lavage contraindicated?
In patients experiencing seizures
What is the primary method used for decontamination to reduce toxin absorption?
Activated charcoal administration
What is the purpose of hemoperfusion in treating poisoning?
Removal of toxins by passing blood through an adsorbent cartridge
When is gastric lavage considered contraindicated in cases of poisoning?
When the patient has ingested a corrosive substance
What can alkaline urine enhance the elimination of in cases of poisoning?
Salicylates
What are examples of substances responding well to dialysis in cases of poisoning?
$ ext{Li}$, methanol, and salicylates
What is the characteristic clinical sign associated with sympathomimetic toxidrome?
Dilated pupils and diaphoresis
What are examples of diagnostic clues for poisoning?
Colored emesis, stool, urine, nails, and odors associated with specific toxins
What is the purpose of cathartics in poison ingestion treatment?
To enhance intestinal pressure and motility
What is necessary early steps for a poisoned patient who is delirious, stuporous, or comatose?
Ensuring adequate ventilation and oxygenation
What are the primary objectives of the evaluation stage in suspected poisoning?
Assessment of vital signs and the effectiveness of respiration and circulation
What is the first priority in the treatment of a poisoned patient?
Clinical stabilization
What is necessary early steps for a poisoned patient who is delirious, stuporous, or comatose?
Continuous ECG, pulse oximetry, and establishment of IV access
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?
$Glucose$
What must be considered for possible administration in patients with altered mental status?
$Oxygen$, $Glucose$, $Thiamine$, $Naloxone$, and/or $Flumazenil$
When should oxygen be administered to a poisoned patient?
$To any patient with respiratory distress or altered mental status$
What can alkaline urine enhance the elimination of?
$Acidic toxins$
What is the characteristic clinical sign of cholinergic toxidrome?
Meiosis and tachycardia
Which decontamination method should be avoided in patients with comatose or seizing conditions?
Induction of emesis
Which substance may require phenobarbital or dialysis for treating its induced seizures?
Theophylline
What is the primary characteristic of sympathomimetic toxidrome?
Tachycardia and hypertension
What is the primary method used for decontamination to reduce toxin absorption?
Activated charcoal
What are the clinical signs associated with anticholinergic toxidrome?
Tachycardia, delirium, and dilated pupils
Which toxidrome includes hypotension and respiratory depression as primary characteristics?
Opiate toxidrome
What is the first priority in the treatment of a poisoned patient?
Clinical stabilization
What are the primary objectives in the evaluation stage of suspected poisoning?
Assessment of vital signs and cardiopulmonary function
What is necessary early steps for a poisoned patient who is delirious, stuporous, or comatose?
Continuous ECG monitoring
When should oxygen be administered to a poisoned patient?
When there is evidence of inadequate oxygenation
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?
Glucose
What measures pulse rate and the degree of oxygen saturation of hemoglobin?
Pulse oximetry
What is considered for possible administration in patients with altered mental status?
Oxygen and glucose
What is the primary purpose of hemoperfusion in poisoning treatment?
To remove toxins from the blood using an external cartridge containing charcoal or adsorbent
What are examples of substances responding well to dialysis in poisoning cases?
Lithium, methanol, and salicylates
What are the contraindications for cathartics in poisoning treatment?
Intestinal obstruction and renal insufficiency
What is the primary classification of antidotes based on?
Chemical, receptor, dispositional, and functional classes
What are examples of diagnostic clues for poisoning?
$Colored$ $emesis$, $stool$, $urine$, $nails$, and odors associated with specific toxins
What factors affect dialysis effectiveness in poisoning treatment?
$Tissue$ $binding$, $volume$ of distribution, and molecular weight
What is the primary purpose of symptomatic treatment for poisoning?
Based on functional antagonism
What is the primary purpose of antidotes in poisoning treatment?
Specific medicinal interventions effective for particular toxins
What are the adverse effects of cathartics in poisoning treatment?
Dehydration and electrolyte disturbances
Which method involves flushing the entire GI tract with polyethylene glycol and an added electrolyte lavage solution?
Whole bowel irrigation (WBI)
What is the primary purpose of activated charcoal in poison ingestion treatment?
To prevent toxin absorption into the bloodstream
What can alkaline urine enhance the elimination of in cases of poisoning?
Acids such as salicylates
What is the typical dose ratio of activated charcoal to toxin in poison ingestion treatment?
$10:1$
What is the purpose of acid or base load in poison ingestion treatment?
To change the urinary pH affecting charge status of substances in blood
What are cathartics primarily used for in poison ingestion treatment?
To draw water into the gut for intestinal evacuation
When is multiple dose activated charcoal (MDAC) useful in poison ingestion treatment?
For sustained-release drugs and foreign bodies not removed by charcoal
Which toxidrome presents with hypotension, respiratory depression, and meiosis as primary characteristics?
Opiate toxidrome
What is the recommended treatment for patients with suspected opiate use?
Naloxone
What is the characteristic clinical sign associated with anticholinergic toxidrome?
Tachycardia
Which decontamination method can remove around 30% of a toxic substance load within 1 hour of ingestion?
Emesis induced with syrup of ipecac
What are the primary characteristics of sedative-hypnotic toxidrome?
Sedation and coma
Which substance may require phenobarbital or dialysis for treating its induced seizures?
Theophylline
Adverse effects of cathartics are dehydration and electrolyte disturbances
True
Dialysis involves blood circulated through a semi-permeable membrane
True
Antidotes are specific medicinal interventions effective for all toxins
False
Hemoperfusion involves blood pumped through an external cartridge containing charcoal or adsorbent
True
Examples of substances responding well to dialysis are lithium, methanol, and salicylates
True
Symptomatic treatment for poisoning is based on functional antagonism
True
Antidotes can be classified into chemical, receptor, dispositional, and functional classes
True
Diagnostic clues for poisoning include colored emesis, stool, urine, nails, and odors associated with specific toxins
True
Increased water retention leads to decreased intestinal pressure and motility
False
Factors affecting dialysis effectiveness include tissue binding, volume of distribution, and molecular weight
True
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
Test your knowledge on the use of gastric lavage in advanced pregnancy and foreign material ingestion cases. Learn about the challenges and indications of this medical procedure.
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