Toxicology Principles and Management

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Questions and Answers

What is the primary focus of resuscitation management in poisoned patients?

Assessment of lifestyle choices

Psychological support services

Long-term rehabilitation strategies

Emergency management protocols (correct)

Which of the following techniques is used for airway management in case of neck injury?

Jaw thrust technique (correct)

Head-tilt or chin-lift technique

Endotracheal intubation

Finger sweep method

Which sign is NOT indicative of airway obstruction?

Dyspnea

Tachypnea

Bradycardia (correct)

Cyanosis

What technique should be avoided in cases of neck injury during airway management?

Head-tilt or chin-lift technique Signup and view all the answers

What does the acronym ABCD stand for in the context of resuscitation management?

Airway, Breathing, Circulation, Dextrose Signup and view all the answers

What is the purpose of supplemental oxygen during breathing assessment?

To provide additional support for abnormal breathing Signup and view all the answers

What is one of the key signs that indicate the need for airway management?

Hoarseness Signup and view all the answers

Which principle is NOT included in the management of toxicity?

Long-term therapy Signup and view all the answers

What is a contraindication for decontamination?

Bowel obstruction Signup and view all the answers

When can charcoal be administered after poison ingestion in cases of anticholinergic poisoning?

6 to 8 hours later Signup and view all the answers

Which of the following substances should not be given with charcoal within 30 minutes?

Ipecac syrup Signup and view all the answers

What role does a cathartic serve when administered with activated charcoal?

Aids in the excretion of charcoal toxin complex Signup and view all the answers

What is the primary use of polyethylene glycol electrolyte solution in decontamination?

To clean the entire bowel Signup and view all the answers

What is a common clinical feature of sympathomimetic toxidrome?

Tachycardia Signup and view all the answers

Which of the following would be an expected finding in organophosphate poisoning?

Abdominal colic Signup and view all the answers

What type of pupils is associated with cocaine poisoning?

Dilated pupils Signup and view all the answers

In which scenario would family members be consulted for a patient history?

When the patient is unconscious or unable to communicate Signup and view all the answers

What characterizes cholinergic toxidrome?

Diarrhea and miosis Signup and view all the answers

Which symptom is not typically associated with sympathomimetic toxidrome?

Bradycardia Signup and view all the answers

What does the presence of needle marks indicate in a clinical assessment?

Drug abuse or addiction Signup and view all the answers

Which vital sign may indicate intoxication in a suspected poisoning case?

Variations in pulse rate Signup and view all the answers

What are the primary symptoms of opioid toxidrome?

Miosis, CNS depression, and hypoventilation Signup and view all the answers

Which laboratory test measures the difference between anions and cations in the blood?

Anion gap Signup and view all the answers

What is a common outcome when performing a laboratory investigation on a victim of toxic exposure?

Identification of the toxic agent and assessment of organ functions Signup and view all the answers

What is the normal value range for the anion gap in mEq/L?

8 to 16 Signup and view all the answers

In cases of skin exposure to corrosive substances, which of the following steps is not recommended?

Transfer the patient to a toxic environment Signup and view all the answers

Which of the following methods can be used to prevent or delay the absorption of a toxic agent?

Decontamination procedures Signup and view all the answers

What is the appropriate action to take when a corrosive agent has come into contact with the eyes?

Irrigate the eyes with normal saline for at least 15 minutes Signup and view all the answers

Which biological fluid is frequently used for laboratory investigations in cases of toxicity?

Blood or urine Signup and view all the answers

What is the primary action of Ipecac syrup in forced emesis?

It induces vomiting through nerve activation. Signup and view all the answers

In which situation is forced emesis contraindicated?

Patients with severe cardiovascular disease. Signup and view all the answers

What is the maximum dose of Ipecac syrup for a child aged 5-12 years?

20 ml Signup and view all the answers

Which of the following is a disadvantage of gastric lavage?

It poses a risk of esophageal rupture. Signup and view all the answers

Activated charcoal primarily functions by which mechanism?

Adsorbing toxins to its surface. Signup and view all the answers

When is gastric lavage considered the best option?

When emesis is contraindicated or ineffective. Signup and view all the answers

Which of the following substances is contraindicated for gastric lavage?

Corrosive agents Signup and view all the answers

What is the expected time frame for emesis to occur after administering Apomorphine?

Within 1-3 minutes Signup and view all the answers

Study Notes

Toxicology Introduction

The study of toxicology focuses on the effects of poisonous substances on living organisms.

Principles of Toxicity Management

Management of toxicity involves seven key areas:

Resuscitation (emergency management)

Clinical evaluation

Laboratory investigation

Decontamination of toxins

Enhancing elimination of toxins

Administration of specific antidotes

Supportive treatment

Resuscitation (Emergency Management)

Resuscitation of poisoned patients follows the ABCD protocol:

Airway management (avoiding obstruction and hypoxia)

Finger sweep (remove dentures, saliva, etc.)

Optimize airway position (head-tilt/chin-lift or jaw thrust) - avoiding neck injuries

Head down, left sided position (for secretions to drain).

Endotracheal intubation (nasotracheal or orotracheal)

Surgical airway management (laryngostomy and tracheostomy)

Potential causes: flaccid tongue, pulmonary aspiration of gastric contents, respiratory arrest

Signs/symptoms: dyspnea, air hunger, hoarseness, cyanosis, sweating, tachypnea.

Breathing assistance (supplemental oxygen, assisted/mechanical ventilation)

Circulation support (measuring heart rate, blood pressure; vasopressors [e.g. dopamine and norepinephrine] for shock; intravenous fluids; ECG monitoring)

The need for dextrose administration is mentioned but the specific conditions are not explained.

Clinical Evaluation

History: Gathering information about the incident (type of poison, ingestion amount, duration, source).

Obtaining info from patients, family, friends, or rescuers if unable to provide their history.

Clinical Assessment: Physical examination helps identify specific clinical features for quicker poison identification/ diagnosis.

Skin color (e.g., red in CO poisoning)

Presence of needle marks (possible drug abuse)

Increased sweating and flushing

Eye examination; Pupil size (dilated or constricted in response to different poisons)

Lacrimation (increased tears)

General GIT (Gastrointestinal Tract) assessment (salivation, dryness, corrosion, abdominal pain, diarrhea & vomiting etc.)

CVS (Cardiovascular System) assessment (tachycardia, bradycardia, blood pressure)

CNS (Central Nervous System) assessment (coma, tremors, convulsions, hyperthermia/hypothermia)

Respiratory Examination: checking for breathing abnormalities like hypoventilation, hyperventilation, pulmonary edema.

Toxidrome: Group of signs & symptoms that occur from exposure to a particular drug or toxin. It can aid identification

C.1. Sympathomimetic Toxidrome:

Results from toxins that stimulate the catecholamines release or toxins preventing catecholamine uptake,

Symptoms include dilated pupils, tachycardia, hypertension, agitation, seizures, diaphoresis. (Drugs such as cocaine, amphetamines)

C.2. Cholinergic Toxidrome:

Results from excess acetylcholine,

Symptoms commonly observed in organophosphate & carbamate insecticide poisoning.

C.3. Opioid Toxidrome:

Results from stimulation of opioid receptors,

Common symptoms include miosis (constricted pupils), CNS depression, and hypoventilation. (Drugs such as heroin and morphine)

Laboratory Investigation

Laboratory screening of biological fluids (blood, urine, saliva, spinal fluid, hair etc.) is to help identify toxic agents/ functions of affected organs,

Examples:

Arterial blood gases (measuring PO2 and PCO2)

Electrocardiogram (ECG)

Kidney function tests (creatinine, albumin, BUN)

Liver function tests (ALT, AST)

Electrolytes (Na+, K+, Cl-, Mg+2, Ca+2, HCO3−)

Anion gap (measurement to define the difference between anions and cations in the blood)

Laboratory tests are also performed on tissues of deceased patients.

Testing can be done while toxins/drugs/metabolites are present in the body fluid or tissues.

Decontamination

Dermal Exposure:

Remove the affected person from the hazardous environment.

Remove contaminated clothing.

Wash the affected area thoroughly with water and/or saline.

Towels, cloths, etc., must be put into hazardous waste bags.

Topical agents for specific toxins such as olive oil for phenol or calcium gluconate gel for oxalic/hydrofluoric acid, etc.

Soap water for organophosphorus skin toxicity.

Eye Exposure:

Remove contact lenses (if worn).

Irrigate the eye with normal saline or tap water for minimum 15 min. until tears return to normal pH.

Anesthetic eye drops for corrosive exposure.

Refer to an ophthalmologist is needed.

GIT Exposure:

Forced emesis (Ipecac syrup): Use to induce vomiting in conscious patients (within a few hours post-ingestion.) Avoid in cases with corrosive toxins or if unconscious/comatose, etc.

Gastric Lavage: Wash out the stomach when emesis is ineffective/contraindicated.

Oral Adsorbents: Activated charcoal (fine, black powder given as slurry with water) is used orally or through a tube to bind to ingested toxins, preventing them from being absorbed into the body,

Whole bowel irrigation: Polyethylene glycol electrolyte solution to flush toxins from the entire bowel.

Contraindications for forced emesis - corrosives, hydrocarbons, petroleum distillates

Other considerations like the lack of bowel sounds, bowel obstruction, constipation, stomach distention & risk of pulmonary aspiration.

Charcoals effectiveness depends on the type of toxin

Charcoal should not be given with Ipecac unless the patient has already vomited.

Cathartics: Saline, magnesium sulfate, citrate, sorbitol. Use with activated charcoal to improve excretion.

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Description

Explore the foundational concepts of toxicology, focusing on the effects of poisonous substances and the critical aspects of toxicity management. This quiz covers emergency management techniques, including resuscitation protocols and the seven key areas of toxicity management. Test your knowledge on how to handle toxic exposure effectively.