Smoke Inhalation, Cyanide and Carbon Monoxide
This is a thermal degradation product of particulate matter that if present on body, face or airway is suggestive of inhalational injury.
Soot
These are hallmark characteristics of Methemoglobinemia presentation
cyanosis despite oxygen delivery
chocolate brown blood
These 3 major mechanisms of toxicity can be expected with envenomation of the Crotalinae spp.
local tissue inflammation
coagulopathy
systemic effects such as hypotension and angioedema
NOT recommended for the routine treatment of smoke inhalation
corticosteroids
This competitive antagonist of ADH is the main antidotal treatment for methanol and ethylene glycol poisoning
Fomepizole
What rapid diagnostic test allows for measurements of carboxyhemoglobin and methemoglobin levels?
Co-oximetry
Contraindications for methylene blue for Methemoglobinemia include
anemia
renal failure
SSRIs (serotonin modulators)
known G6PD deficiency
pregnancy
inappropriate initial actions to take place after a snake bite include
torniquets
incision and/or suction of the wound
venom extraction devices
this medication is recommended to improve oxygenation and ventilation in smoke inhalation due to its mechanism of action on changes induced by irritants in acute reversible bronchoconstriction in asthma or COPD
nebulized albuterol (beta-2 agonists)
The pediatric dose of this antidote is the same as the adult dose, and is not weight based
CroFab
What is the volume & rates of administration of fluid that a 75 kg patient should receive if they present with second-degree thermal burns, present on their face and covering most of their arms?
8100 mL total
4050 mL in first 8 hours (~500 mL/hr; 506.25 to be exact)
4050 mL in next 16 hours (~250 mL/hr; 253.125 to be exact)
Toxic metabolites of methanol and ethylene glycol are
M = formic acid
EG = oxalic acid
These are indications for antivenom administration
moderate to severe swelling
hypotension/angioedema
PT/fibrinogen/platelet levels indicative of coagulopathies
This therapy provides most benefit if administered within 6 hours, adverse effects include middle ear barotrauma and progressive myopia that is reversible
HBO
Once initial control is achieved, how long should continued/maintance control occur, and at what dose?
2 vials Q6H up to 18 hours
This is a nonspecific clinical presentation of carbon monoxide poisoning
flu-like symptoms
This is a hallmark lab finding of toxic alcohol poisoning
Elevated anion gap metabolic acidosis
This is the main adverse effect to be concerned about with CroFab administration
hypersensitivity reaction
What is the dose of this vitamin B-12 precursor that chelates cyanide from the cytochrome system and acts as a nitric oxide scavenger?
5 grams (70 mg/kg IV)
This glycosaminoglycan is theorized to reduce airway inflammation and decrease fibrin deposition in an airway injured by smoke inhalation, and is recommended for use in intubated patients with confirmed smoke inhalation and ARDS
nebulized heparin
Results of these rapid evaluation labs suggest cyanide toxicity and should prompt recommendation of antidotal therapies, especially if a patient was involved in an enclosed-space fire and presents with altered mental status + hemodynamic instability (looking for name of lab and value).
Lactate of > 10 mmol/L
Carboxyhemoglobin > 10%
Co-ingestion of what agent can be protective in toxic alcohol poisoning?
Ethanol
Signs of initial control and should prompt maintenance and continued control of CroFab administration
halting progression of local edema & ecchymosis
improvement in coagulation abnormalities
resolution of systemic effects
What antidotal agents have a common adverse effect of discoloration of skin and urine (name, indication, and expected color)?
Cyanokit (cyanide toxicity, red)
Methylene blue (MetHg; blue)
Name 2 mechanisms by which hyperbaric oxygen may be administered
Monoplace chamber
Multiplace chamber