TOXIDROMES
DECONTAMINATION
NERD SH%T (GAPS)
100
WHAT 2 THINGS CAN DIFFERENTIATE ANTICHOLINERGIC TOXICITY FROM SYMPATHOMIMETIC?
URINARY RETENTION AND DIAPHORESIS
100
GIVE AN INDICATION AND A CONTRAINDICATION FOR GASTRIC LAVAGE
INDICATION: RECENT INGESTION (<1 HOUR) OF A LIFE THREATENING DRUG LIKE CCB OR TCA
CONTRAINDICATIONS: LARGE PILLS THAT WOULDN'T FIT THROUGH TUBE, CAUSTICS, HYDROCARBONS, NONTOXIC OR MILD INGESTIONS
100
WHAT'S THE CALCULATION FOR ANION GAP?
AG = NA - (CL + HCO3)
NORMAL VALUE IS 12 +/- 4
200
JIMSONWEED
WILL CAUSE ANTICHOLINERGIC TOXICITY
200
WHAT TOXINS ARE POORLY BOUND TO ACTIVATED CHARCOAL?
PHAILS
PESTICIDES
HEAVY METALS/HYDROCARBONS
IRON
LITHIUM
SOLVENTS
200
WHAT DOES MUDPILES/CAT STAND FOR?
METHANOL/METFORMIN
UREMIA
DKA
PARALDEHYDE/PHENFORMIN
ISONIAZID/IRON
LACTIC ACID
ETHYLENE GLYCOL
SALICYLATES/STARVATION KETOACIDOSIS
CYANIDE/CARBON MONOXIDE
ALCOHOLIC KETOACIDOSIS
TOLUENE
300
HOW TO YOU TREAT ANTICHOLINERGIC TOXICITY?
BENZOS, "SUPPORTIVE CARE", SODIUM BICARB FOR WIDE COMPLEX TACHYDYSRHYTHMIAS, PHYSOSTIGMINE (CHOLINESTERASE INHIBITOR)
300
WHAT ARE 2 INDICATIONS FOR WHOLE BOWEL IRRIGATION?
AGENT NOT BOUND BY ACTIVATED CHARCOAL
SUSTAINED RELEASE PRODUCT
BODY PACKER/STUFFER
PATIENT BECOMING MORE TOXIC DESPITE MAXIMAL TREATMENT
300
WHAT TYPE OF POISONING IS OSMOLAR GAP USEFUL FOR?
TOXIC ALCOHOL POISONING
A VERY ELEVATED OSMOLAR GAP IS LIKELY A TRUE POSITIVE WITH TOXIC ALCOHOL INGESTION
NORMAL LEVEL IS <10
OG = MEASURED SERUM OSLMOLALITY - CALCULATED SERUM OSMOLALITY
400
WHAT ARE 2 MIMICS OF SYMPATHOMIMETIC TOXIDROME?
HYPOGLYCEMIA, ETOH WITHDRAWAL, BENZO WITHDRAWAL
SYMPTOMS SIMILAR TO ANTICHOLINERGIC TOXICITY, EXCEPT FOR THESE PEOPLE WILL BE DIAPHORETIC AND WILL NOT HAVE URINARY RETENTION
400
WHAT ARE 2 INDICATIONS FOR MULTIPLE DOSE ACTIVATED CHARCOAL?
THEOPHYLLINE
SUSTAINED-RELEASE DRUGS
PHENOBARBITAL
SALICYLATES
CARBAMAZEPINE
400
GIVE 2 CAUSES OF AN ELEVATED OSMOLAR GAP
TOXIC ALCOHOLS (METHANOL, ETHYLENE GLYCOL, ISOPROPANOLOL)
MANNITOL, PROPYLENE GLYCOL, GLYCEROL
500
NAME 4 SYMPTOMS OF ANTICHOLINERGIC TOXICITY
"MAD AS A HATTER, HOT AS A HARE, DRY AS A BONE, BLIND AS A BAT, RED AS A BEET"
INCREASED HR
INCREASED BP
DRY, FLUSHED SKIN
DILATED PUPILS
AGITATION
HYPERTHERMIA
HALLUCINATIONS
SEIZURES
URINARY RETENTION
SEDATION
COMA
600
HOW DO YOU TREAT SYMPATHOMIMETIC TOXIDROMES?
BENZOS, FLUIDS, COOLING
700
NAME 3 DRUG CLASSES THAT CAN CAUSE ANTICHOLINERGIC TOXICITY
ANTIHISTAMINES, ATROPINE, TCAs, ANTIPARKINSONIAN AGENTS, ANTIPSYCHOTICS, MUSCLE RELAXERS, CERTAIN MUSHROOMS
800
NAME 3 CAUSES OF CHOLINERGIC TOXIDROMES?
ORGANOPHOSPHATES, INSECTICIDES, PHYSOSTIGMINE, PILOCARPINE, MUSHROOMS
900
WHAT ARE THE 2 MNEMONICS COMMONLY USED FOR CHOLINERGIC TOXICITY?
SLUDGE (SALIVATE, LACRIMATION, URINATRION, DEFECATION, GI UPSET, EMESIS) PLUS "KILLER B'S" (BRADYCARDIA, BRONCHORRHEA, BRONCHOSPASM)
DUMBBELS (DIARRHEA, URINATION, MIOSIS/MUSCLE WEAKNESS, BRADYCARDIA, BRONCHORRHEA, EMESIS, LACRIMATION, SALIVATION)
1000
WHAT 2 AGENTS ARE USED TO TREAT CHOLINERGIC TOXICITY?
ATROPINE - TREATS MUSCARINIC SYMPTOMS (SLUDGE, KILLER B'S)
PRALIDOXIME (2-PAM) - TREATS NICOTINIC SYMPTOMS (MUSCLE FASCICULATIONS, WEAKNESS, RESPIRATORY MUSCLE FAILURE)
1100
WHAT SORT OF TOXIDROME WILL DRUGS LIKE HALDOL, PHENOTHIAZINES, METOCLOPRAMIDE CAUSE?
EXTRAPYRAMIDAL TOXIDROME
OCULOGYRIC CRISIS, RIGIDITY, TORTICOLLIS, TRISMUS, DYSPHAGIA, DYSTONIA, AKATHISIA (INABILITY TO REMAIN STILL), NEUROLEPTIC MALIGNANT SYNDROME, TARDIVE DYSKENISIA
TREATMENT: BENADRYL, BENZOS, BENZTROPINE