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NCA 623 Poisonings-Toxicities Study Set Exam
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NCA 623 Poisonings-ToxicitiesStudy Set Exam
- assess for potential danger
- consider gut & skin decontamination to prevent further absorption
- treat complications as they occur
-observe for AT LEAST 4-6 hrs; longer if they ingested a sustained release or drugs that
can slow GI motility (anticholinergics, asa, opioids) - Answer initial eval asymptomatic
patient OD?
-FIRST: treat any life threatening complications (ABC)
- admit to ICU with close surveillance - Answer treatment symptomatic patients
presenting with drug OD?
Tylenol - Answer signs of ____ OD:
early asymptomatic
N/V within 24 hrs
RUQ pain
hypotension/hypothermia
PE: hepatatoxicity, increased INR, jaundice
AMS,s tupor, delirium, coma, asterixis, flapping tremor
Tylenol level on arrival + 3-4 hours after first dose
elevated AST (MOST sensitive)
elevated ALT, BUN, Cr, and T. bili
prolonged PT
metabolic acidosis
Monitor- LA, Alk phos, PO4 - Answer labs/diagnostics tylenol OD
activated charcoal IF 4hrs time of ingestion
N-acetylcysteine (Mucomyst)
,-can give IV or inhaled - Answer treatment tylenol OD
7.5 G - Answer with tylenol > __ grams at risk LIVER injury - may need HD with these
large amounts to decrease liver injury risk (esp with alochol or hx liver disease)
Salicylate (ASA) - Answer signs of ____ OD:
N/V (acute)
fever
tiniitus
HA/dizziness
PE findings: tachypnea and cyanosis (Mild)
agitation, confusion, coma, seizures, CV collapse/death (serious)
ABG - respiratory alkalosis with underlying metabolic acidosis
high serum salicylate level
abnormal electrolytes - Answer labs/diagnostics Salicylate (ASA) OD?
> 10 G: activated charcoal + gastric lavage followed by more activated charcoal
volume replacement (NS or D5) to prevent cerebral hypoglycemia
NaHCO3 (correct acidosis)
HD if lyte.acid-base imbalance - Answer treatment Salicylate (ASA) OD?
Salicylate (ASA) - Answer should check this toxicity with anyone presenting with
metabolic acidosis?
Class 1 anti-dysrhythmics (lido, procainamide, quinidine, flecanide) - Answer see this
with ____ OD:
N/V/D
dizziness/blurred vision
tinnitus/hearing loss
confusion
PE findings:
bradycardia, hypotension, CV collapse
seizures/coma/delirium
,respiratory depression
ALI
serum levels to confirm!
ECG showing: bradycardia with AV block, prolonged QRS, PR interval, QTC interval,
and vent arrythmias like torsades
leukopenia
hemolytic anemia
thombocytopenia
---pancytopenia
hepatotoxicity - Answer diagnostics with Class 1 anti-dysrhythmics (lido, procainamide,
quinidine, flecanide) OD?
drug induced lupus - Answer specific adverse reaction of OD with procainamide?
cont ECG + lyte monitoring
NaHCO3
brady - atropine, isoproterenol, or OD pacing
If refractory to above - IV lipid emulsion - Answer treatment Class 1 anti-dysrhythmics
(lido, procainamide, quinidine, flecanide) OD?
digoxin - Answer signs _____ toxicity:
N/V/D
blurred vision/ yellow-halos
anorexia
abdominal pain
fatigue
dizziness/confusion
h/a
hallucinations
brady
AV block
, SVT
atrial tachydysrhythmias
vent arrythmias
hypotension - Answer ecg findings dig toxicity
hyperkalemia
dig levels > 2.4 ng/ml - Answer labs/diagnostics dig toxicity
Cont ECg monitoring
montor K and get to normal level
dysrhytmias treated with lidocaine
brady- atropine or transcutaneous pacing
If early OD- activated charcoal
Digoxin immune Fab (DigiFab) - Answer treatment digoxin toxicity
CCB (-ipine) - Answer signs _____ OD:
AMS (confusion)
light headed
H/A
PE: brady, conduction dysrhythmias, hypotension
cyanosis
seizures/coma/death
AV block
prolonged QRS
asystole
metabolic acidosis
hyperglycemia - Answer diagnostics OD CCB?
Calcium chloride or gluconate!!!!
glucagon bolus (brady/hypotension)
brady- atropine, isoproterenol, pacing
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