NCA 623 Poisonings-Toxicities Study Set Exam

NCA 623 Poisonings-Toxicities
Study 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