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Toxicology

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Information about Toxicology
Health & Medicine

Published on March 16, 2014

Author: lindafowler7509836

Source: slideshare.net

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Toxicology Transition to critical care

The Call Ambulance is transporting a 16 year old girl found unresponsive at home. Moans to light pain stimuli. Color pink. HR 60 RR12 BP 110 / 50 spo2 93% on room air. Parents saw her last night at 2400 when she came home after going out with friends ETA – 10 min

"All substances are poisons; there is none that is not a poison. The right dose differentiates a poison from a remedy." Paracelsus (1493–1541)

Toxic exposures are a common cause of ED visits  2008 – ED saw 2,000 people / day from poisoning Estimated annual poisonings or drug overdoses = 4.5 million 2/3 of toxic exposures reported involve children ENO

Management Provide continuous respiratory and hemodynamic support Patient safety Evaluate the potential for toxicosis Intervene to reduce toxin absorption and promote its excretion Provide substance-specific therapy, including antidote administration

What Questions do you need to ask?  Discuss with neighbor and determine at least 4 important questions

Poison Control Initial Follow - up

LAB?

Toxidrome A constellation of signs and symptoms that suggest a type of toxin

Ways to remember a toxidrome Toxidrome handout Google toxidrome and find a tool Word clues Symptom Clues

Google toxidrome to find one you like

Toxidrome Clues  Anticholinergic: Blind as a bat, mad as a hatter, red as a beet and dry as a bone  Cholinergic: DUMBELS- defication, urination, miosis, bronchospasm, emesis, lacrimation, sedation  Alcohol: hypothermia  Barbiturates: barb blisters  Pulmonary edema: aspirated hydrocarbon, ethyl glycol, ASA,  Gum discoloration: lead arsenic, Vitamin A

Sympathomimetic Illegal street drug Cocaine Amphetamines Meth LSD Over the counter cold agents Albuterol, dopamine, tricyclic antidepressants MOA inhibitors Pharmacologic agents to reduce temperature will be ineffective

Cholinergic Pesticides Organophosphorus warfare – Sarin Soman Tuban Pilocarpine Bethenechol Some mushrooms Control hypoxia Atropine Pralidoxime (2PAM) soon after exposure Benzo - seizures

Anti Cholinergics Atropine Scopolamine Atrovent Antiparkinson drugs Plants – Jimson weed, nightshade, leaves of potato plant Physostigmine – is the cholinergic agent Give slow IV push

Treatment

Treatment GI decontamination Charcoal or binding agents Whole Bowel irrigation Lavage Dermal Decontamination Enhance Elimination Antidotes

Lavage To lavage or not – That is the question

Syrup of ipecac Yes or No?

Activated Charcoal GI decontamination is the preferred treatment Prevents entry into enterohepatic circulation Effective alone or in combination with other therapy Thoughts on administration?

Charcoal Complications Absolute contraindication Repeated dose therapy

Charcoal doesn’t work  Potassium Acids Alkaline Ethanol Cyanide Fe Lead Lithium

Whole Bowel Irrigation When not bound to charcoal For sustained release or enteric coated Toxic substances such as balloons etc Give PEG solution (goLytely or clolyte solution)

Dermal or optic decontamination Procedure – lets practice

Enhance Elimination Alkalinization – goal of urine pH 7.5 – 8 Hemodialysis CAVH – hemofiltration Cathartics - Mag Citrate or Sorbitol – electrolyte imbalance, GI discomfort, cramping

Antidotes See hand out

Specific situations Toxicology Cases

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