Term
| What are 6 symptoms of cocaine/meth/ecstasy use/overdose? |
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Definition
| -chest pain, tachypnea, HTN, agitation, tachycardia, diaphoresis |
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Term
| List the labs and rads you would use for a pt coming in with symptoms of cocaine/meth/ecstasy overdose |
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Definition
-monitor
-EKG
-pulse ox
-urine Tox
-UA
-CMP
-ABGs
-creatine kinase
-cardiac enzymes
-consider head CT |
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Term
| What are the mainstay for treating cardiac and CNS symptoms in a pt experiencing cocaine/meth/ecstasy OD? What should be avoided? |
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Definition
benzodiazepines
-Ativan (Lorazepam) 2 mg IV
-Valium 5-10 mg IV
*avoid antipsychotics- can trigger seizures, hyperthermia, and arrhythmias |
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Term
| What is used to treat cocaine induced wide complex tachydysrythmia? |
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Definition
| sodium bicarbonate 1-2 mEq titrated to maintain normal pH |
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Term
| What should be avoided in tx cardiac symptoms in pts experiencing cocaine/meth/ecstasy OD? what should be used |
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Definition
-AVOID beta blockers
-use benzo's, if unresponsive use nitroprusside (0.3 mcg/kg/min IV) or phentolamine (2.5-5 mg IV) |
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Term
| How are "body packers" treated? |
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Definition
| polyethylene glycol whole bowel irrigation |
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Term
| What are 3 common symptoms associated with opiate OD? |
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Definition
| lethargy, respiratory depression, pinpoint pupils |
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Term
| What are 7 labs and rads that should be run when a pt is suspected of an opiate OD? |
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Definition
-urine and/or serum tox screen
-UA
-CMP
-monitor
-pulse ox
-EKG
-O2 |
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Term
| What drug is used to treat the respiratory depression and CNS depression of an opiate OD? |
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Definition
-Narcan (naloxone)
2 mg IV, SC, or IM for apnea
0.4 mg IV for resp or CNS depression |
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Term
| What are 5 labs to run on a pt with ethanol OD? |
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Definition
glucose
urine box screen
CMP
liver panel
serum alcohol level |
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Term
| what is the tx for a pt with ethanol OD? |
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Definition
IV of normal saline
treat hypoglycemic with IV 50% dextrose
thiamine 100 mg IV or TM
agitation or seizure activity: Ativan IM or IV |
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Term
| What is isopropanol commonly found in? What is the principle toxic metabolite? What are the clinical presentations? |
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Definition
-rubbing alcohol, solvents, paint thinners, hair products, antifreeze
-acetone
-similar to ETOH but with longer and deeper CNS depression, severe presents with coma, respiratory depression, and hypotension, possible hemorrhagic gastritis |
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Term
| what is the treatment for isopropanol OD? |
|
Definition
-iv normal saline
-Vasopressors: dopamine (5-20 mcg/kg/min), dobutamine (2-20 mcg/kg/min) or norepinephrine (0.5-30 mcg/min)
-dialysis if alcohol level above 400 mg/dL
-hospital admit
-psych referral |
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Term
| Where is methanol often found? ethylene glycol? |
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Definition
-solvents, paint, windshield fluid, antifreeze. metabolizes into formaldehyde and formic acid
-coolants, polishes, detergents. metabolizes into toxic compounds glycolic and glycolic acid |
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Term
| what are the signs and symptoms of methanol or ethylene glycol OD? |
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Definition
-CNS depression and visual disturbances ( snow storm)
-sig. anion gap acidosis
-N/V, abd pain
-retinal edema or hyperemia of optic disc |
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|
Term
| how do you treat methanol poisoning? |
|
Definition
-fomepizole 15 mg/kg IV load, followed by 10 mg/kg Q 12 hrs. if not avail use ethanol 800 mg/kg IV load with continuous infusion at 100 mg/kg/hr
-monitor glucose and treat if needed
-dialysis
-Folate 50 mg IV
-for low pH: sodium bicarbonate 1-2 mEq/kg
-hypocalcemia: calcium gluconate or calcium chloride
-admit, monitor, and consult medical toxicologist |
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Term
| how do you treat ethylene glycol poisoning? |
|
Definition
-fomepizole 15 mg/kg IV load, followed by 10 mg/kg Q 12 hrs. if not avail use ethanol 800 mg/kg IV load with continuous infusion at 100 mg/kg/hr
-monitor glucose and treat if needed
-dialysis
-Pyridoxine 100 mg IV
-Thiamine 100 mg IV
-for low pH: sodium bicarbonate 1-2 mEq/kg
-hypocalcemia: calcium gluconate or calcium chloride
-admit, monitor, and consult medical toxicologist |
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Term
| List 9 symptoms of TCA overdose |
|
Definition
-coma
-confusion
-delirium
-mydriasis (dilated pupils)
-dry mouth
-hypotension
-seizures
-tachycardia
-urinary incontinence |
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|
Term
| how do you manage seizures associated with TCA OD? |
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Definition
Benzo's
Adult: Lorazepam (Ativan) 2-4 mg IV
Child: 0.05-0.1 mg/kg |
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Term
| what should be used to alkalinize urine in a pt with tCA OD? |
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Definition
sodium bicarbonate (1 mEq/mL solution) to keep urine pH <7.5
adult: 50 mEq bolus
child: 1-2 mEq/kg up to 50 mEq bolus |
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Term
| what should be used to manage hypotension in a pt with TCA OD? |
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Definition
adult: dopamine or norepinephrine 8-12 mcg/min
child: dopamine 0.1 mcg/kg/min (may titrate to 6 mcg/min max) |
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Term
| what is the most common cause of hepatic failure? |
|
Definition
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Term
| What are 6 signs of APAP OD? |
|
Definition
anorexia
lethargy
N/V
jaundice
pallor |
|
|
Term
| What is the current max dose of APAP in adults and children? when does damage occur? |
|
Definition
-4 gram adults
-90 mg/kg children
-7-10 grams adult and 150 mg/kg kids |
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|
Term
| what is the tx for a patient with APAP OD? |
|
Definition
-monitor LFTs
-antidote is N-acetylcysteine (NAC) aka Mucomyst: 150 mg/kg IV over 60 min then 50 mg/kg IV over 4 hours then 100 mg/kg IV over 16 hours
-continue tx for 48-72 hours if LFTs continue to rise |
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Term
| Name as many signs and symptoms of salicylate OD as possible |
|
Definition
-alkalosis OR acidosis
-coma
-diaphoresis
-disorientation
-hyponatremia
-hyperglycemia OR hypoglycemia
-hyperventilation
-N/V
-renal failure
-seizures
-tinnitus
-deafness |
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|
Term
| when does serious salicylate toxicity occur? |
|
Definition
|
|
Term
| what is the tx for salicylate OD? |
|
Definition
-consider gastric lavage
-load crystalloid to maintain urine output (adult: NS 1-2 liter bolus; child NS 20 cc/kg bolus)
-alkalinize urine: 3 sodium bicarb ampules in 850 m: D5W, add 40 mEq KCl if not hyperkalemic (adult: infuse at 150-200 mL/hr or 2-3 mL/kg/hr; child: infuse at 1.5-2 times maintenance) |
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