toxicology djorgenmorris
TRANSCRIPT
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Toxicology
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Routes of Exposure• Inhalation• Ingestion• Surface absorption• Injection
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Treatments• Decontamination• Gastric lavage• Activated charcoal• Whole bowel irrigation• Ipecac • Dialysis• Antidotes
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Antidotes• Acetaminophen – Mucomist 140
mg/kg• Benzodiazepine- Flumazenil 0.2 mg q
min• Carbon monoxide- Oxygen• Cyanide- amyl nitrate• Opiates- Naloxone 2-5 mg• Beta Blockers- glucagen • Organophosphates- Atropine
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Get a Good History• What?• How much?• When?• Don’t care about the where and why• Any alcohol?
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We no longer use the coma cocktail
• Dextrose• Narcan• Thiamine
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Surface Absorbed Toxins• Cyanide• Organophosphates• Others• Treat with supporting measures
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Carbon Monoxide• Odorless, tasteless gas• Endogenous sources – breakdown of
hemoglobin• Exogenous sources – combustion• Methylene chloride breakdown in
liver• Mild to fatal
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Industrial Solvent
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Carbon Monoxide• Half life is normally 240 – 360
minutes• With 100 % oxygen, it is 80 minutes• With hyperbaric treatment, 22 minutes
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Signs and Symptoms
• Headache• Dizziness• Confusion• Seizures• Coma• Pulmonary edema (extreme)• Metabolic acidosis (extreme)
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Cyanide• Gaseous product of combustion
(plastics, wool, silk, rubber, polyurethane, asphalt)
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Signs and Symptoms• Burning sensation in mouth and
throat• Headache, confusion, combativeness• Hypertension and tachycardia
followed by hypotension• Seizures and coma• Pulmonary edema• Use Cynokit (hydroxocobalamin)
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Cardiac Medications• Bradycardia
– (may not respond to atropine)
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Cardiac Meds Antidotes• Beta Blockers – Glucagon• Calcium channel blockers – calcium
chloride– Norvasc, vascor, cardizem, cardene,
procardia, verapamil• Digoxin - Digibond
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Caustic Substances• Acids• Bases (alkalis)• Strong acid pH < 2• Strong alkalis ph > 12.5
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Acid or Base?
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Acid or Base?
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Acid or Base
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Acid or Base?
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Acid or Base?
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Acid or Base?
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Acid or Base?
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Acid or Base?
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Hydrofluoric Acid• Creates calcium fluoride in tissues• Pulls calcium from bones• Death in less than 2.5 % body surface
area
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Alcohol• Rarely seen in prehospital setting
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Hydorcarbons• Burns, wheezing, hypoxia, headache,
dizziness, slurred speech, ataxia, dulled reflexes
• Gastric lavage may be useful• Charcoal does not bind to these
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Tricyclic Antidepressants• Not as common;
– narrow therapeutic index• Amitriptyline (Elavil), amoxapine,
clomipramine, doxepin, imipramine, nortripyline
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Tricyclic OD• Dry mouth, blurred vision, urinary
retention, constipation• Confusion, hallucinations,
hyperthermia, respiratory depression, seizures, tachycardia and hypotension, dysrhythmias
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Tricyclic OD• Sodium bicarbonate for significant
cardiac toxicity• If overdose with benzodiazepines, do
not give Flumazenil… seizures!
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MAOI• Monoamine Oxidase Inhibitors• Narrow therapeutic index• Multiple drug and food interactions
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MAOI• Headache, agitation, restlessness, tremors• Nausea• Palpitations, tachycardia• Hypertension• Hyperthermia• Bradycardia, hypotension, coma, and death
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Seratonin Reuptake Inhibitors• Prozac• Luvox• Paxil• Zoloft
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Lithium• Treatment of bipolar (manic-
depressive) disorder• Dry mouth, thirst, tremor, muscle
twitching, reflexes, confusion, stupor, seizures, coma, nausea, vomiting, diarrhea, bradycardia, dysrhythmias
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Salicylates• Aspirin• 300 mg / kg causes toxicity• Metabolic acidosis• Use charcoal• Bicarb• Dialysis
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Acetaminophen• 150 mg / kg is toxic• Death by liverStage 1: ½ hr to 24 hrs n/v weaknessStage 2: 24 – 48 hrs abd pain, decreased urineStage 3:72 – 96 hrs liver disruptionStage 4: 4-14 days Recovery or death
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Tylenol Antidote• Mucomyst
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Iron• 20 mg/kg is toxic• vomiting, diarrhea• abdominal pain• shock• metabolic acidosis• bowel scarring
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Contaminated Food• Shigella• Salmonella• E. Coli• Clostridium
botulinum• Paralytic shellfish
poisoning• Scombroid
(histamine)
• N/V/D and abd pain
• Red Tide • Treat like allergic
reaction
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Organophosphate Poisoning• Salivation• Lacrimation• Urination• Diarrhea• GI distress• Emesis
•Treat with atropine
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Bites and Stings
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Africanized Honeybees
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Brown Recluse
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Spider Bite
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Black Widow
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Scorpion Stings• Use constricting band• Do not give analgesics
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Venomous Snakes• Pit Vipers• Elapidae (coral snake)
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Common Pit Vipers• Cottonmouths• Rattlesnakes• Copperheads
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• http://www.flmnh.ufl.edu/herpetology/fl-guide/snakekey.htm
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Name the Florida Snake
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Florida Racer
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Cottonmouth (water moccasin)
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Eastern Diamond Back Rattlesnake
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Copperhead
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Timber Rattlesnake
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Pygmy Rattlesnake
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Florida Corn Snake
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Marine Animal Injection• Heat will relieve pain and inactivate venom• Secondary infection possible
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Galerina
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Amanita
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Any questions?