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Chapter 145 , Rosen 7 th  edition
TOX JEOPERDY  General Toxidrome Decontamination Odor 50 50 50 50 50 100 100 100 100 100 200 200 200 200 200 300 300 300 300 300  500 500 500 500
True of False ,[object Object],[object Object],[object Object],[object Object],[object Object]
True of False ,[object Object],[object Object],[object Object],[object Object],[object Object]
OBTAINING AN OVERDOSE HISTORY    ▪      Obtain all prescription bottles and other containers when possible. Perform a pill count. Be sure that the bottles contain the medications listed. Identify any unknown tablets.    ▪      Contact the prescribing physician(s) or the pharmacy as listed on the bottles to determine previous overdoses or other medications that the patient may have available. Identify underlying medical and psychiatric disorders and medication allergies. Review past medical records.    ▪      Talk to the patient's family and friends in the emergency department. If necessary, call the patient's home to ask questions of others. The persons providing the important elements of the history should be identified in the chart.    ▪      Search the patient's belongings for drugs or drug paraphernalia. A single pill hidden in a pocket, for example, may provide  the  most important clue to the diagnosis.    ▪      Have family members (or the police) search the patient's home, including the medicine cabinet, clothes drawers, closets, and garage: such searches may also provide clues that make the diagnosis. This has the added benefit of involving the family in the patient's care.    ▪      Always look for track marks on the patient. Consider body packing or body stuffing.
In the pupillary examination of the poisoned patient : ,[object Object],[object Object],[object Object],[object Object]
In the pupillary examination of the poisoned patient : ,[object Object],[object Object],[object Object],[object Object]
ALL ARE TOXINS CAUSING DELIRIUM EXCEPT  ,[object Object],[object Object],[object Object],[object Object],[object Object]
ALL ARE TOXINS CAUSING DELIRIUM EXCEPT  ,[object Object],[object Object],[object Object],[object Object],[object Object]
Toxins and Odor  ,[object Object]
Toxins and Odor
Toxins and Odor
Toxins and Odor
Toxins and Odor
Toxins and Odor
Toxins and Odor  ,[object Object]
Toxins and Odor  ,[object Object],[object Object],[object Object],[object Object],[object Object]
Toxins and Odor  ,[object Object],[object Object],[object Object],[object Object],[object Object]
Toxins and Odor  ,[object Object],[object Object],[object Object],[object Object],[object Object]
Toxidromes ,[object Object],[object Object],[object Object]
Toxidromes ,[object Object],Common signs Delirium with mumbling speech, tachycardia, dry flushed skin, dilated pupils, myoclonus, slightly elevated temperature, urinary retention, decreased bowel sounds. Seizures and dysrhythmias may occur in severe cases.  Common causes Antihistamines, antiparkinsonians, atropine, scopolamine, amantadine, antipsychotics, antidepressants, antispasmodics, mydriatics, muscle relaxants, many plants (e.g., jimson weed, Amanita muscaria)
Toxidromes ,[object Object],[object Object],[object Object]
Toxidromes ,[object Object],Common signs Delusions, paranoia, tachycardia (or bradycardia with pure alpha-agonists), hypertension, hyperpyrexia, diaphoresis, piloerection, mydriasis, hyper-reflexia. Seizures, hypotension, and dysrhythmias may occur in severe cases.  Common causes Cocaine, amphetamine, methamphetamine and its derivatives, over-the-counter decongestants (phenylpropanolamine, ephedrine, pseudoephedrine). In caffeine and theophylline overdoses, similar findings, except for the organic psychiatric signs, result from catecholamine release.
Toxidromes ,[object Object],[object Object],[object Object]
Toxidromes ,[object Object],Common signs Confusion, central nervous system depression, weakness, salivation, lacrimation, urinary/fecal incontinence, gastrointestinal cramping, emesis, diaphoresis, muscle fasciculations, pulmonary edema, miosis, bradycardia/tachycardia, seizures  Common causes Organophosphate and carbamate insecticides, physostigmine, edrophonium, some mushrooms
Toxidromes ,[object Object],[object Object],[object Object]
Toxidromes ,[object Object],Common signs altered mental status, fever, agitation, tremor, myoclonus, hyper-reflexia, ataxia, incoordination, diaphoresis, shivering, and sometimes diarrhea Common causes Fluoxetine (Prozac),  sertraline (Zoloft),  paroxetine (Paxil),  fluvoxamine (Luvox), and citalopram (Celexa)  are commonly used SSRIs.  venlafaxine (Effexor), nefazodone (Serzone), and mirtazapine (Remeron).
About Gastric decontamination True / False ? ,[object Object],[object Object],[object Object],[object Object]
About Gastric decontamination True / False  ,[object Object],[object Object],[object Object],[object Object]
About AC ? ,[object Object],[object Object],[object Object],[object Object]
About AC ? ,[object Object],[object Object],[object Object],[object Object]
All of the following agents doesn’t bind to Charcol / EXCEPT? ,[object Object],[object Object],[object Object],[object Object],[object Object]
All of the following agents doesn’t bind to Charcol / EXCEPT? ,[object Object],[object Object],[object Object],[object Object],[object Object]
About Whole-bowel irrigation usage ,[object Object],[object Object],[object Object],[object Object]
About Whole-bowel irrigation usage ,[object Object],[object Object],[object Object],[object Object]
In Gastric lavage / all are true EXCEPT? ,[object Object],[object Object],[object Object],[object Object]
In Gastric lavage / all are true EXCEPT? ,[object Object],[object Object],[object Object],[object Object]
What is the antidote and its dose for ?  ,[object Object]
What is the antidote and its dose for ?  ,[object Object],[object Object],[object Object],[object Object]
What is the antidote and its dose for ?  ,[object Object]
What is the antidote and its dose for ?  ,[object Object],DMSA  dimercaptosuccinic acid (succimer) Reported useful for arsenic and lead as well; one 100-mg capsule per 10-kg body weight tid for 1 wk, then bid, with chelation breaks  EDTA Ethylenediaminetetra- acetic acid 75 mg/kg/day by continuous infusion; watch for nephrotoxicity, best done in hospital
What is the antidote and its dose for ?  ,[object Object]
What is the antidote and its dose for ?  ,[object Object],Atropine Test dose, 1–2 mg IV in adults, 0.03 mg/kg in children; titrate to drying of pulmonary secretions Protopam Loading dose, 1–2 g IV in adults, 25–50 mg/kg in children; adult maintenance, 500 mg/hr or 1–2 g q4–6h
What is the antidote and its dose for ?  ,[object Object]
What is the antidote and its dose for ?  ,[object Object],Methylene blue 1–2 mg/kg IV, one 10-mL dose of 10% solution (100 mg) is typical for an adult without anemia
What is the antidote and its dose for ?  ,[object Object]
What is the antidote and its dose for ?  ,[object Object],Latrodectus antivenin  One vial by slow IV infusion is usually curative; may cause anaphylaxis
[object Object],[object Object]
[object Object],[object Object],[object Object]
In Tox. Screen / True or False  ,[object Object],[object Object],[object Object],[object Object]
In Tox. Screen / True or False  ,[object Object],[object Object],[object Object],[object Object]
Following are Radiopaque Drugs Except:  ,[object Object],[object Object],[object Object],[object Object],[object Object]
Following are Radiopaque Drugs Except:  ,[object Object],[object Object],[object Object],[object Object],[object Object]
What is the antidote of Valproic acid ? What is the dose of it ?
What is the antidote of Valproic acid ? What is the dose of it ? ,[object Object],[object Object],[object Object]

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Clinical Series

  • 1. Chapter 145 , Rosen 7 th edition
  • 2. TOX JEOPERDY General Toxidrome Decontamination Odor 50 50 50 50 50 100 100 100 100 100 200 200 200 200 200 300 300 300 300 300 500 500 500 500
  • 3.
  • 4.
  • 5. OBTAINING AN OVERDOSE HISTORY    ▪     Obtain all prescription bottles and other containers when possible. Perform a pill count. Be sure that the bottles contain the medications listed. Identify any unknown tablets.    ▪     Contact the prescribing physician(s) or the pharmacy as listed on the bottles to determine previous overdoses or other medications that the patient may have available. Identify underlying medical and psychiatric disorders and medication allergies. Review past medical records.    ▪     Talk to the patient's family and friends in the emergency department. If necessary, call the patient's home to ask questions of others. The persons providing the important elements of the history should be identified in the chart.    ▪     Search the patient's belongings for drugs or drug paraphernalia. A single pill hidden in a pocket, for example, may provide the most important clue to the diagnosis.    ▪     Have family members (or the police) search the patient's home, including the medicine cabinet, clothes drawers, closets, and garage: such searches may also provide clues that make the diagnosis. This has the added benefit of involving the family in the patient's care.    ▪     Always look for track marks on the patient. Consider body packing or body stuffing.
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  • 54. What is the antidote of Valproic acid ? What is the dose of it ?
  • 55.