1. A doctor presents information on drug overdoses and poisonings. Key points discussed include signs and symptoms of intoxication, interventions for toxin removal like activated charcoal and decontamination methods, specific treatments for certain toxins, and supportive care measures.
2. Diagnosis of overdoses involves obtaining a substance ingestion history and physical exam findings. Vital signs can provide clues to the toxin. Lab tests may also help identify the toxin and its effects.
3. Management involves resuscitation, increasing toxin elimination, and use of antidotes or other interventions as needed. The presentation provides details on diagnosing and treating overdoses of various substances like acetaminophen, ethy
1. A doctor presents information on drug overdoses and poisonings. Key points discussed include signs and symptoms of intoxication, interventions for toxin removal like activated charcoal and decontamination methods, specific treatments for certain toxins, and supportive care measures.
2. Diagnosis of overdoses involves obtaining a substance ingestion history and physical exam findings. Vital signs can provide clues to the toxin. Lab tests may also help identify the toxin and its effects.
3. Management involves resuscitation, increasing toxin elimination, and use of antidotes or other interventions as needed. The presentation provides details on diagnosing and treating overdoses of various substances like acetaminophen, ethy
1. A doctor presents information on drug overdoses and poisonings. Key points discussed include signs and symptoms of intoxication, interventions for toxin removal like activated charcoal and decontamination methods, specific treatments for certain toxins, and supportive care measures.
2. Diagnosis of overdoses involves obtaining a substance ingestion history and physical exam findings. Vital signs can provide clues to the toxin. Lab tests may also help identify the toxin and its effects.
3. Management involves resuscitation, increasing toxin elimination, and use of antidotes or other interventions as needed. The presentation provides details on diagnosing and treating overdoses of various substances like acetaminophen, ethy
We||| Corne|| Med|ca| Co||ege 1he Method|st nosp|ta| nouston, 1exas D|sc|osure I have no con|ct of |nterest |n re|anon to th|s presentanon. Severa| o-|abe| uses of drugs w||| be mennoned. Cb[ecnves Descr|be phys|ca| and |aboratory hnd|ngs |n panents w|th |ntox|canon Cut||ne resusc|tanon and stab|||zanon measures D|scuss |ntervennons to decrease tox|n absorpnon and |ncrease e||m|nanon L|st |ntervennons and anndotes for se|ected tox|ns Management of Drug Cverdose kesusc|tanon and stab|||zanon D|agnos|s 1ox|n e||m|nanon Anndote and]or spec|hc |ntervennons Suppornve care D|agnos|s n|story Substance and quannty 1|me of |ngesnon Susta|ned-re|ease or regu|ar Acute or chron|c hys|ca| exam|nanon V|ta| s|gns Neuro|og|c hnd|ngs
V|ta| S|gns C|ues -8 0 8 neart kate 8|ood ressure 1emp ke|anve Change Amphetam|nes]coca|ne Anncho||nerg|cs Sympathom|mencs Narconcs Annhypertens|ves Sedanve]hypnoncs Increas|ng Decreas|ng Gastro|ntesnna| Decontam|nanon Ipecac - |nduced emes|s Catharncs Gastr|c |avage Who|e bowe| |rr|ganon Acnvated charcoa| Acnvated Charcoa| Dose: 1 g]kg Most eecnve w|th|n 1-2 h of |ngesnon May need nasogastr|c tube Not eecnve for: Iron Cyan|de L|th|um nydrocarbons A|coho|s Ac|d]A|ka||s L||m|nanon of 1ox|ns Mu|np|e doses of charcoa| 8arb|turates, theophy|||ne, carbamazep|ne, dapsone, qu|n|ne Iorced d|ures|s A|ka||ne d|ures|s (ur|ne pn>7) Sa||cy|ates, barb|turates, pr|m|done nemod|a|ys|s]hemoperfus|on Connnuous d|a|ys|s techn|ques 1. Wh|ch one of the fo||ow|ng agents |s most ||ke|y to resu|t |n death |n a po|soned panent?
A. Methamphetam|ne 8. I|uoxenne C. Lthano| D. Acetam|nophen L. Metopro|o| Deaths from o|son|ng (2011) Sedanve]hypnoncs]annpsychoncs 401 Acetam|nophen a|one (162) + comb|nanons (183) 34S Card|ovascu|ar drugs 30S Cp|o|ds 249 Anndepressants 229 Snmu|ants]street drugs 169 A|coho|s 147 Annconvu|sants 88 !!"#$%&'()% +,- (' ./0 ,/)% 1$2)3$/ 45647859:66 Acetam|nophen A|ways cons|der as a poss|b|e co|ngestant Un|ntennona| overdose occurs |n S0-61 of ||ver fa||ure cases 2S-33 of un|ntennona| overdoses take >1 acetam|nophen product Max|mum da||y dose of 3 g ohen exceeded k|sk factors: chron|c a|coho||sm, ma|nutr|non, drugs |nduc|ng C4S0 Acetam|nophen roducts 1y|eno| arthr|ns 6S0 mg 1y|eno| extra-strength S00 mg M|do| S00 mg Sudafed S|nus 32S mg V|cod|n LS 7S0 mg V|cod|n]Lortab S00 mg Darvocet-N100 6S0 mg Norco]U|tracet 32S mg Acetam|nophen (AA) Charcoa| |s eecnve |f g|ven ear|y Assess AA |eve| !4 h aher |ngesnon Use kumack-Mauhew nomogram to determ|ne tox|c|ty on|y |n &)%;/( .3<'( |ngesnons Assess transam|nases for mu|np|e or chron|c |ngesnons kumack-Mauhew Nomogram Acetam|nophen Anndote: ora| or IV N-acety|cyste|ne Most eecnve w|th|n 8 h Used up to 24 h aher |ngesnon Chron|c, mu|np|e or |ate |ngesnons Abnorma| transam|nases (>S0 IU]L) AA |eve| >10 g]mL (10 mo|]L) nepanc fa||ure present 2. Wh|ch of the fo||ow|ng agents resu|ts |n an osmo|ar gap and norma| an|on gap?
A.Methano| 8. L|th|um C.Lthy|ene g|yco| D.Lthy|ene g|yco| and ethano| L. Iron Metabo||c Ac|dos|s |n 1ox|co|ogy Lthy|ene g|yco| Methano| Sa||cy|ates Acetam|nophen Iron Carbon monox|de Cyan|de Va|pro|c ac|d ropofo| ropy|ene g|yco| Lthy|ene G|yco| and Methano| C||n|ca| hnd|ngs - CNS, GI, card|opu|monary symptoms Metabo||c hnd|ngs An|on gap metabo||c ac|dos|s Csmo|ar gap C|ues Cxa|ate crysta|s V|sua| d|sturbances www.||brary.med.utah.edu Metabo||sm of A|coho|s Lthy|ene g|yco| G|ycoa|dehyde Iorma|dehyde Iorm|c ac|d G|yco||c ac|d G|yoxy||c ac|d Methano| +/3$=$/ >(=?>#$;(%.&( Cxa||c ac|d Lthano| Lthy|ene G|yco| and Methano| Inh|b|non of a|coho| metabo||sm Lthano| (ora| or IV) Iomep|zo|e nemod|a|ys|s to remove a|coho| and metabo||tes Leve| >2S mg]dL Metabo||c ac|dos|s kena| fa||ure V|sua| symptoms
Lthy|ene G|yco| and Methano| Cther therapy Io||n|c ac|d (methano| tox|c|ty) 1h|am|ne Io|ate G|ucose 8|carbonate ropy|ene G|yco| 1ox|c|ty Most common|y occurs w|th |orazepam use for >3 dys Increased an|on gap and osmo|ar gap CNS depress|on or ag|tanon kena| dysfuncnon Se|zures Arrhythm|as nemo|ys|s ropy|ene G|yco| 1ox|c|ty Stop |orazepam or other drug Sedate w|th another agent M|dazo|am ropofo| Ientany| nemod|a|ys|s usua||y not requ|red 8enzod|azep|nes A|prazo|am common, ? more tox|c Anndote = umazen|| Not a subsntute for |ntubanon kesedanon concerns Contra|nd|canons Cyc||c anndepressants Chron|c benzod|azep|ne use 8radycard|a |n 1ox|co|ogy 8arb|turates "-8|ockers Ca|c|um channe| b|ockers C|on|d|ne Cho||nerg|c drugs (pyr|dosngm|ne) D|gox|n "-hydroxybutyrate Crganophosphates] carbamates Sedanve]hypnoncs "-8|ockers]Ca|c|um Channe| 8|ockers G|ucagon Ca|c|um (ch|or|de or g|uconate) Ventr|cu|ar pac|ng Atrop|ne, dopam|ne, ep|nephr|ne Insu||n eug|ycem|a (|nsu||n 0.1-10 U]kg]h + g|ucose 10-7S g]h) M||r|none L|p|d emu|s|on L|p|d Lmu|s|on as Anndote otenna| for use w|th ||poph|||c card|otox|c med|canons Used w|th |oca| anesthenc-|nduced arrest Most|y an|ma| stud|es]case reports Cyc||c anndepressants, verapam||, proprano|o|, ateno|o|, ha|oper|do|, organophosphates Coca|ne CV 1ox|c|ty Dysrhythm|as S|nus tachycard|a Ventr|cu|ar hbr|||anon] tachycard|a nypertens|on Aornc d|ssecnon Acute coronary syndromes Day 1 Day 3 Acute Coronary Syndromes Asp|r|n N|trog|ycer|n 8enzod|azep|nes hento|am|ne "-8|ockers (|n absence of acute sympathom|menc hnd|ngs) keperfus|on Cther Coca|ne 1ox|c|nes u|monary edema, bronchospasm, a|veo|ar hemorrhage Levam|so|e contam|nanon Intesnna| |schem|a]|nfarcnon kena| fa||ure khabdomyo|ys|s nypertherm|a !!@ +A ,$// B<#; 455C745D9E64 !!@ +A +3.> F(#A.'$/ 45667EG9655G Coca|ne No spec|hc anndote Ag|tanon 8enzod|azep|nes sychos|s na|oper|do| 1reat spec|hc comp||canons Amphetam|nes and Methamphetam|nes koutes - |nha|anon, snornng, IV, ora| Comp||canons Myocard|a| |schem|a Arrhythm|as Card|omyopathy Intracran|a| b|eed khabdomyo|ys|s Amphetam|nes and Methamphetam|nes Gastr|c empty|ng not he|pfu| Charcoa| has ||m|ted ro|e 8enzod|azep|nes for ag|tanon Suppornve care Annc|pate comp||canons 8ath Sa|ts Mephedrone, MDV (methy|ened|oxy- pyrova|erone), pyrova|erone Snmu|ant and ha||uc|nogen Snorted, |n[ected, |nha|ed Sympathom|menc eects, parano|a, aggress|ve behav|or Se|zures, rhabdomyo|ys|s, rena| fa||ure, stroke, hypertherm|a Sedanon w|th |orazepam, suppornve care www.freeads48.com Synthenc Mar|[uanas]Cannab|no|ds 8|nd to C8 receptors |n bra|n]sp|na| cord So|d as k2 and Sp|ce |n 2000s |n Germany Sp|ce re|eased by "1he syche De||" |n London Not detected |n ur|ne drug screens www.|ega|buds.com C||n|ca| Lects CNS: se|zures, ag|tanon, parano|a CV: tachycard|a, hypertens|on, |schem|a Autonom|c: fever, mydr|as|s Metabo||c: hypoka|em|a, hyperg|ycem|a GI: nausea, vom|nng kena|: acute k|dney |n[ury Muscu|oske|eta|: rhabdomyo|ys|s 3. A 30 year o|d w|th h|story of depress|on presents w|th AMS and the LkG be|ow.
Wh|ch one of the fo||ow|ng |ntervennons |s |nd|cated for the arrhythm|a? A. Am|odarone 8. Card|overs|on C. Magnes|um su|fate D. Sod|um b|carbonate L. Metopro|o| (Cyc||c) Anndepressants A|rway, card|ac mon|tor|ng Charcoa|, cons|der |avage 8|ood a|ka||n|zanon (pn 7.4S-7.SS)]sod|um |oad|ng nyperton|c sa||ne |n refractory cases Annarrhythm|c drugs Vasopressors - #-agon|st 8enzod|azep|nes for se|zures Cr|ter|a for 8|carbonate Use Card|ac conducnon de|ay kS >0.10 or 0.14 or 0.16 sec W|de comp|ex tachyarrhythm|a Card|ac arrest k|ght bund|e branch b|ock k avr !3 mm kefractory hypotens|on Cra| nypog|ycem|c Agents S0 g|ucose IV or ora|, then S or 10 g|ucose G|ucagon 1 mg SC or IM Cctreonde S0-100 g q 8h SC]IV Inh|b|ts |nsu||n re|ease Shortens hypog|ycem|c per|od L|th|um 1ox|c|ty (L| > 2.S - 4 mmo|]L) Centra| nervous system Arrhythm|as (|ess common) May cons|der who|e bowe| |rr|ganon Cpnm|ze |ntravascu|ar vo|ume Immed|ate and 2 h L| + |eve|s nemod|a|ys|s, connnuous rep|acement therap|es rescr|pnon Narconcs Cra|, snornng,IV use Deaths |ncreased 66 from 2001-200S (206 for methadone) Cxycodone, hydrocodone common|y d|verted Ientany| formu|anons ro|onged eects w|th susta|ned-re|ease forms Narconc Cverdose Anndote = Na|oxone IV, IM, SC, SL, endotrachea| 0.4 - 10 mg (h|gher doses for synthenc agents) t 1]2 = 4S-70 m|n Connnuous |nfus|on Suppornve care 1ramado| Lethargy, coma kesp|ratory depress|on Ag|tanon Se|zures 1achycard|a, n1N May cause fa|se (+) ur|ne tox|co|ogy for C Cho||nerg|c Syndrome Crganophosphates, carbamates Nerve gases (sar|n) SLUDGL man|festanons 8radycard|a, weakness 1reatment Atrop|ne (for secrenons) ra||dox|me (for weakness) 4. An ICU panent overdosed on a monoam|ne ox|dase |nh|b|tor and uoxenne. 1he panent |s de||r|ous, has had severa| se|zures, and has tremors of the extrem|nes. Wh|ch one of the fo||ow|ng shou|d be adm|n|stered? A. Dantro|ene 8. Lorazepam C. roprano|o| D. 8romocr|pnne L. na|oper|do|
www.herbmed.org www.mskcc.org]aboutherbs D|methy|amy|am|ne (DMAA) Supp|ement that |ncreases energy, concentranon and metabo||sm Structure s|m||ar to amphetam|nes Assoc|ated w|th deaths |n so|d|ers dur|ng exerc|se keports of ||ver and rena| fa||ure, se|zures, tachycard|a, n1N, |ntracran|a| hemorrhage, card|omyopathy nosp|ta|-Acqu|red Intox|canons GabapennnAMS, coma Narconcs nand san|nzersethano|, |sopropy| a|coho| Methemog|ob|nem|a$ top|ca| anesthencs ropy|ene g|yco| (|orazepam) ropofo| |nfus|on syndrome
ropofo| Infus|on Syndrome n|gh r|sk: Seps|s, |mpa|red C 2 de||very, head |n[ury, ICU panents w|th pro|onged |nfus|on of h|gh doses Can occur |n surg|ca| panents rece|v|ng |ow doses " C||n|ca| hnd|ngs: Myocard|a| fa||ure, arrhythm|as, |acnc ac|dos|s, hyperka|em|a, rhabdomyo|ys|s, rena| fa||ure, bradycard|a, hyper||pem|a Summary Use v|ta| s|gns and neuro|og|ca| hnd|ngs to suggest c|asses of tox|ns Lmcacy of GI decontam|nanon and tox|n e||m|nanon techn|ques |s ||m|ted Adm|n|ster |nd|cated anndotes for spec|hc tox|ns Lar|y adm|n|stranon of N-acety|cyste|ne prevents tox|c|ty |n acetam|nophen overdose Use benzod|azep|nes to contro| ag|tanon due to sympathom|menc tox|ns 1hank you for your auennon
Practice Guidelines For Central Venous Access 2020 An Updated Report by The American Society of Anesthesiologists Task Force On Central Venous Access PDF
(Progress in Brain Research 161) John T. Weber and Andrew I.R. Maas (Eds.) - Neurotrauma - New Insights Into Pathology and Treatment (2007, Elsevier, Academic Press)