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Copy of Acutely Poisoned Patient

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by

Howell Foster

on 25 February 2016

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Transcript of Copy of Acutely Poisoned Patient

The Acutely Poisoned Patient
Howell Foster PharmD, DABAT
Arkansas Poison & Drug Information Center
UAMS College of Pharmacy
Goals and Objectives
1.Learn the basic clinical approach to potentially poisoned patients
2.Learn the significance of common patterns of intoxication
3.Learn the basic approaches to decontamination
4.Learn the specific antidotes for selected intoxications
5.Learn the rationale for removal of absorbed toxicants
Assessment
What shall we do?
Patient awake?
Cooperative?
History?
Physical Exam
Laboratory
Decontaminate?
Activated Charcoal
Lavage
Enhanced Elimination
Diagnosis?
Antidote?
Supportive Care
Airway
Breathing
Circulation
History
Thiamine
Glucose
Naloxone
Route
Amount
Containers
MSDS
Fire
Homicide
Suicide
Physical Exam
Extremely important
Especially in an uncooperative patient
May narrow the diagnosis significantly
Cholinergic Syndrome
Peripheral
Central
Peripheral
Muscarinic
Nicotinic
Central
Coma
Seizures
SLUDGE
Antimuscarinic Syndrome
Peripheral
Central
Urinary Retention
EPS
Dopamine
Acetylcholine
Narcotic Overdose
Adrenergic
Antimuscarinic
Withdrawal
Opioids
Ethanol
Benzodiazepines
Alpha 2 agonists
Beta Blockers?
Miscellaneous
Needle Marks
Stains
Skin changes
Odors
Odors
Organophosphates
Arsenic
Freons
Phosgene
Cyanide
Ketones
Isopropyl Alcohol
Zinc Phosphide
Common Major Signs
Conduction changes
Acid/Base changes
Altered mental status
GI dysfunctions
Seizures
Laboratory
Electrolytes
BUN/Cr
Glucose
APAP/ASA
Lab cont
ABG's
EKG
PT/Liver Fx
UDS
Urine analysis
Serum Lactate
Wide QRS
Na+ Channel Blockade
Membrane stabilizing
Think 1a agents
Quinidine
M Metformin/Methanol
U Uremia
D DKA
P Protease Inhibitors/NRTI
I Iron/Isoniazid
L Lactic Acidosis
E Ethylene Glycol
S Salicylates
Altered Mental Status
GI Dysfunction
Both non-specific
Seizures
Numerous causes
Sinus bradycardias
Beta blockers/CCB
Cholingeric agents
Digitalis
Emesis
Lavage
Sinus tachycardia
Non-specific
C Chloral Hydrate
H Heavy Metals
I Iron
P Phenothiazines/PDB
S SR Preparations
Conclusions?
What is a poison?
Paracelsus
"All things are poison, and nothing is without poison; only the dose permits something not to be poisonous."

Dose makes the poison.
Acetylcholine
Pilocarpine
Blockade of Acetylcholine
Atropine
Scopolamine
Hyoscyamine

Antidopaminergic
Haloperidol
Anticholinergic Centrally
Benztropine
Diphenhydramine
Narcotics Bust In Hot Springs
April 2015
Heroin fatalities
3 fatalities 2003
35 fatalities 2013
Toxic Hemoglobinemias
Carboxyhemoglobin
Methemoglobin
Sulfhemoglobin
Drugs that commonly cause MetHg
Dapsone
Phenazopyridine
Benzocaine
Toxidromes
Occam's Razor
Hickam's Dictum
"patients can have as many diseases as they damn well please"
Oxidation of hemoglobin
70% is considered lethal
http://streetrx.com/
Full transcript