Toxicologic Exposure

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Toxicologic Exposure by Mind Map: Toxicologic Exposure

1. Physical

1.1. ABCs

1.2. Vitals

1.3. Toxic Syndromes

1.3.1. Anticholinergic

1.3.1.1. Blind as a bat, mad as a hatter, red as a beet, hot as hades, dry as a bone, the bowel and bladder lose their tone and the heart runs alone

1.3.2. Cholinergic

1.3.2.1. SLUDGE - Salivation, Lacrimation, Urination, Diarrhea, GI distress, Emesis

1.3.2.2. Killer B's - Bronchorrhea, Bronchospasm, Bradycardia

1.3.3. Narcotic

1.3.3.1. CNS depression, hypothermai, Pinpoint pupils, Bradypnea

1.3.4. Sympathomimetic

1.3.4.1. Hypertension, CNS excitation, Tachycardia, Seizure

2. History

2.1. What

2.2. Quantity

2.3. Route

2.4. When

2.5. Why

2.6. What else

3. Decontamination

3.1. Charcoal Ineffective In:

3.1.1. Iron

3.1.2. Lithium

3.1.3. Lead

3.1.4. Hydrocarbons

3.1.4.1. CHAMP: Camphor, Halogenated, Aromatic, heavy Metals, Pesticides

3.1.5. Toxic Alcohols

3.2. Whole Bowel Irrigation Indications:

3.2.1. Sustained/Delayed Release medications

3.2.2. Potential Bezoir

3.2.3. Iron/Heavy Metals

3.2.4. Lead Pain Chips

3.2.5. Lithium

3.2.6. Body Packers

3.3. Urine Alkalinization

3.3.1. Procedure

3.3.1.1. Sodium bicarb 1-2mEq/kg IV bolus or 3-4 meq/kg IV over 1 h

3.3.2. Targets

3.3.2.1. Urine ph 7.5-8.5, keep serum pH < 7.55

3.4. Dialysis

3.4.1. Drugs Removed By Dialysis

3.4.1.1. Ethanol

3.4.1.2. Methanol

3.4.1.3. Aspirin

3.4.1.4. Lithium

3.4.1.5. Barbituates

3.4.1.6. Gentamicin

3.4.1.7. Paraquat

3.4.1.8. Ethylene Glycol

4. Drugs Which Serum Levels Affect Therapy

4.1. Acetaminophen

4.2. Salicylate

4.3. Lithium

4.4. Digoxin

4.5. Valproate

4.6. Phenytoin

4.7. Carbamazepine

4.8. Theophylline

4.9. Carbon monoxide

4.10. Methemoglobin

4.11. Methanol

4.12. Ethylene Glycol

4.13. Iron

4.14. Paraquat

5. Antidotes (pediatric doses)

5.1. Acetaminophen

5.1.1. N-Acetylcysteine 150mg IV over 60 min followed by 50mg/kg IV over 4h then 100mg / kg IV over 16 h

5.2. Calcium Channel Blockers

5.2.1. Calcium Chloride 10mlIV (0.2-0.25mL/KG), Glucagon 3-10mgIV (50-10mcg/kg IV)

5.3. Hypermagnesemia

5.3.1. Calcium Gluconate 10% 10-30mL IV (0.6-0.8 mL/kgIV)

5.4. Cyanide

5.4.1. Sodium nitrite 10mL IV (0.33mL/kg IV), Hydroxocobalamin 70mg/kg iv over 30 min

5.5. Iron

5.5.1. Deferoxamine 15mg/kg/iV or 2g IM (15mg/kg/h IV or 90mg/kg IM)

5.6. Digoxin

5.6.1. Digibind 5-10 vials acute, 3-6 vials chronic (1-2 vials)

5.7. Methanol/Ethylene Glycol)

5.7.1. Fomepizole 15mg/kg IV then 10mg/kg IV every 12h

5.8. Opioid

5.8.1. Naloxone 0.4-2mg IV (0.01mg IV)

5.9. Anticholinergic

5.9.1. Physostigmine 0.5-2mg slow IV over 2-5 min (0.02mg/kg IV)

5.10. Cholinergics

5.10.1. Pralidoxime 1-2gIV over 5-10min followed by 500mg/h infusion (20-40mg/kg IV over 5-10min followed by 20mg/kg/h infusion)

5.11. Heparin

5.11.1. Protamine 25-50mg IV (0.6mg/kg IV)

5.12. Wernike Syndrome

5.12.1. Thiamine 100mg IV (5-10mg IV)