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Description : Check out this medical titled "Toxicology Review" by Christian La Rivière, MD, FRCPC.

This medical talks about Toxicology is the study of the adverse effects of chemical, physical, or biological agents on living organisms and the environment. It involves the investigation of the nature, mechanism, detection, and treatment of toxic substances and their effects on living organisms, including humans. Toxicology is a multidisciplinary field that draws on knowledge from chemistry, biology, physics, medicine, pharmacology, and other related disciplines.

Toxicologists study the ways in which chemicals and other substances can cause harm, ranging from minor irritation to life-threatening conditions. They work to identify the hazards associated with various substances, assess the risks they pose to human and animal health, and develop strategies to mitigate or prevent exposure to these hazards.

Toxicology has many applications, including drug development, environmental monitoring, forensic science, occupational health and safety, and public health. It plays a critical role in protecting human and animal health by identifying and minimizing exposure to harmful substances and by helping to develop safe and effective treatments for various conditions.

Tags : Toxicology, Emergency Medicine, Emergency Medicine

Published on : Apr 14, 2023 | Views : 1534 | Downloads : 1

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Slide 1-

Toxicology Review Christian La Rivière, MD, FRCPC
Slide 2-

Outline Overview Toxicologic history and physical exam Common toxidromes Management of the undifferentiated poisoned patient
Slide 3-

Toxicology the study of chemicals and how they affect humans nearly any substance has the ability to be poisonous if taken in great enough quantity
Slide 4-

Ten Most Lethal Poisonings in Adults
Slide 5-

Ten Most Lethal Poisons in Kids
Slide 6-

Medications Dangerous to Children in 1 or 2 doses Beta blockers Calcium channel blockers Glyburide Oil of Wintergreen (methyl salicylate) TCA Camphor Clonidine and the imidazolines Opioids Lomotil Toxic alcohols
Slide 7-

Approach to the Poisoned Patient Supportive care is the cornerstone of treatment of poisoned patients Your attention to this will do more good for your patient than any other single intervention
Slide 8-

Approach (cont’d) ABC’s-stabilize as needed Oxygen, monitor, IV, glucose level, narcan? Hx-what, how much, when? Px-general exam, toxidromes Labs-drug levels, drug screen? Charcoal within 1 hour Antidote if available
Slide 9-

The Toxicology History Gather information from all sources possible pill bottles time of ingestion (good luck!) amount ingested types of ingestions/co-ingestions
Slide 10-

History (cont’d) environmental/occupational history Past Medical History Past Psychiatric History
Slide 11-

Physical Exam useful at framing the “toxidrome” Vital Signs: very important in determining severity and type of ingestion
Slide 12-

General Appearance says a lot! track marks? smells of ___?
Slide 13-

Odors in the Overdose History
Slide 14-

Skin, Mucous Membranes dry mouth or lots of secretions? skin warm and flushed or diaphoretic? any rash? cyanosis?
Slide 15-

Neuro Exam GCS helpful at giving a global assessment of LOC, but can be misleading always look at the pupils any evidence of a post-ictal state?
Slide 16-

Miosis (small pupils) opioids clonidine PCP cholinergics (insecticides, certain mushrooms)
Slide 17-

Mydriasis (dilated pupils) sympathomimetics (cocaine, speed, Ectacy, etc.) anticholinergics sedative-hypnotic withdrawal (EtOH, benzo withdrawal)
Slide 18-

Substances that can cause seizures Tricyclics Isoniazid Cocaine, amphetamines Salicylates (Aspirin) Anticholinergics Organophosphates (insecticides)
Slide 19-

Respiratory crackles and wheezes may indicate organophosphate poisoning! stridor and immediate respiratory distress may point to a caustic ingestion
Slide 20-

Radiology Radiopaque items “C” chloral hydrate “H” heavy metals “I” iron “P” phenothiazines “S” slow release(enteric coated) X-ray affect TX only in iron O.D.
Slide 21-

Toxidrome a constellation of signs or symptoms that are associated with a toxin most patients will not exhibit all aspects of the toxidrome mixed ingestions complicate the picture
Slide 22-

Toxidromes Opioid Sympathomimetics Cholinergics Anticholinergics Other toxidromes
Slide 23-

Opioids heroin, methadone, prescription meds CNS depression, respiratory depression, miosis
Slide 24-

Other Effects of Opioids hypotension bradycardia hypothermia non-cardiogenic pulmonary edema
Slide 25-

Sympathomimetics cocaine, amphetamines, MDMA HTN, tachycardia, dilated pupils, diaphoresis, agitation
Slide 26-

Cholinergics organophosphatepesticides, etc. remember: “SLUDGE” and the “Killer B’s”
Slide 27-

Cholinergics Salivation Lacrimation Urination Defecation Gastrointestinal upset (nausea, abdo pain) Emesis
Slide 28-

Cholinergics The “Killer B’s” Bradycardia Bronchorrhea Bronchospasm
Slide 29-

Anticholinergics tricyclics, dimenhydrinate, diphenhydramine, muscle relaxants
Slide 30-

Anticholinergics hot as hell dry as a bone mad as a hatter red as a beet blind as a bat
Slide 31-

Preventing Absorption
Slide 32-

Ipecac There are really no indications for the use of ipecac syrup to induce vomiting
Slide 33-

Gastric Lavage Questionable effectiveness No evidence of improved patient outcome Risk of serious complications ~3%
Slide 34-

Activated Charcoal Binds toxins to its surface and being non-absorbable allows charcoal-toxin complex to be excreted via the GI tract Toxic if aspirated do not give if decreased LOC or greater than 1 hour from ingestion Not bound by charcoal: Iron, lithium, cyanide, strong acids and bases, ethanol, methanol, ethylene glycol Ions/Acids/Bases/Alcohols
Slide 35-

Whole Bowel Irrigation Polyethylene glycol electrolyte solution (PEG, GoLytely) Useful for large ingestions of substances: Not bound by charcoal Late presentation after overdose Extended release preparations Need a nasogastric tube 1-2 L/hr for adults and 0.5 L/hr for peds
Slide 36-

Antidotes Carbon monoxide Opiates Acetominophen Methanol Ethylene glycol Iron Cyanide Organophosphates Oxygen Naloxone N-acetylcysteine Ethanol/Fomepizole Ethanol/Fomepizole Deferoxamine Nitrites/Thiosulfate Atropine/2-PAM
Slide 37-

Antidotes Isoniazid Beta-Blockers Sulfonylureas Digoxin Methemoglobinemia Benzodiazepines Pyridoxine Glucagon Diazoxide Digibind Methylene blue Flumazenil
Slide 38-

The End!Questions??