Preguntas amir. 2020, Exámenes de Cardiología

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INTOXICACIONES

Dr. Alberto M.

González Chávez

TOXINDROME SINGOS/SINTOMAS EJEMPLOS

Colinérgico

DUMBBELS: Diarrea, Uresis alta, Miosis, Bradicardia, Broncoespasomo, Emesis, Lagrimeo, Salivación Organofosforados Pilocarpina Piridostigmina Hongos muscarínicos

Anticolinérgico

Caliente como el infierno (Hipertermia), Ciego como murciélago (Midriasis, visión borrosa), Seco como hueso (Anhidrosis), Rojo como remolacha (Vasodilatación), Loco como una cabra (Alucinaciones y Delirio) Antidepresivos tricíclicos Atropina Escopolamina Antihistamínicos

Opiáceo

Triada: Coma, Depresión respiratoria y MIOSIS. Morfina Oxicodona Heroína

Sedativo-hipnótico

Depresión del SNC, Depresión respiratoria y coma Alcohol Barbitúricos Benzodeacepinas

Extrapiramidal

Síntomas parkinsonianos: tremor, tortícolis, trismus, rigidez, crisis oculogira, opistóstonos, disfonia y disfagia Fenotiazidas Haloperidol Metoclopramida

Síndrome colinérgico

Toxíndromes

Antídotos específicos

Agente Antídoto

Acetaminofen N-acetilcisteína Anticolinergicos Fisostigmina Anticolinesterasas Atropina Benzodiacepinas Flumazenil B-bloqueadores Glucagon Bloqueadores de canales de Calcio Calcio, Glucagon, Insulina Monóxido de carbono Oxigeno, cámara hiperbárica Cocaína Benzodiacepinas Antidepresivos triciclicos Bicarbonato de sodio Heparina Protamina Teofilina Carbon activado, hemofiltración Isoniazida Piridoxina Metahemoglobina Azul de metileno Opioides Naloxona Pediatric Fundamental Critical Care Support. Society of critical care medicine. Secon Edition. Capitulo 13

DROGA SX ABSTINENCIA TRATAMIENTO

Alcohol

Tremor, taquicardia, Hipertensión, Delirium. Mortalidad 15-20% Benzodiacepinas Haloperidol MVI ¨Banana bag¨

Barbitúricos

Ansiedad, Convulsiones, Delirium, Tremor, Depresión cardiorespiratoria Benzodiacepinas

Benzodiacepinas

Ansiedad, convulsiones, tremor. Benzodiacepinas

Cocaína /

Anfetamina

Depresión, hiperfagia, Somnolencia Soporte! No B-Bloquadores

Opioides

Ansiedad, isomnio, fiebre, nausea, diarrea, Flulike, estertores Buprenorfina

DIGOXINA Favorecida x

Suspender digital y diuréticos

Reponer K+

Bradiarritmias – Atropina

TV – Lidocaína

TSV - Verapamil

MANEJO

HipoKalemia, ERC, Hipotiroidismo, Verapamilo, Amioradona

• Extracardiacas: Nausea, Vómito, Diarrea, Síncope, ESCOTOMAS,

Verde o amarillo

• Niveles normales: 1-2 mcg/dL Walls T, Pediatric Gastrointestinal Decontamination, Emergency Medicine Practice, 2008, Vol 5, Num 9 Peña L, Arroyave C, Toxicología clínica, CIB, 2010

Ac´s antidigital (Digitalis atidot)

Resincolestiramina

Caso 1

1. After leaving him alone for approximately 5 minutes, a mother walks into the kitchen to find her 2 - year-old child holding an empty bottle of oven cleaner (main ingredient sodium hydroxide). While he is in no apparent distress, she immediately takes him to the emergency department. He is seen within an hour of ingestion. What is the appropriate management of this patient? A. Ineutralization of substance B. Endoscopy C. Oral fluids D. Charcoal E. Ipecac adminstration

Caso 2

1. A 44 - year-old male is rushed to the emergency department after he began complaining of blurry vision in both eyes that developed over the last 45 minutes. He has also experienced excessive sleepiness, having fallen asleep mid-sentence repeatedly over the last several hours. The patient has a past history of alcoholism and reports consuming 1 quart of locally-produced moonshine 12 hours ago. Which of the following sets of signs, symptoms, and findings would be expected upon further evaluation of this patient? A. Photophobia, calcium oxalate crystals on urine microscopy, anion gap metabolic acidosis B. Abdominal pain, diarrhea, nausea, hematemesis, metabolic acidosis C. Optic disk hyperemia, anion gap metabolic acidosis, increased osmolar gap D. Tinnitus, tachypnea, metabolic acidosis, respiratory alkalosis E. Miosis, diarrhea, increased urination, salivation, elevated troponins, hypomagnesemia

Caso 2

1. A 44 - year-old male is rushed to the emergency department after he began complaining of blurry vision in both eyes that developed over the last 45 minutes. He has also experienced excessive sleepiness, having fallen asleep mid-sentence repeatedly over the last several hours. The patient has a past history of alcoholism and reports consuming 1 quart of locally-produced moonshine 12 hours ago. Which of the following sets of signs, symptoms, and findings would be expected upon further evaluation of this patient? A. Photophobia, calcium oxalate crystals on urine microscopy, anion gap metabolic acidosis B. Abdominal pain, diarrhea, nausea, hematemesis, metabolic acidosis C. Optic disk hyperemia, anion gap metabolic acidosis, increased osmolar gap D. Tinnitus, tachypnea, metabolic acidosis, respiratory alkalosis E. Miosis, diarrhea, increased urination, salivation, elevated troponins, hypomagnesemia Etinelglicol Hierro Salicilatos Organofos

Caso 2

1. A 37 - year-old farmer presents to the emergency department with acute onset of complaints of diarrhea, excessive tearing, and increased saliva production. He is concerned that he is dehydrated, as he has also been urinating with increased frequency over the past several hours. Physical exam is significant for a moderately agitated, diaphoretic male who demonstrates pinpoint pupils. You suspect an exposure to a toxic substance might be the cause of his symptoms. Which of the following pharmacologic treatments would be most appropriate for the likely exposure? A. Neostigmine B. Bethanecol C. Donepezil D. Pilocarpine E. Atropine

Caso 2

1. A 22 - year-old male is found unresponsive by his roommate on the floor of his apartment. He is immediately transported to the emergency department. The patient's medical history is significant for anxiety and major depressive disorder poorly-controlled with amitryptiline. The patient's roommate reports that he noted an empty, open bottle of medicine on the floor of the apartment. Physical exam in the ED is significant for a very lethargic and confused male with dilated pupils and global hyperreflexia. Vital signs are as follows: T 38. 7 C, HR 112 bpm, BP 148 / 92 mmHg, RR 8 , O 2 sat 94 % on room air. Basic metabolic panel is significant for a metabolic acidosis. Which of the following antidotes would be the most appropriate treatment for this patient's suspected overdose? A. Dimercaprol B. Protamine sulfate C. Flumezenilo D. Sodium bicarbonate E. Glucagon