 | Prep for USMLE |
| Forum | Resources | New Posts | Register | Login | » |
|
| Author | 6 Posts | |||||||||||||||||||||||||||||||||||||||||||
|
Delusional
Forum Elite Topics: 41 Posts: 226 |
A 62 year old patient who has suffered from Herpes Zoster 8 months ago which was complicated by a neuralgia....is on treatment for the painful disorder.....Patient says he cannot recollect the name of the medication... But he claims he has grown tired of his pains and had decided to kill himslef and ingested 20 of the tablets about 2 1/2 hours ago.. O/e... patient showed dry mouth, dilated pupils and tachycardia Questions: 1.. what is the next step in management of this patient... a...gastric lavage b...Ipecac c...EKG d...neostigmine e...pralidoxime 2...how should you start treatment of this patient.?... 3...what are the complications of this toxicity?
|
Prep4USMLE.com
|
Advertisement
|
|
smitha
| Forum Elite Topics: 53 Posts: 236
This is a case in which the toxicity simulates anti cholinergic syndrome.This is due to TCA toxicity .....TCA (mostly Amitryptilline), is given for treating post herpetic neuralgia. TCA overdose is one of the few times in which GASTRIC LAVAGE is useful even after the first hour coz the anticholinergic effects impair peristalsis & hence, delay gastric emptying. So, the next best step wud be-------GASTRIC LAVAGE. How do u treat it basically..........gastric lavage & charcoal given. If cardiotoxicity is present, bicarbonate is also given, which protects the heart from TCAs . Supportive measures wud be tepid sponge & sedation, to control high temperature. As in other anticholinergic syndrome toxicity(like pure atropine), physostigmine or neostigmine r not indicated(in fact c/I ) for the fact that they cause bradyarrhythmias & convulsions.......so, it's not given. Adverse effects/Problems with this toxicity are.........3 "C's..... Convulsions, Cardiotoxicity & Coma. Cardiotoxicity includes.........cardiac dysrrhythmia with WIDENING OF QRS complex, ventricular tachycardia(mainly) and also sometimes, atrial arrhythmias or conduction delays. Most specific test to diagnose............serum drug levels. But in acute severe toxicity/ serious toxicity..........EKG is more important for diagnosis. Hope this answer is right................. 
|
Delusional
| Forum Elite Topics: 41 Posts: 226
Yes....more than right.... Good answer.....Well...one thing is that for any patient with presumptive TCA toxicity.... EKG is always first thing to do because u can never predict what is serious toxicity with TCA unless you actually do the EKG or obviously if the patient is comatose or in seizures....and the typical finding that wld be mentioned on the EKG if brought in the test wld be prolonged QT interval (like quinidine) with risk of Torsades de Pointes.... Again.......Perfect answer........ Excellent Job Satya....... :wink:
|
| Topics: Posts:
Very nice Explonations. So What should we answer if asked like What is next step in the management of this pt Is it the EKG or Gastric Lavage Please Clarify. Thanks. Sujala.
|
smitha
| Forum Elite Topics: 53 Posts: 236
Well, i guess finally it wud be better to go for EKG then sujala, coz u need to base ur t/t depending on that.............just r/o the dangerous thing FIRST!!!!!!!!!!! .............the cardiotoxicity.............
|
AAAAA
| Forum Fanatic Topics: 159 Posts: 2013
EKG
|
|
| | |||||||||||||||||||||||||||
|
This thread is closed, so you cannot post a reply.
 Similar forum topicspost herpetic neuralgia Q.Post Herpatic Neuralgia herpetic whitlow | Related resources Practical Guide to the Care of the Medical Patient |
Advertise | Support | Premium | Contact |
Your Privacy Choices