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  <head>
    <title>059-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Toxicology foundations">
      <outline text="Orientation and immediate approach">
        <outline text="Physiology applied under uncertainty">
          <outline text="Histories incomplete, products mixed"/>
        </outline>
        <outline text="Protect staff and stop exposure">
          <outline text="Remove clothing, brush off dry chemicals"/>
        </outline>
        <outline text="Stabilise airway, breathing, circulation"/>
        <outline text="Normal early findings do not exclude delay">
          <outline text="Delayed release, metabolites, hepatic toxicity"/>
        </outline>
        <outline text="History: substance, maximum amount, time, route"/>
        <outline text="Self-poisoning: psychosocial review after stabilisation">
          <outline text="Low intent does not reduce dose"/>
        </outline>
      </outline>
      <outline text="Toxidromes">
        <outline text="Opioid: low consciousness, slow breathing, small pupils"/>
        <outline text="Sedative-hypnotic: no unique pupil pattern"/>
        <outline text="Sympathomimetic: agitation, mydriasis, sweating"/>
        <outline text="Antimuscarinic: mydriasis with dry flushed skin">
          <outline text="Reduced bowel sounds, urinary retention"/>
        </outline>
        <outline text="Cholinergic: secretions, bronchospasm, small pupils"/>
        <outline text="Serotonin toxicity: hyperreflexia, clonus, heat"/>
        <outline text="Neuroleptic malignant syndrome: slower, rigid"/>
        <outline text="Malignant hyperthermia: anaesthetic-triggered"/>
      </outline>
      <outline text="Testing and decontamination">
        <outline text="Paracetamol measured despite no symptoms"/>
        <outline text="QRS widening: sodium-channel blockade"/>
        <outline text="QT prolongation: polymorphic ventricular tachycardia"/>
        <outline text="Urine screens: treat the patient, not the screen"/>
        <outline text="Charcoal: early, cooperative, protected airway">
          <outline text="Aspiration can be catastrophic"/>
          <outline text="Poor binding of alcohols, metals, corrosives"/>
        </outline>
        <outline text="Whole-bowel irrigation for selected cases"/>
      </outline>
      <outline text="Paracetamol and salicylate">
        <outline text="Paracetamol saturates conjugation">
          <outline text="Reactive metabolite depletes glutathione"/>
        </outline>
        <outline text="Nomogram only for single timed ingestion"/>
        <outline text="N-acetylcysteine replenishes glutathione"/>
        <outline text="Salicylate uncouples and stimulates respiration">
          <outline text="Early respiratory alkalosis, later acidosis"/>
        </outline>
        <outline text="Toxicity can worsen as serum level falls"/>
        <outline text="Avoid intubation, preserve hyperventilation"/>
      </outline>
      <outline text="Opioids, sedatives, antidepressants">
        <outline text="Ventilation is the priority"/>
        <outline text="Naloxone titrated to breathing">
          <outline text="May wear off before the opioid"/>
        </outline>
        <outline text="Flumazenil can precipitate seizure"/>
        <outline text="Tricyclics block fast sodium channels">
          <outline text="Bicarbonate treats cardiovascular toxicity"/>
        </outline>
        <outline text="Serotonin reuptake inhibitors often milder"/>
      </outline>
      <outline text="Stimulants and hyperthermia">
        <outline text="Catecholamine excess: agitation, vasospasm, heat"/>
        <outline text="Benzodiazepines reduce central activation"/>
        <outline text="Rapid external cooling, not antipyretics"/>
        <outline text="Serotonin toxicity: stop, sedate, cool"/>
        <outline text="Neuroleptic malignant syndrome: stop, support"/>
        <outline text="Malignant hyperthermia: immediate dantrolene"/>
      </outline>
      <outline text="Alcohols and gases">
        <outline text="Ethanol intoxication is a diagnosis of exclusion"/>
        <outline text="Methanol: formic acid, vision, basal ganglia"/>
        <outline text="Ethylene glycol: acidosis, kidney, oxalate"/>
        <outline text="Fomepizole blocks alcohol dehydrogenase"/>
        <outline text="Carbon monoxide: pulse oximetry can look normal">
          <outline text="High oxygen, co-oximetry, hyperbaric advice"/>
        </outline>
        <outline text="Cyanide blocks electron transport">
          <outline text="Lactic acidosis, prompt antidote"/>
        </outline>
      </outline>
      <outline text="Pesticides, metals, corrosives">
        <outline text="Organophosphates inhibit acetylcholinesterase">
          <outline text="Atropine to secretions and perfusion"/>
          <outline text="Weakness after apparent recovery"/>
        </outline>
        <outline text="Lead: children and pregnancy vulnerable">
          <outline text="Remove source, chelate by level and symptoms"/>
        </outline>
        <outline text="Acids coagulate, alkalis penetrate"/>
        <outline text="Oropharynx does not predict oesophagus"/>
      </outline>
      <outline text="Envenomation and bites">
        <outline text="Record time, place, progression"/>
        <outline text="Keep still, immobilise, pressure guidance">
          <outline text="No cutting, sucking, freezing, tourniquet"/>
        </outline>
        <outline text="Antivenom by syndrome, ready for anaphylaxis"/>
        <outline text="Bites: irrigate, tetanus, rabies, antibiotics">
          <outline text="Hand and fist injuries: urgent surgery"/>
        </outline>
      </outline>
      <outline text="Heat, cold, immersion">
        <outline text="Heat exhaustion lacks neurological dysfunction"/>
        <outline text="Heat stroke: encephalopathy, organ injury">
          <outline text="Cold-water immersion, do not delay"/>
        </outline>
        <outline text="Hypothermia: bradycardia, coagulopathy">
          <outline text="Handle gently, rewarm by severity"/>
        </outline>
        <outline text="Drowning: ventilation and oxygenation first"/>
      </outline>
    </outline>
  </body>
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