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The clinical triad of pinpoint pupils (miosis) + drowsiness/coma + respiratory depression is the classic presentation of Opioid Poisoning.
Opioid toxidrome:
- CNS depression (lethargy β coma)
- Respiratory depression (RR <12/min β most dangerous)
- Miosis (pinpoint pupils)
- Bradycardia, hypotension
Antidote: Naloxone (Narcan) β opioid receptor antagonist
\[\text{Dose: } 0.1\,\text{mg/kg}\,\text{IV/IM/intranasal (max 2 mg per dose)}\]
- Onset IV: 1β2 minutes
- Duration: 30β90 minutes (shorter than most opioids β may need repeat doses or infusion)
- Monitor for re-narcotization
Other antidotes (important for nurses):
| Poison | Antidote |
|---|---|
| Organophosphates | Atropine + Pralidoxime |
| Paracetamol | N-Acetylcysteine |
| Benzodiazepines | Flumazenil |
| Iron | Desferrioxamine |
| Lead | DMSA (Succimer), EDTA |
| Carbon monoxide | 100% Oβ / Hyperbaric Oβ |
Rhesus (Rh) Isoimmunization Prevention is critical in Rh-negative pregnant women:
Sensitizing events requiring Anti-D administration:
- Amniocentesis, CVS, cordocentesis
- Antepartum hemorrhage (APH)
- External cephalic version (ECV)
- Abdominal trauma
- Miscarriage/termination
- Ectopic pregnancy
- Delivery (within 72 hours)
Routine prophylaxis: Anti-D 300 mcg IM at 28 weeks (and some protocols: 28 + 34 weeks).
Dose:
- First trimester sensitizing event: \(250\,\text{IU}\) (50 mcg)
- After 20 weeks / delivery: \(500\,\text{IU}\) (100 mcg) or \(300\,\text{mcg}\) (1500 IU)
The Kleihauer-Betke test estimates fetal-maternal hemorrhage volume to calculate additional Anti-D dose needed:
\[\text{Additional dose} = \frac{\% \text{fetal cells} \times \text{maternal blood volume}}{30} \times 300\,\mu\text{g}\]
Without prophylaxis, risk of sensitization after delivery = 16%. With Anti-D = reduced to <0.1%.
Sickle cell anemia results from what molecular abnormality?
Sickle cell anemia is caused by a point mutation (GAG β GTG) in the Ξ²-globin gene, replacing glutamate (Glu) with valine (Val) at position 6, causing hemoglobin polymerization.
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