8) Toxicology and Environmental

Question 1

Sedative Hypnotic Toxidrome

Answer 1

(Opiates, Benzos, Ethanol, Barbituates)

• decreased level of consciousness
• bradypnea
• respiratory depression
• hypotension
• miosis

Question 2

Anticholinergic Toxidrome

Answer 2

(Diphenhydramine, other OTC drugs)

• tachycardia
• pyrexia
• dry mouth
• mydriasis
• flushed skin

Question 3

Cholinergic Toxidrome

Answer 3

(Agriculture exposure to organophsophate based pesticides and industrial accidents)
"SLUDGE"
-salivation
-lacrimation
-urination
-diarrhea
-GI distress
-emesis

Question 4

Sympathomimetic Toxidrome

Answer 4

(Cocaine, Meth, Ephedrine, Ecstasy)

• HTN
• tachycardia
• mydriasis
• arrhythmias

Question 5

Tx of unconscious patient w/ “coma cocktail”

Answer 5

Glucose, thiamine, naloxone and oxygen

Question 6

Decontamination method of choice

Answer 6

Activated charcoal

Question 7

What does not work w/ activated charcoal

Answer 7

Ethanol, hydrocarbons, heavy metals, acids and alkalis

Question 8

Anthrax

Answer 8

aerobic gram positive, spore forming

• incubation < 1 week
• Tx: fluroquinolones or doxycycline

Question 9

Tylenol OD

Answer 9

hepatotoxicity caused by glutathione depletion
Tx: activated charcoal
-NAC
-hemodialysis

Question 10

Tx of heroin OD

Answer 10

Naloxone

Question 11

Cocaine OD

Answer 11

Tx cardiac effects like you would tx a cardiac dz

but NOOOO beta blockade

Question 12

Amphetamine OD

Answer 12

largely supportive, benzos, activated charcoal if possible mixed ingestion

Question 13

Tx of hallucinogenic OD

Answer 13

Supportive w/ benzo to control acute agitation

Question 14

tx of ethanol intoxication

Answer 14

Iv hydration, supplemental thiamine, folate and glucose

Question 15

Isopropyl alcohol ingestion

Answer 15

aka rubbing alcohol
**osmolal gap and ketosis
Tx: largely supportive
-fluids, pressors, dialysis

Question 16

Methanol ingestion

Answer 16

aka glass cleaners, de-cingin products, antifreeze
Tx: Gastric lavage, admin of ethanol or 4-MP to block the converio to methanol to toxic metabolites
-dialysis if severe metabolic acidosis

Question 17

Ethylene Glycol ingestion

Answer 17

aka anti freeze and automotive coolants

Tx: give ethanol to block conversion

Question 18

TCA OD

Answer 18

stabilize w/ ACLS protocols

• *sodium bicarb for those w/ ventricular dysrhythmias w/ hypotension or QRS widening
• activated charcoal

Question 19

Digoxin Toxicity

Answer 19

-increases myocardial contractility and slows the electrical conduction at the AV node
-No specific PE findings…hypotension and brady
-get digoxin level and electrolyte panel
Tx: cardiac monitor, activated charcoal, (see pg 206)

Question 20

Most common cause of lethal poisoning in the world

Answer 20

Carbon Monoxide

Question 21

Effect of CO

Answer 21

binds to Hgb w/ 200x affinity than oxygen to form carboxyhemoglobin (hbCO)
***LEFTward shift of oxyhemoglobin dissociation curve

Question 22

clues to dx of CO poisoning

Answer 22

• multiple individuals from the same location w/ similar sump
• known exposure to CO producing equipment
• beginning of cooler weather that may prompt the resignation of fireplaces and dormant heating units

Question 23

PE of CO poisoning

Answer 23

-hemodynamic abn
-tacypnea
-cherry red skin discoloration (RARE)
Labs = HbCO >10%

Question 24

Tx of CO poisoning

Answer 24

general supportive care and delivery of supplement oxygen

-hyperbaric oxygen is only for level >25%, >15% in pregnancy, neuropyschological dysfunction, hemodynamic instability

Question 25

Hypothermia =

Answer 25

body temp <35
-osborn J wave of EKG (slow positive deflection a the end of the QRS complex that is characteristic of hypothermia but not specific)
Tx: rewarming

Question 26

Frostbite =

Answer 26

numbness, erythema and white discoloration

Tx: rewarming w/ careful attention; can cause acidosis and hyperkalemia

Question 27

Preferred tx of heat stroke

Answer 27

-rapid cooling in ice water