Acute Care/Toxidromes

Question 1

Management of stable polymorphic VT?

Answer 1

Magnesium 2g over 10 minutes

Question 2

Management of fast AF if stable

Answer 2

Beta blocker
Consider digoxin or amiodarone if evidence of heart failure
Anticoagulate if over 48 hours

Question 3

What to give in regular SVT if amiodarone ineffective

Answer 3

Beta blocker or verapamil

Question 4

What to give in regular SVT if beta blocker or verapamil ineffective

Answer 4

Cardioversion

Question 5

Stable VT management

Answer 5

300mg amiodarone

Question 6

What strength and volume of adrenaline is given for anaphylaxis?

Answer 6

1:1000 (1mg in 1ml), 0.5ml (500micrograms)

Question 7

What strength of adrenaline is given in cardiac arrest?

Answer 7

1:10000

Question 8

When can you take a first paracetamol level?

Answer 8

4 hours

Question 9

When should NAC ideally be administered in paracetamol overdose?

Answer 9

Within 8 hours

Question 10

When would you start NAC before getting blood results back?

Answer 10

Massive overdose
Staggered overdose
Uncertain timeframe

Question 11

Describe the opiate toxidrome

Answer 11

Reduced RR
Can be bradycardic/hypotensive
Reduced GCS
Pinpoint pupils
Often hypothermic

Question 12

Opiate antidote

Answer 12

Naloxone

Question 13

What drugs cause a hypnotic toxidrome?

Answer 13

Benzodiazepines
Z drugs

Question 14

Describe the hypnotic toxidrome

Answer 14

Decreased resp rate
May have bradycardia/ hypotension
Decreased GCS
Pupils normal or dilated
Often hypothermic

Question 15

What is the difference between the hypnotic and the opiate toxidrome?

Answer 15

Hypnotic pupils normal or dilated
Opiate pin point pupils

Question 16

What is the antidote for benzodiazepines, and would you give it in a recreational overdose?

Answer 16

Flumenazil
No as need to make sure it is pure benzo use

Question 17

Examples of sympathomimetics

Answer 17

Caffeine
Cocaine
Amphetamines incl meth
MDMA/ecstasy

Question 18

Describe the sympathomimetic toxidrome

Answer 18

RR increase
HR and BP increase
Dilated pupils
Agitated
Hyperthermic and diaphoretic

Question 19

Sympathomimetic toxidrome management

Answer 19

Supportive
Maybe benzos (no specific antidote)

Question 20

Management of coronary artery vasospasm secondary to cocaine

Answer 20

As per ACS
Add in IV benzo

Question 21

What drugs cause an anti-cholinergic toxidrome?

Answer 21

Atropine
Glycopyrronium Aka glycopyrrolate
Antihistamines
TCAs

Question 22

Describe the anticholinergic toxidrome

Answer 22

Normal or increased RR
HR and BP increased
Dilated pupils
General agitation/restlessness
Hyperthermic
DRY skin

Question 23

What is the difference between a sympathomimetic and anticholinergic toxidrome?

Answer 23

Sympathomimetic increased sweating
Anticholinergic reduced sweating

Question 24

What ECG abnormalities can anticholinergic drugs cause?

Answer 24

Increased PR, QRS and QTc

Question 25

What are the potential effects of tricyclic overdose

Answer 25

QT prolongation with ventricular arrhythmia
Depressed cardiac contractility and hypotension
High risk of seizures and comas

Question 26

Tricyclic overdose management

Answer 26

IV sodium bicarbonate
Fluids for hypotension and arrhythmia
AVOID antiarrhythmics
Benzos for seizures

Question 27

What drugs cause the cholinergic toxidrome?

Answer 27

Organophosphates
Nerve agents
Pyridostigmine

Question 28

Describe the cholinergic toxidrome

Answer 28

No change to RR/HR/BP
Pinpoint pupils
Salivation, diaphoresis, lacrimation
Urination
Defaecation
Emesis
GI distress

Question 29

Cholinergic toxidrome management

Answer 29

Atropine
Supportive management
Remove toxic agent
PPE