Ch 28 Flashcards
The hyperpnea and tachypnea associated with methyl alcohol intoxication is secondary to:
an elevated blood pH.
heart failure.
hypoxemia.
metabolic acidosis.
metabolic acidosis
Drug misuse is defined as:
- the use of legal medications that is not in accordance with a physician’s order.
- any use of a drug that causes physical, psychological, or legal harm to the user.
- the habitual use of illicit drugs for the purpose of inducing a euphoric feeling.
- inadvertent misuse of a licit or illicit drug that causes physical harm to the user.
any use of a drug that causes physical, psychological, or legal harm to the user.
You are transporting a chronic heroin abuser to whom you have just administered naloxone. The patient is responsive to verbal stimuli, and her respirations, blood pressure, and pulse rate have improved following your treatment. With an estimated time of arrival at the hospital of 20 minutes, which of the following should concern you the most?
- There is a high potential that the patient will suddenly become violent.
- The patient may deteriorate and require further naloxone administration.
- Low doses of naloxone often precipitate seizures in chronic heroin abusers.
- The patient will require immediate intubation if her respirations decrease.
The patient may deteriorate and require further naloxone administration.
Which of the following is a sign or symptom of organophosphate poisoning?
Tachycardia
Pupillary dilation
Vomiting
Constipation
vomiting
Which of the following drugs is classified as an anticholinergic?
Diazinon
Phenylephrine
Thiopental
Atropine
Atropine
Prehospital treatment for a patient who overdosed on aspirin may include:
flumazenil.
an antipyretic.
calcium chloride.
sodium bicarbonate.
Sodium bicarbonate
You respond to a local motel for a young woman who was sexually assaulted. Upon your arrival, you find the patient sitting on the bed talking to a police officer. The last thing she remembers is meeting “some guy” at a nightclub the evening before and then having a few drinks with him. She is conscious, but sleepy. Her respirations are 12 breaths/min and regular, pulse rate is 56 beats/min and strong, and blood pressure is 102/58 mm Hg. The cardiac monitor reveals sinus bradycardia at 50 beats/min. You should:
- assist her ventilations with a bag-mask device, start an IV line, administer 0.5 mg of atropine, and transport.
- monitor her oxygen saturation, start an IV line at a keep-vein-open rate, transport, and monitor her en route to the hospital.
- give her supplemental oxygen, conduct a secondary assessment at the scene to collect evidence, and transport her.
- conclude that she was unknowingly administered a narcotic analgesic, start an IV line, and give her 2 mg of naloxone.
monitor her oxygen saturation, start an IV line at a keep-vein-open rate, transport, and monitor her en route to the hospital.
You are transporting a patient who is under the influence of methamphetamine. The patient, who is clearly anxious, has a blood pressure of 160/90 mm Hg, a pulse rate of 140 beats/min, and a respiratory rate of 24 breaths/min. The patient suddenly becomes violent and begins thrashing around, trying to get off the stretcher. After asking your partner to stop the ambulance to assist you with the patient, you should:
administer a beta blocker and reassess.
assess his blood glucose level.
administer 4 mg/kg of ketamine IM.
start an IV line and give him morphine.
administer 4 mg/kg of ketamine IM.
From an anatomic and physiologic perspective, inhaled toxins:
- quickly reach the alveoli and rapidly gain access to the circulatory system.
- often take several hours before clinical signs and symptoms manifest.
- typically take between 15 and 20 minutes to exert a systemic effect.
- generally provide a large window of opportunity for treatment.
quickly reach the alveoli and rapidly gain access to the circulatory system.
When chlorine gas comes in contact with the body’s mucous membranes, it forms:
a strong alkali.
boric acid.
sulfuric acid.
hydrochloric acid.
hydrochloric acid.
Spray paints and lacquer thinner contain which of the following substances?
Benzene
Toluene
Carbon tetrachloride
Methylene chloride
Toluene
Treatment for cyanide poisoning may include:
calcium gluconate.
activated charcoal.
calcium chloride.
amyl nitrite.
amyl nitrite.
Which of the following cardiac rhythm disturbances most commonly results from inadvertent overdose of a prescribed cardiac medication?
Bradycardia
Tachycardia
Atrial flutter
Atrial fibrillation
Bradycardia
You are caring for an alcoholic patient who has been abstinent for about 2 days. The patient is confused, restless, and tells you that he sees snakes crawling on the walls. His blood pressure is 76/52 mm Hg, pulse rate is 150 beats/min and weak, and respirations are 24 breaths/min with adequate depth. In addition to administering oxygen, you should:
- treat his hypotension with crystalloid fluid boluses.
- administer 6 mg of adenosine to slow his heart rate.
- sedate him with 5 mg of Valium and transport at once.
- provide emotional support only and transport immediately.
treat his hypotension with crystalloid fluid boluses.
Common signs and symptoms of a tricyclic antidepressant overdose include:
tachypnea and severe hypertension.
excessive salivation and diarrhea.
altered mental status and tachycardia.
constricted pupils and AV heart block.
altered mental status and tachycardia.
The toxicity of carbon monoxide arises primarily from its:
ability to destroy hemoglobin molecules.
affinity for hemoglobin in red blood cells.
ability to markedly decrease the metabolic rate.
destructive properties on ferric ions.
affinity for hemoglobin in red blood cells.
Which of the following is a sign of severe MAOI toxicity?
Dementia
Hypertension
Diaphoresis
Hyperthermia
Hyperthermia
A young man is found unresponsive by his girlfriend. Your assessment reveals marked respiratory depression; a slow, weak pulse; and pinpoint pupils. There are numerous medication bottles found in his home. Which of the following has he most likely ingested?
Sudafed
Benadryl
Valium
Oxycodone
Oxycodone
Metabolic acidosis, hyperkalemia, and rhabdomyolysis that occurs with MAOI toxicity are usually the result of:
respiratory failure.
acute renal failure.
persistent seizures.
cardiac dysrhythmias.
Persistent seizures
Crack is a combination of:
marijuana, heroin, and baking soda.
cocaine, baking soda, and water.
heroin, cocaine, and distilled water.
ecstasy, marijuana, and alcohol.
cocaine, baking soda, and water.
An unresponsive middle-aged man ingested a half-full bottle of Valium approximately 30 minutes ago. His respirations are slow and shallow, his pulse is slow and weak, and his blood pressure is significantly low. The cardiac monitor reveals sinus bradycardia. You should:
- insert a supraglottic airway, establish vascular access, administer up to 4 L of normal saline, and give him 0.1 mg/kg of naloxone.
- assist his ventilations, administer flumazenil via slow IV push if allowed by protocol, and consider that he likely ingested another type of CNS depressant.
- administer oxygen via nonrebreathing mask, start an IV line, and give 150 mg of amiodarone to prevent lethal ventricular dysrhythmias.
- immediately intubate his trachea, hyperventilate him to minimize acidosis, establish vascular access, and administer up to 10 mg of flumazenil.
assist his ventilations, administer flumazenil via slow IV push if allowed by protocol, and consider that he likely ingested another type of CNS depressant.
Ingestion of the foxglove plant can result in which of the following symptoms?
Renal failure
Dysrhythmias
Bradycardia
Severe gastroenteritis
Dysrhythmias
Poisoning with which of the following is most often the result of improper food storage or canning?
Salmonella
Listeria
Clostridium botulinum
Toxoplasma
Clostridium botulinum
Lithium is most commonly used to treat patients with:
bipolar disorder.
schizophrenia.
depression.
chronic anxiety.
Bipolar disorder
A 22-year-old woman experienced an acid chemical burn to her left forearm. She complains of intense pain and tingling in her fingers. She is conscious and alert, and denies any other symptoms. You should:
administer oxygen via nonrebreathing mask.
apply a light coat of baking soda to the burn.
cover the burn and transport at once.
begin immediate irrigation with water.
begin immediate irrigation with water.
You would expect a person to be hypertensive and tachycardic following exposure to:
ethanol.
morphine.
phenobarbital.
bath salts.
bath salts
What is the poisonous part of the apricot plant?
Bulb
Root
Leaf
Seed
seed
Fluid-refractory hypotension following a barbiturate overdose is treated most effectively with:
calcium.
dopamine.
atropine.
naloxone.
dopamine
Cardiac arrest following a narcotic overdose is usually the result of:
a cardiac dysrhythmia.
seizures.
renal failure.
respiratory arrest.
respiratory arrest
Organophosphates exert their effect by:
blocking the parasympathetic nervous system.
stimulating the cholinergic nervous system.
agonizing the sympathetic nervous system.
destroying the body’s acetylcholine.
stimulating the cholinergic nervous system.
You have administered a total of 10 mg of Narcan to an unresponsive 30-year-old man whom you believe has overdosed on a narcotic. However, the patient remains unresponsive, is hypoventilating, and is bradycardic. Your transport time to the closest appropriate hospital is 40 minutes. You should:
- insert a laryngeal mask airway, transport at once, and begin an epinephrine infusion en route to the hospital.
- insert a nasogastric tube to decompress his stomach, administer another 2 mg of Narcan, and transport.
- continue assisted ventilation for 2 to 3 minutes, insert an advanced airway device, and transport immediately.
- insert an oropharyngeal airway, continue bag-mask ventilations at a rate of 20 breaths/min, and transport.
continue assisted ventilation for 2 to 3 minutes, insert an advanced airway device, and transport immediately.
A common sign or symptom of carbon monoxide toxicity is:
jaundice.
pallor or cyanosis.
cherry red skin color.
bradycardia.
pallor or cyanosis
A person who compulsively uses a drug, despite the fact that they know the drug will cause physical or psychological harm, is:
an abuser.
dependent.
addicted.
tolerant.
addicted
The toxic chemical in castor beans is:
caladium oxalate.
ricin.
lantadene A.
cyanide.
RICIN
A person who is “speedballing” is:
- using cocaine in combination with heroin, by injecting them either underneath the skin or directly into a vein, in order to regulate the high.
- packaging cocaine in small plastic bags and swallowing them for the purpose of transporting the cocaine from one location to another location.
- highly addicted to methamphetamine, cocaine, and marijuana and mixes all three drugs together to achieve various levels of euphoria.
- using heroin to withdraw or detoxify themselves from cocaine by gradually increasing the amounts of heroin taken while decreasing the amounts of cocaine used.
using cocaine in combination with heroin, by injecting them either underneath the skin or directly into a vein, in order to regulate the high.
Appropriate prehospital treatment for a patient who has overdosed on a stimulant and is excessively tachycardic and violent includes:
antidepressants.
beta-blockers.
benzodiazepines.
activated charcoal.
benzodiazepines.
A patient in the later stages of iron poisoning would be expected to present with:
diarrhea.
tachycardia.
hypotension.
liver failure.
liver failure
Cyanide blocks the utilization of oxygen at the cellular level by:
combining with cytochrome oxidase.
binding to monoamine oxidase.
binding to the hemoglobin molecule.
directly destroying red blood cells.
combining with cytochrome oxidase.
The clinical presentation of a stimulant abuser includes:
excitement, hypertension, tachycardia, and dilated pupils.
an irregular pulse, hyperpyrexia, hypotension, and bradycardia.
hypotension, tachycardia, constricted pupils, and hypothermia.
somnolence, hypotension, bradycardia, and a staggering gait.
excitement, hypertension, tachycardia, and dilated pupils.
You would expect a person using methamphetamine to present with:
diarrhea.
hypoventilation.
bradypnea.
hypertension.
hypertension
Immediate treatment for a patient who overdosed on a narcotic and is hypercarbic includes:
ventilation with a bag-mask device.
insertion of a nasogastric tube.
endotracheal intubation.
naloxone, 0.4 to 2 mg IV push.
ventilation with a bag-mask device.
Which of the following interventions is influenced strongly by the amount of time that has elapsed since a patient ingested a toxic substance?
IV therapy
Gastric lavage
Intubation
Transport
Gastric lavage
Pulse oximetry will not provide a true assessment of arterial oxygenation in patients with carbon monoxide toxicity because:
the device falsely interprets oxyhemoglobin as carboxyhemoglobin.
carbon monoxide turns the blood dark red, which indicates low oxygen content.
carbon monoxide damages the computer chip inside the pulse oximeter.
the device cannot determine whether carbon monoxide or oxygen is bound to the hemoglobin.
the device cannot determine whether carbon monoxide or oxygen is bound to the hemoglobin.
A known alcoholic man is found unresponsive by a law enforcement officer. An empty container of antifreeze was found near him. Your assessment reveals that his respirations are deep and rapid, his pulse rate is rapid and weak, and his pupils are dilated and sluggishly reactive. As your partner administers high-flow oxygen to the patient, you should:
assess his blood glucose level and apply a cardiac monitor.
give him 100 mg of thiamine IM and assess his blood pressure.
start an IV line and give 1 mEq/mg of sodium bicarbonate.
start an IV line and begin administering a saline fluid bolus.
assess his blood glucose level and apply a cardiac monitor.
A 45-year-old woman is found unresponsive in an alley. During your assessment, you note that she is tachycardic and breathing rapidly. She has an obvious odor of alcohol on her breath. Your most immediate concern should be to:
obtain a blood glucose reading.
start an IV line and administer naloxone.
determine the etiology of her tachycardia.
take actions to prevent aspiration.
take actions to prevent aspiration.
Patients with alcoholism are prone to subdural hematomas and gastrointestinal bleeding because:
they fall more frequently than sober people.
their blood-clotting mechanisms are impaired.
they are at higher risk for violent assault.
alcohol causes significant immunocompromise.
their blood-clotting mechanisms are impaired.
Exposure to sarin or tabun would result in:
pupillary dilation.
excessive lacrimation.
hyperthermia.
severe tachycardia.
excessive lacrimation.
You are transporting a young female who intentionally ingested a large quantity of her prescribed Pamelor. She is conscious, but drowsy, and complains of a dry mouth and blurred vision. The cardiac monitor reveals sinus tachycardia at 120 beats/min. You are administering high-flow oxygen and have established a patent IV line. With regard to her ECG rhythm, you should be especially alert for:
QT interval narrowing.
QRS widening.
a prolonged PR interval.
AV heart block.
QRS widening
Management for an ingested poison focuses mainly on:
treating the systemic effects that result.
neutralizing the poison in the stomach.
administering a counteracting agent.
the prompt induction of vomiting.
neutralizing the poison in the stomach.
Which of the following is an ECG change that would most likely be observed in a patient with tricyclic antidepressant toxicity?
High-grade AV block
Shortened PR interval
Terminal R wave in aVR
Shortened QT interval
Terminal R wave in aVR
Symptoms of delirium tremens usually begin within how many hours after the last alcohol intake?
72 to 96
24 to 48
48 to 72
12 to 24
48 to 72 hours
Which of the following antidepressant medications has the highest safety margin?
Paroxetine
Nortriptyline
Imipramine
Doxepin
Paroxetine
A 100-pound violent young woman who requires four large paramedics to subdue and contain her is most likely under the influence of:
mescaline.
PCP.
LSD.
ketamine.
PCP
Severe salicylate toxicity produces:
bradypnea.
increased pH levels.
metabolic acidosis.
respiratory acidosis.
metabolic acidosis
If administered in conjunction with nitrates, sildenafil would most likely cause:
severe hypotension.
coronary vasospasm.
ventricular tachycardia.
respiratory depression.
severe hypotension.
A middle-aged woman who has been taking 2 mg of clonazepam each day for 6 months finds that she now requires 4 mg each day to achieve the same effect. This is an example of:
tolerance.
drug abuse.
habituation.
physical dependence.
tolerance
Alcohol potentiates Valium. This means that:
the use of alcohol negates the use of Valium.
alcohol enhances the effects of Valium.
alcohol antagonizes the effects of Valium.
Valium makes alcohol a toxic substance.
alcohol enhances the effects of Valium.
Which of the following types of medications contain amphetamine?
Nasal decongestants
Anti-inflammatory drugs
Drugs used to treat insomnia
Drugs used to treat anxiety
Nasal decongestants
A 29-year-old woman was found unresponsive by her husband. When you arrive at the scene and begin your assessment, you note that the patient’s respirations are slow and shallow, her pulse is slow and weak, and her pupils are dilated. Your partner begins assisting the patient’s ventilations as you assess her blood pressure, which is 70/48 mm Hg. The patient’s husband hands you an empty bottle of phenobarbital, which was filled the day before, and tells you that his wife takes the medication for seizures. After establishing vascular access, you should:
instruct your partner to hyperventilate the patient at 24 breaths/min.
give her up to 10 mg of naloxone to reverse the effects of the drug.
begin a dopamine infusion at 10 mg/kg/min and titrate as needed.
administer crystalloid fluid boluses to improve her blood pressure.
administer crystalloid fluid boluses to improve her blood pressure.
Which of the following is a sign of marijuana use?
Hallucinations
Significant delirium
Drowsiness
Decreased appetite
Drowsiness
A woman drives her husband to your EMS station after he was exposed to a large amount of pesticide. Your assessment reveals that he is responsive to pain only, is hypoventilating, is markedly bradycardic, and is incontinent of urine and feces. The cardiac monitor reveals marked sinus bradycardia. As your partner assists the patient’s ventilations, you should:
administer 1 to 2 mg of pralidoxime IM and transport immediately.
start an IV line and give sodium bicarbonate to alkalinize his urine.
obtain a 12-lead ECG tracing to detect signs of myocardial injury.
establish vascular access and begin administering atropine sulfate.
establish vascular access and begin administering atropine sulfate.
An acetone breath odor is common following exposure to:
aspirin.
turpentine.
camphor.
chloral hydrate.
aspirin
Upon arriving at the scene of an incident involving a chlorine gas spill, you should:
begin triaging all patients.
don a protective breathing apparatus.
remove all patients from the scene.
park the ambulance upwind.
park the ambulance upwind.
Which of the following statements regarding methyl alcohol is correct?
Methyl alcohol is not recognized as a poison, although it has many properties of a poison when consumed in sufficient quantities.
Methyl alcohol is also known as wood alcohol, and is present in paints, paint removers, windshield washer fluid, and varnishes.
Also referred to as methanol, methyl alcohol is colorless and odorless and requires large amounts to cause toxicity.
The signs and symptoms of methyl alcohol poisoning typically appear within 15 to 20 minutes following ingestion of as little as 5 to 10 mL.
Methyl alcohol is also known as wood alcohol, and is present in paints, paint removers, windshield washer fluid, and varnishes.
Death from acetaminophen overdose is most often caused by:
metabolic alkalosis.
progressive liver failure.
gastrointestinal bleeding.
acute splenic rupture.
Progressive liver failure
Which of the following medications is a tricyclic antidepressant?
Zoloft
Fluoxetine
Clomipramine
Prozac
Clomiparmine
Gamma-hydroxybutyrate is most commonly used to:
enhance the senses.
treat chronic coughing.
facilitate sexual assault.
induce euphoria.
facilitate sexual assault.
Tricyclic antidepressant medications:
are very safe because they have a large therapeutic window.
are the first-line therapy for the treatment of depression.
may produce toxic effects with even minimal dosing errors.
generally require high doses to achieve a therapeutic effect.
may produce toxic effects with even minimal dosing errors.
You should be most suspicious that a patient has systemic iron toxicity if they present with:
hypertension.
bradypnea.
hematemesis.
severe nausea.
hematemesis.
In general, symptoms of arsenic poisoning appear within which timeframe after arsenic ingestion?
30 minutes to several hours
2 to 6 hours
24 to 36 hours
12 to 24 hours
30 minutes to several hours
What is a lethal dose of ethylene glycol in a 190-pound man?
50 mL
175 mL
150 mL
120 mL
175ml
The most important prehospital treatment intervention for a patient with carbon monoxide poisoning is:
providing high-flow oxygen.
monitoring pulse oximetry.
monitoring cardiac rhythm.
establishing vascular access.
providing high flow oxygen
Inadvertent lithium toxicity would most likely occur in a patient who is taking:
any medication used to control blood pressure.
a tricyclic antidepressant.
SSRIs.
NSAIDs.
NSAIDs.
During your assessment of a 33-year-old woman who you suspect is under the influence of a drug, the patient tells you that she was “listening to the painting on the wall” before you arrived. Her pulse rate and blood pressure are both elevated. This clinical presentation is most consistent with the use of:
LSD.
marijuana.
PCP.
methamphetamine.
LSD
If you are treating a patient with a suspected benzodiazepine overdose and find that the patient is hypotensive, bradycardic, and comatose:
you should rapidly administer 2 mg of naloxone via the IV, IO, or IM route.
avoid administering flumazenil and transport the patient immediately.
you should consider concomitant overdose with another CNS depressant.
it is likely that the patient is also under the influence of methamphetamine.
you should consider concomitant overdose with another CNS depressant.
The recommended dose and method for administering naloxone to a patient who overdosed on a narcotic and is unresponsive and hypoventilating is:
- 5 to 10 mg via the endotracheal tube until the pupils dilate.
- 0.4 to 2 mg slowly until the patient’s respirations improve.
- 0.4 to 2 mg rapidly until the patient regains consciousness.
- 0.1 mg/kg rapidly until the patient’s respirations improve.
0.4 to 2 mg slowly until the patient’s respirations improve.
Toxic effects of alcohol on the liver include:
- acid imbalances.
- hyperglycemia.
- coagulopathy.
- gastritis.
Coagulopathy
A patient who ingested a significant quantity of acetaminophen less than 24 hours ago would most likely present with:
- signs of renal failure and severe vomiting.
- pain in the right upper abdominal quadrant.
- flushed skin, high fever, and abdominal pain.
- malaise, nausea, and a loss of appetite.
Malaise, nausea, and loss of appetite
You are dispatched to a residence for a 61-year-old woman with flulike symptoms. Upon your arrival, the patient greets you at the door. She complains of a headache and nausea, and tells you that she has vomited twice. Her husband, who is lying on the couch in the living room, began experiencing the same symptoms at about the same time. You should:
- carefully assess the residence for any unusual findings.
- suspect that both patients have been exposed to cyanide.
- immediately open all of the windows in the house.
- remove both patients from the residence at once.
Remove both patients from the residence at once
Which of the following is a sign of severe barbiturate withdrawal?
- Nausea and vomiting
- Diaphoresis
- Hallucinations
- Abdominal cramping
Hallucinations
Mild to moderate iron toxicity should be expected with ingestion of how much iron?
- 30 to 80 mg/kg
- 10 to 20 mg/kg
- 20 to 60 mg/kg
- 60 to 90 mg/kg
20 to 60 mg/kg
A 69-year-old man presents with confusion, a headache, dyspnea, and palpitations after he rescued his two grandchildren from their burning house. During your assessment, you note that he has an odd odor on his breath; however, he denies being diabetic. You should:
- have him inhale amyl nitrate for 20 seconds and then 100% oxygen for 40 seconds out of each minute.
- start an IV line of normal saline and administer 10 mL of a 10% solution of calcium chloride.
- start an IV line, sedate and chemically paralyze the patient, and then perform endotracheal intubation.
- administer 1 to 2 g of pralidoxime infused with normal saline solution over a 5- to 10-minute period.
Have him inhale amyl nitrate for 20 second and then 100% oxygen for 40 second out of each minute
In adult patients, oral ingestion of a caustic substance:
- causes immediate death.
- is usually intentional.
- contraindicates intubation.
- requires activated charcoal.
Is usually intentional
Which of the following drugs is an opiate?
- Oxycodone
- Fentanyl
- Tramadol
- Morphine
Morphine
Your first priority when dealing with a patient who may have overdosed is to:
- enter the scene carefully.
- request law enforcement.
- assess the patient’s airway.
- ascertain what the patient took.
Request law enforcement
