DIAGNOSIS AND DECONTAMINATION

Question 1

While taking a _____ may be a more direct method of the determination of the toxin, is it reliable or not?

MANAGEMENT OF POISONED PATIENT

Answer 1

history; Not reliable

Question 2

Perform a carefully directed examination emphasizing key _______ that may uncover one of the common ______ syndromes.

Answer 2

physical findings; autonomic

Question 3

Important variables in the autonomic physical examination includes?

Answer 3

• Blood pressure
• Pulse rate
• Pupil size
• Sweating
• Peristaltic activity
• Vital signs
• Sensorium (Determine whether the patient is comatose, stuporous, lethargic, confused, or alert)

Question 4

Disoriented to surroundings, may have impaired judgement, may need cues to respond to commands

Answer 4

Confused

Question 5

Drowsy, needs gentle verbal or touch stimulation to initiate response

Answer 5

Lethargic

Question 6

Responds slowly to external stimulation and needs repeated stimulation to maintain attention and response

Answer 6

Obtunded

Question 7

Responds only minimally with vigorous stimulation, may only moan as a verbal response

Answer 7

Stuporous

Question 8

No observable response to any external stimuli

Answer 8

Comatose

Question 9

REMEMBER

With the clinician focusing on the patient’s
* Vital signs
* Sensorium (Determine whether the patient is comatose, stuporous, lethargic, confused, or alert)
* Motor signs
* Ocular findings, and other clinical abnormalities (eg, odor on breath, discoloration of urine),
* Clinical toxin-pattern recognition can be achieved and an initial treatment plan formalized.

Answer 9

These clues can be specific symptom complexes associated with certain toxins and can be referred to as toxidromes

Question 10

is a constellation of findings, either from the physical examination or from ancillary testing, which may result from any poison.

Answer 10

Toxidromes

Question 11

The term toxidromes was originated by _______ in 1974 to assist the clinician in identifying the classification of toxins by toxin-specific symptom complexes.

Answer 11

Howard Mofensen

Question 12

NOTE

Often, the hallucinatory pattern of the patient can be specific for certain drugs

Question 13

Causes the patient to experience Lilliputian hallucinations

Answer 13

Atropine

Lilliputian hallucinations are a rare type of visual hallucination where imaginary objects, persons or animals of diminutive size are perceived. These small images are usually described as brightly coloured mobile creatures.

Question 14

With _____, there is a simple visual hallucinatory pattern with objects appearing in the periphery of vision

Answer 14

Cocaine

Question 15

With _______, complex hallucinations are often indistinguishable clinically from a paranoid psychosis

Answer 15

Phencyclidine

Question 16

With ____, the patient experiences a combination of illusions, hallucination, and pseudohallucinations

• illusions - seeing objects in altered forms
• hallucination - experiencing sensations without external stimuli
• pseudohallucinations - knowing when one is hallucinating

Answer 16

LSD

Lysergic acid diethylamide

Question 17

Seeing objects in altered forms

Answer 17

Illusions

Question 18

Experiencing sensations without external stimuli

Answer 18

Hallucination

Question 19

Knowing when one is hallucinating

Answer 19

Pseudohallucinations

Question 20

REMEMBER

Tremors, hyporeflexia and hyperreflexia, and even the nature of seizures can be useful diagnostic tools
* Like hallucinations, seizures caused by specific toxins can exhibit certain specific properties

MOTOR SIGNS

Question 21

______ is unique in that it can cause generalized seizures while the patient is alert

This can be referred to as a ‘‘spinal seizure”

Answer 21

Strychnine

Question 22

NOTE

Other drug-induced seizures will respond only to specific antidotal therapies and not to conventional antiseizure medication.

Question 23

Drug-induced seizures will respond only to specific antidotal therapies.

Examples of this property include:
Anticholinergic-induced seizures, which may respond to _____

Answer 23

physostigmine

Question 24

Drug-induced seizures will respond only to specific antidotal therapies.

Examples of this property include:
Isoniazid-induced seizures, which respond to ______.

Answer 24

pyridoxine

Question 25

Drug-induced seizures will respond only to specific antidotal therapies.

Examples of this property include:
Theophylline-induced seizures rarely respond to ____ alone and often only to _____ therapy.

Answer 25

phenytoin; multidrug

Question 26

_________ and _________ essentially cause an increase in all of the vital signs parameters

VITAL SIGNS

Answer 26

Sympathomimetics ; anticholinergics

Question 27

From [An increase in all of the vital signs parameters]

This is particularly true for cocaine intoxication, where it has been noted that _____ may be a particularly sign for mortality.

VITAL SIGNS

Answer 27

hyperthermia

Question 28

Conversely, organophosphates, opiates, barbiturates, beta blockers, benzodiazepines, alcohol, and clonidine toxicities result in ____-thermia, respiratory depression, and bradycardia

Answer 28

hypothermia

Question 29

OCCULAR FINDINGS can be divided into 2 categories:

Answer 29

1) pupillary size and reactivity
2) demonstration of nystagmus

Nystagmus is a condition where the eyes move rapidly and uncontrollably. They can move: side to side (horizontal nystagmus) up and down (vertical nystagmus) in a circle (rotary nystagmus)

Question 30

Pupillary signs:

Both anticholinergic, sympathomimetic substances, and LSD can result in mydriasis.

But in cocaine intoxication, the pupils will respond to light (miosis), whereas with anticholinergics, the pupils will not.

OCCULAR FINDINGS

Answer 30

Mydriasis refers to the dilation of the pupil, which normally occurs in response to low amounts of light in the environment.

Miosis refers to a constricted pupil or a narrower pupil.

Question 31

NOTE

Agents that contribute to miosis include:

• Organophosphate insecticides,
• Narcotics,
• Bromide, acetone, clonidine, and nicotine.
• Phencyclidine has been known to cause either mydriasis or miosis.

Question 32

Nystagmus: ______ are probably the most common etiology of horizontal nystagmus.

Answer 32

Alcohols

Question 33

Although solvents, lithium, meprobamate, carbamazepine, quinine, phenytoin, alcohol, barbiturates, and primidone can also result in ______ nystagmus.

Answer 33

horizontal

Question 34

Phencyclidine, phenytoin, and sedative hypnotics can cause a ___(long answer)___ nystagmus.

Answer 34

combination of vertical, horizontal, and even rotary