EM/Toxicology

Question 1

When a patient presents with AMS of unknown etiology what three items are given?

Answer 1

Naloxone (narcan), thiamine, dextrose

Question 2

When is gastric emptying useful for managing a pill overdose?

Answer 2

Only in the first hr after ingestion, otherwise it is not very helpful

Question 3

Does charcoal have utility in overdose cases?

Answer 3

Yes it does. It won’t harm anyone so you can give it

Question 4

If a patient ODs on benzodiazepines should you give flumazenil?

Answer 4

No, it may precipitate a seizure

Question 5

Antidote for digoxin

Answer 5

Digoxin-binding Abs

Question 6

Antidote for ethylene glycol or methanol

Answer 6

Fomepizole or methanol

Question 7

Antidote methemoglobinemia

Answer 7

Methylene blue

Question 8

Antidote neuroleptic malignant syndrome

Answer 8

Bromocriptine, Dantrolene

Question 9

Antidote for organophosphates

Answer 9

Atropine, pralidoxime

Question 10

Antidote for TCAs

Answer 10

Bicarbonate (protects the heart)

Question 11

How does acetaminophen toxicity present in the first day? Days 2 - 3?

Answer 11

Day 1: nausea and vomiting

Days 2-3: liver failure

Question 12

During what time period is N-acetylcysteine beneficial in preventing liver toxicity after acetaminophen overdose?

Answer 12

First 24 hours

Question 13

What affect does aspirin have on the brainstem? What effect on the lungs?

Answer 13

Brainstem: causes hyperventilation (respiratory alkalosis)
Lungs: ARDS

Question 14

What are acid/base disturbances in aspirin OD and in which order do they present?

Answer 14

Respiratory alkalosis from brainstem evoked hyperventilation occurs first
Metabolic acidosis occurs second

Question 15

Treatment of aspirin overdose

Answer 15

Bicarbonate to alkalinize the urine
Charcoal to block absorption
Dialysis if necessary

Question 16

All patients that come in with some sort of overdose should have what drug levels checked too as possible co-ingestions?

Answer 16

Acetaminophen
Aspirin
Ethanol

Question 17

How should you handle a benzodiazepine overdose?

Answer 17

Don’t give flumazenil. Let the patient sleep and it will pass

Question 18

How does digoxin toxicity often present?

What effect does digoxin have on potassium?

Answer 18

GI disturbance most commonly; other symptoms are yellow halos in visual field, confusion, arrhythmia

Digoxin causes hyperkalemia; Digoxin overdose can be made worse by hypokalemia

Question 19

Hypocalcemia and oxalic acid crystals in urine are signs of what toxicity?

Answer 19

Ethylene glycol

Question 20

What types of drugs may precipitate methemoglobinemia?

Answer 20

Oxidizing drugs. Any -caine, nitrates, anestheticsm dapsone.

Question 21

How will methemoglobinemia appear on ABG?

What can make dx?

Answer 21

Normal PO2

Methemoglobin level

Question 22

What are the most dangerous complications of TCA overdose? What other presenting symptoms may they have?

Answer 22

Arrhythmia, Cardiotoxicity

Other Sx: dilated pupils, dry mouth, constipation, urinary retention (all related to anticholinergic effects)

Question 23

Abdominal pain, rigidity, and hypocalcemia in a patient without abdominal tenderness is suggestive of what exposure? Tx?

Answer 23

Black widow spider bite

Antivenim

Question 24

How do brown recluse spider bites present?

Mgmt?

Answer 24

Local bruising, bullae, and dark lesions

Debride the wound

Question 25

What is the best initial therapy for acute angle closure glaucoma? What are other drugs which may be provided?

Answer 25

Initial: Pilocarpine (causes miosis)

Others: acetazolamide, mannitol, latanoprost, timolol, apraclonidine

Question 26

What presents with visual problems described as “a curtain coming down”?

Answer 26

Retinal detachment

Question 27

How is uveitis diagnosed and what is tx?

Answer 27

Diagnosed with slit lamp exam

Tx: steroids

Question 28

Are there any specific therapies for corneal abrasion? What can make dx?

Answer 28

No

Fluorescein stain