Environmental/Toxicology Flashcards
Normal body temperature
- 0 C
98. 6 F
Mild hypothermia temperature (C), common signs
32-36 C
slowing heart rate, shivering
Moderate hypothermia temperature (C), common signs
28-32 C
loss of shivering, altered LoC, reduced drug metabolism
Severe hypothermia temperature (C), common signs
Two major causes of heat loss
evaporation, radiation
Thermoregulation ceases at what temp
28 C
What is the appropriate and inappropriate drug for treating stimulant overdose (cocaine, meth)?
Appropriate: benzodiazepines, nitro
Inappropriate: B-blockers
Signs of digoxin toxicity
Blurry vision, including green/yellow halos
Abnormal EKG, prolonged PR
“Dig-dip” is not sign of toxicity, only that PT is on digoxin
Acetaminophen overdose proceeds in how many distinct stages? Each lasting about how long?
4 stages
24 hrs
The most common drug overdose in the USA is:
Acetaminophen - responsible for the most ED visits and most admissions to ICU
Describe stage 1 of acetaminophen overdose
0-24hrs GI upset (N/V), may be asymptomatic
Describe stage 2 of acetaminophen overdose
24-48 hrs
N/V, RUQ pain, elevation of liver enzymes
Describe stage 3 of acetaminophen overdose
48-96 hrs
Acute liver failure (jaundice, abnormal coags, encephalopathy)
Describe stage 4 of acetaminophen overdose
> 96 hrs
Death from liver failure or recovery (full recovery up to 3 months)
Describe the initial presentation of acetylsalicylic acid (aspirin) overdose
N/V, headache, tinnitus, tachypnea
Tylenol overdose is any ingestion greater than
200mg/kg
Aspirin overdose is any ingestion greater than
approx 150mg/kg
The antidote for tylenol overdose is
N-acetylcysteine (NAC aka Mucomyst)
Defibrillation of a hypothermia PT is often not effective until body temperature is
30 degC
Define afterdrop in the hypothermic patient
Prehospital external warming results in cold blood returning to core, increased risk of dysrhythmia
What transfusion reaction occurs within minutes of administration?
Acute hemolytic reaction - donor blood rapidly destroyed by host antibodies, usually caused by ABO type incompatibility
Anaphylactic reaction to blood transfusion most often occurs after how long
> 30 minutes
The antidote for coumadin toxicity is
Vitamin K, FFP
Treatment for digitalis toxicity includes
Digibind, pacing for severe bradycardia
The antidote for malignant hyperthermia is
Dantroline
What are the signs of malignant hyperthermia in the vented patient?
Recent administration of succinylcholine or anesthetic gas
Rapid, uncorrectable elevation of ETCO2
May see elevated temp, muscle rigidity
The most critical, life-saving treatment for heat stroke is
Rapid, active external cooling (submersion, ice sheets)
The most common type of decompression injury from diving is
Pulmonary (the “chokes”) - presents like PE
May also cause neuro symptoms
How can arterial gas embolism (AGE) may be differentiated from decompression illness (DCI)?
AGE is rapid onset (
Two types of decompression illness are:
The “bends” - severe joint pain
The “chokes” - respiratory or neuro symptoms
What gas law describes how gases in the lungs expand when a scuba diver ascends?
Boyle’s Law (P = 1/V)
Describe hypoxic hypoxia
Reduced alveolar oxygen exchange (low FiO2, APE, lung disease)
Describe hypemic hypoxia
Reduced oxygen carrying capacity of the blood (anemia, CO poisoning, sulfa/nitrate drug use)
Describe stagnant hypoxia
Reduced cardiac output (PPV, PE, heart failure)
Describe histotoxic hypoxia
Poisoning of cytochrome oxidase system, resulting in metabolic disorder (CN/CO/EtOH toxicity)
Hallucinations are most common with what street drug poisonings?
PCP, LSD
Treatment of organophosphate poisoning includes
Atropine, Pralidoxime
Benzodiazepines (for seizures)
The antidote for benzodiazepine overdose is
Romazicon
The antidote for ethanol toxicity is
Fomepizole
The antidote for B-blocker overdose is
Glucagon
A patient with ethylene glycol ingestion would initially present with
Nystagmus, headache, elevated anion gap, confusion
The antidote for heparin overdose is
Protamine sulfate
What is the antidote for iron overdose? How do you know treatment is effective?
Deferoxamine
Pink urine
An elevated BUN may indicate
Dehydration, Renal failure, Intra-abdominal hemorrhage
The antidote for carbon monoxide poisoning is
High FiO2, hyperbaric chamber
The antidotes for cyanide poisoning are
Cyanokit (Amyl nitrate, sodium nitrite, sodium thiosulfate)
Hydroxycobalamin
