Get your EM here

Question 1

suicidal kid after OD refusing treatment

Answer 1

any SI cannot refuse rx

if needed can intubate and put OG tube down w/ activated charcoal
forcing them to drink may –> aspiration

Question 2

Telling jimpson weed (anticholinergic) apart from cocaine (sympathomimetic) OD

Answer 2

both= big pupil + delirium

cocaine= sweaty

j weed= dry

Question 3

Anticholinergic toxidrome

Answer 3

Hot as a hare: increased body temperature
Blind as a bat: mydriasis (dilated pupils)
Dry as a bone: dry mouth, dry eyes, decreased sweat
Red as a beet: flushed face
Mad as a hatter: delirium

Question 4

Belladonna is

Answer 4

deadly night shade- Anticholinergic

Question 5

Charcoal does not bind ______ in ODs

Answer 5

metals (such as iron)
alcohols
hydrocarbons

Whole bowel irrigation is used in cases where charcoal is not effective, with certain sustained release products, and in cases of illicit drug packet ingestions (body packers)

Question 6

Indicator of severe toxicity with TCA OD

Answer 6

QRS prolonged

Question 7

Acute salicylate overdose characteristically causes a? acid base

Answer 7

metabolic acidosis mixed with a respiratory alkalosis.

Question 8

The lethal dose of APAP is ___________

Answer 8

150mg/kg
the antidote is N-acetylcysteine (Mucomyst)
and
repeated doses of activated charcoal

Question 9

An acetaminophen level drawn at _________ can be plotted on the Rumack-Matthew nomogram to guide therapy based on the potential for hepatic toxcicity

Answer 9

hours 4-20

Question 10

Unlike the Rumak nomogram of acetaminophen, the ___________ is associated with aspirin ingestions

Answer 10

Done nomogram

Question 11

The hallmark signs and symptoms of clonidine toxicity include:

Answer 11

hypotension, bradycardia, mental status change, respiratory depression, and miosis. The presentation very closely mimics opioid toxicity.

Question 12

Amitriptyline has anticholinergic activity that will cause a sinus tachycardia. Additional EKG findings with TCA toxicity include?

Answer 12

interval prolongation and terminal 40 ms right axis deviation.

Question 13

_________ binds directly to free iron and thus is the antidote for iron toxicity.

Answer 13

Deferoxamine

often causes the patient’s urine to turn color (vin rosé urine).

Question 14

_________ is the antidote for isoniazid toxicity

Answer 14

Pyridoxine

Question 15

Severe lead toxicity can commonly result in which of the following clinical symptoms
A. Stocking glove peripheral neuropathy
B. Constipation
C. Dermatitis
D. Memory loss

Answer 15

D. Memory loss

Question 16

A 27 year old woman is brought into the emergency department by her roommate 30 minutes after ingesting a bottle of aspirin in a suicide attempt. Which of the following acid-base disorders is most likely to be present in this patient?

Answer 16

Respiratory alkalosis due to stimulation of the respiratory center and increased CO2 production

A primary metabolic acidosis typically develops as well.

Question 17

For which of the following cases (all of which are characterized by an ingestion history known with certainty) is gastric lavage most likely indicated?

• Adult patient, nortriptyline ingestion (50 mg/tab x 100 tablets, 45 minutes PTA)
• Adult patient, ibuprofen ingestion (800 mg/tab x 5 tabs, 20 minutes prior to arrival (PTA) in the ED
• Adult patient, kerosene ingestion (8 oz, 20 minutes PTA)
• Adult patient, metoprolol ingestion (100 mg/tab x 100 tablets, 6 hours PTA)

Answer 17

nortriptyline ingestion - Gastric lavage (GL) is generally not effective if performed more than a few hours (exact time ranges depend on clinical circumstances) after ingestion. Due to risks of lavage (aspiration, gastric/esophageal perforation), trivial ingestions are not an indication for GL. Due to the risk of aspiration with hydrocarbons and further injury with caustic ingestions, GL is contraindicated for hydrocarbon and caustic ingestions.

Question 18

Sympathomimetics and anticholinergics such as Jimson Weed can be differentiated by the presence of ___________ although both can cause delirium and mydriasis

Answer 18

sweating

Question 19

Some toxins _______________do not bind to charcoal.

Answer 19

heavy metals such as lithium, lead, and

iron

Question 20

Due to the risk of aspiration with hydrocarbons and further injury with caustic ingestions, _________ is contraindicated for hydrocarbon and caustic ingestions.

Answer 20

Gastric lavage

Question 21

charcoal is contraindicated in patients with

Answer 21

• unprotected airways- risk of aspiration

- caustic ingestions as the black color of the charcoal interferes with the EGD eval

Question 22

_____________ are common precipitants of lithium toxicity in the patient chronically taking lithium

Answer 22

Dehydration, over-diuresis, and drug-drug interaction (particularly NSAIDs)

rx: Hemodialysis

Question 23

__________ are the treatment mainstay for cocaine toxicity.

Answer 23

Benzodiazepines

Question 24

The hallmark signs and symptoms of clonidine toxicity include:

Answer 24

hypotension, bradycardia, mental status change, respiratory depression, and miosis. The presentation very closely mimics opioid toxicity.

Question 25

_______ can serve as an antidote for beta blocker, calcium channel blocker, or insulin overdoses.

Answer 25

glucagon

Question 26

Severe lead toxicity can commonly result in which of the following clinical symptoms

• Dermatitis
• Stocking glove peripheral neuropathy
• Memory loss
• Constipation

Answer 26

-Memory loss

Lead toxicity affects a variety of systems. The central nervous system effects are many and range from encephalopathy and seizure to sleep disturbance and memory deficits. The peripheral nervous system can also be involved, with paresthesias and wrist drop being common. Colicky abdominal pain is often present. While dermatitis is not common in lead poisoning, you can see bluish lead lines on the gingiva.