PME3 tox

Question 1

What are the steps in the Primary Survey for general management approach?

Answer 1

Scene safety: assess and ensure no ongoing harm. Airway: anticipate airway loss, suction as necessary. Breathing: support ventilations if necessary. Circulation: assess for dysrhythmias, shock, and adequacy of circulation. Disability: consider 4 Hs & 4 Ts. Exposure: decontamination and isolate emesis.

Question 2

What should be included in the Secondary Survey for general management approach?

Answer 2

Detailed history taking, including medications, allergies, and past medical history. Physical examination tailored to the clinical presentation.

Question 3

What does the Reassessment involve in the general management approach?

Answer 3

Continuous monitoring of patient’s response to interventions. Reevaluate and adjust management plans based on patient’s progress and any deterioration.

Question 4

What are the clinical features of Anticholinergic Toxidrome?

Answer 4

Agitated delirium, tachycardia, hyperthermia, dilated pupils, dry flushed skin, urinary retention.

Question 5

What are the common causes of Anticholinergic Toxidrome?

Answer 5

Antipsychotics, antihistamines, tricyclic antidepressants, benztropine, atropine, carbamazepine.

Question 6

What is the management for Anticholinergic Toxidrome?

Answer 6

Physostigmine as an antidote. Supportive care, including cooling measures for hyperthermia and sedation if necessary.

Question 7

What are the clinical features of Opiate Toxidrome?

Answer 7

Decreased conscious state, bradypnoea/apnoea, miosis, ventilatory failure.

Question 8

What are the common causes of Opiate Toxidrome?

Answer 8

Heroin, morphine, other opiates.

Question 9

What is the management for Opiate Toxidrome?

Answer 9

Naloxone administration. Ventilatory support and monitoring of respiratory function.

Question 10

What are the clinical features of Mixed Cholinergic Toxidrome?

Answer 10

Brady- or tachycardia, hypo- or hypertension, miosis or mydriasis, sweating, salivation, bronchospasm, muscle weakness.

Question 11

What are the common causes of Mixed Cholinergic Toxidrome?

Answer 11

Organophosphates, carbamates, chemical warfare agents.

Question 12

What is the management for Mixed Cholinergic Toxidrome?

Answer 12

Atropine and oximes as antidotes. Supportive care including ventilatory support.

Question 13

What are the clinical features of Sympathomimetic Toxidrome?

Answer 13

Hypertension, tachycardia, agitation, mydriasis, sweating.

Question 14

What are the common causes of Sympathomimetic Toxidrome?

Answer 14

Amphetamines, cocaine.

Question 15

What is the management for Sympathomimetic Toxidrome?

Answer 15

Beta blockers (e.g., propranolol) for specific conditions. Supportive care focusing on cardiovascular and neurological stability.

Question 16

What are the clinical features of Serotonin Syndrome?

Answer 16

Altered mental state, autonomic dysfunction, hyperthermia, sweating, hyperreflexia, clonus/myoclonus.

Question 17

What is the management for Serotonin Syndrome?

Answer 17

Supportive care, including cooling for hyperthermia. Benzodiazepines for seizures and agitation.

Question 18

What should be monitored in Serotonin Syndrome?

Answer 18

Monitoring for and managing complications like hyperkalaemia.

Question 19

What are the clinical features of Tricyclic Antidepressant (TCA) Overdose?

Answer 19

Rapid CNS deterioration, seizures, QRS prolongation, terminal R wave in aVR.

Question 20

What is the management for Tricyclic Antidepressant (TCA) Overdose?

Answer 20

Sodium bicarbonate for sodium channel blockade. Amiodarone for refractory ventricular tachycardia or fibrillation.

Question 21

What should be monitored in Tricyclic Antidepressant (TCA) Overdose?

Answer 21

Early airway management and supportive care.

Question 22

What are the clinical features of Monoamine Oxidase Inhibitor (MAOI) Overdose?

Answer 22

Agitation, confusion, seizures, hyperthermia, sympathomimetic toxicity.

Question 23

What is the management for Monoamine Oxidase Inhibitor (MAOI) Overdose?

Answer 23

Aggressive cooling for hyperthermia.

Question 24

What additional management is considered for Monoamine Oxidase Inhibitor (MAOI) Overdose?

Answer 24

Benzodiazepines for seizures.

Question 25

What should be avoided in the management of Monoamine Oxidase Inhibitor (MAOI) Overdose?

Answer 25

Consideration for GTN in significant hypertension. Avoidance of beta blockers due to risk of unopposed alpha agonism.

Question 26

What are the challenges in managing Cardiovascular Toxidromes?

Answer 26

Compound dysrhythmias, high likelihood of refractory presentations, electrolyte and metabolic disturbances.

Question 27

What is the initial management for Cardiovascular Toxidromes?

Answer 27

Early 12-lead ECG and serial monitoring.

Question 28

What supportive care is important for Cardiovascular Toxidromes?

Answer 28

Specific antidotes like atropine, calcium gluconate, sodium bicarbonate as appropriate.

Question 29

What are the clinical features of Box Jellyfish envenomation?

Answer 29

Severe pain, skin necrosis, cardiovascular collapse.

Question 30

What is the management for Box Jellyfish envenomation?

Answer 30

Vinegar application, antivenom, analgesia, and magnesium administration.

Question 31

What are the clinical features of Irukandji Syndrome?

Answer 31

Delayed severe pain, hypertension, tachycardia.

Question 32

What is the management for Irukandji Syndrome?

Answer 32

Vinegar application, analgesia, magnesium, GTN.

Question 33

What are the clinical features of Stonefish and Stingray envenomation?

Answer 33

Immediate extreme pain, systemic symptoms including seizures and paralysis.

Question 34

What is the management for Stonefish and Stingray envenomation?

Answer 34

Hot water immersion, pain relief, wound stabilization, and transport for surgical care.

Question 35

What are the clinical features of Ciguatera Fish Poisoning?

Answer 35

Nausea, vomiting, diarrhea, cramps, tingling, dizziness, respiratory paralysis.

Question 36

What is the management for Ciguatera Fish Poisoning?

Answer 36

Symptomatic management, symptoms typically resolve in days to weeks.

Question 37

What are the clinical features of Pufferfish (Tetrodotoxin) Poisoning?

Answer 37

Similar to ciguatera fish poisoning.

Question 38

What is the management for Pufferfish (Tetrodotoxin) Poisoning?

Answer 38

Symptomatic management.

Question 39

What are the clinical features of heat-related illnesses?

Answer 39

Muscle cramps, nausea, vomiting, dizziness, headache, confusion, seizures.

Question 40

What is the management for heat-related illnesses?

Answer 40

Rapid cooling, rehydration, monitoring and treating complications like hyperkalaemia.

Question 41

What are the clinical features of Anticholinesterase Pesticides Poisoning?

Answer 41

Altered consciousness, respiratory failure, seizures, bradycardia, bronchorrhoea, fasciculations.

Question 42

What is the management for Anticholinesterase Pesticides Poisoning?

Answer 42

Atropine, pralidoxime, decontamination, supportive care.

Question 43

What are the clinical features of Paraquat poisoning?

Answer 43

GI corrosive injury, multiple organ failure, pulmonary fibrosis.

Question 44

What is the management for Paraquat poisoning?

Answer 44

Supportive care, antioxidants, hemodialysis in severe cases.

Question 45

What are the clinical features of Glyphosate poisoning?

Answer 45

Mild GI symptoms.

Question 46

What is the management for Glyphosate poisoning?

Answer 46

Symptomatic and supportive care.

Question 47

What are the clinical features of opioid overdose?

Answer 47

CNS depression, respiratory depression, miosis.

Question 48

What is the management for opioid overdose?

Answer 48

Naloxone, supportive care.

Question 49

What are the clinical features of benzodiazepine overdose?

Answer 49

CNS depression, respiratory depression, hypotension.

Question 50

What is the management for benzodiazepine overdose?

Answer 50

Flumazenil (with caution), supportive care.

Question 51

What are the clinical features of psychostimulant (amphetamines, cocaine) overdose?

Answer 51

Hypertension, tachycardia, agitation, hyperthermia, mydriasis.

Question 52

What is the management for psychostimulant (amphetamines, cocaine) overdose?

Answer 52

Benzodiazepines, cooling measures, supportive care.

Question 53

What are the clinical features of carbon monoxide toxicity?

Answer 53

Headache, dizziness, confusion, cherry red skin, respiratory failure.

Question 54

What is the management for carbon monoxide toxicity?

Answer 54

Removal from exposure, 100% oxygen, hyperbaric oxygen therapy.

Question 55

What are the clinical features of cold injuries (chilblains, trench foot, frostbite, hypothermia)?

Answer 55

Tissue damage, numbness, pain, blistering, systemic hypothermia symptoms.

Question 56

What is the management for cold injuries (chilblains, trench foot, frostbite, hypothermia)?

Answer 56

Gradual rewarming, pain management, supportive care.

Question 57

What are the 4 H's & T's

Answer 57

Hypoxia, Hypokalaemia/hyperkalaemia, Hypothermia/hyperthermia, Hypovolaemia, Tension pneumothorax, Tamponade, Toxins