Poisonings

Question 1

What are the 3 things to do with an unresponsive patient?

Answer 1

Hypoxia: Place on 100% O2 nonrebreather (also useful prior to intubation)
Hypoglycemia: obtain a point of care fingerstick blood glucose
Opioids: administer Narcan 0.4 to 2mg IV to reverse opiates

Question 2

Anticholinergic Symptoms

Answer 2

Mad as a hatter (Altered mental status)
Blind as a bat (mydriasis)
Hot as Hades
Red as a beat
Dry as a bone

Question 3

Anticholinergic Common Drugs

Answer 3

TCA’s Tricyclic antidepressants
Antihistamines
Overactive bladder medication

Question 4

Cholinergic Symptoms (SLUDGE)

Answer 4

Salivation
Lacrimation
Urination
Diaphoresis and defecation
Gastrointestinal upset
Excessive bradycardia or tachycardia (muscarinic or nicotinic)

Question 5

Cholinergic Causes

Answer 5

Organophosphate Poisoning and Nerve Agents

Question 6

Cholinergic Treatment

Answer 6

Atropine, pralidoxime, decontaminate

Question 7

Sympathomimetic Poisoning

Answer 7

Tachycardia
Hypertension
Mydriasis
Diaphoresis
Hyperthermia
Agitation

Question 8

Sympathomimetic Drugs

Answer 8

over-the-counter cold agents (containing ephedrine), illegal street drugs (eg, cocaine, amphetamines, methamphetamine), dietary supplements (ephedra), and illicit designer drugs (eg, 3,4-methylenedioxy methamphetamine (MDMA, “ecstasy”)

Question 9

Sympathomimetic Treatment

Answer 9

sedation, hydration, and treatment of complications such as rhabdomyalysis and hyperthermia.

Question 10

Opioid Overdose

Answer 10

Apnea
Hypoxia
Unresponsiveness
Flash pulmonary edema (rare)

Question 11

Opioid overdose treatment

Answer 11

Naloxone and possibly Intubation. Naloxone will wear off before the opiate so continue to monitor.

Question 12

How does activated charcoal work?

Answer 12

Bind to toxins and prevent absorption

Question 13

When do you have to give charcoal by?

Answer 13

Work best Within one hour of ingestion. Can still give later though. Don’t give if somnolent (aspiration). Doesn’t work well with alcohol, hydrocarbons or metals (iron).

Question 14

Acetaminophen overdose

Answer 14

May be asymptomatic initially. 4 stages: (1 and 2) nausea, vomiting, Lethal dose is 150 mg/kg,

Question 15

Acetaminophen antidote

Answer 15

n-acetylcysteine

Question 16

Aspirin overdose

Answer 16

ill appearing, breathing fast, vomiting, confused, and sometimes febrile.

Question 17

Aspirin overdose pathology

Answer 17

uncoupling of oxidative phosphorylation. This causes a profound anoin gap metabolic acidosis.

Question 18

Aspirin overdose treatment

Answer 18

Sodium bicarb and dialysis

Question 19

TCA overdose pathology

Answer 19

direct alpha-adrenergic blockade, inhibition of norepinephrine and serotonin reuptake, and blockade of fast sodium channels in myocardial cells.

Question 20

TCA overdose treatment

Answer 20

In the setting of QRS widening, Sodium bicarbonate should be administered. Seizures are treated with benzodiazepines

Question 21

What are the three toxic alcohols?

Answer 21

isopropanol, methanol, and ethylene glycol.

Question 22

Diagnostic tests for ethylene glycol ingestion

Answer 22

Anti-freeze. Woods lamp to urine –> see fluorescence. Calcium oxalate crystals. Anion gap metabolic acidosis.

Question 23

Methanol overdose

Answer 23

metabolized to formaldehyde.

Question 24

Treatment of methanol and ethylene glycol

Answer 24

blockade production of ADH. Fomepizole.