Tox/Environment

Question 1

Indications for Whole Bowel Irrigation (4)

Answer 1

lithium

iron

extended release Ca channel blockers and beta blocker

body packers

Question 2

Ingestions that can be Dialyzed (4)

Answer 2

alcohols
salicylates
theophylline
lithium

Question 3

Meds that Charcoal doesn’t Bind

Answer 3

C-PHAILS

Caustics
Pesticides
Hydrocarbons
Alcohols
Iron
Lithium
Solvents

Question 4

Calculated Osm

Answer 4

2Na + gluc/18 + BUN/2.8 + Ethanol/4.6

Question 5

What is the treatment for hydrofluoric acid ?

Answer 5

give Ca and Mg

Question 6

Black Widow Spider Bite v. Brown Recluse

Answer 6

Black Widow - Neurotoxins (acetylcholine and NE)–> muscle cramping and CNS excitation; may mimic acute abdomen, looks like sympathomimetic picture

Brown Recluse - hemolysis, poor healing ulcer

Question 7

Indications for Hyperbaric O2 in CO Poisoning

Answer 7

 LOC
 Carboxyhemoglobin > 25% (15-20% if pregnant)
 > 50 years old
 Metabolic acidosis persists after fluid rehydration
 Cerebellar dysfunction or other hard neurologic findings

Question 8

Ciguatera v. Scombroid

Answer 8

Ciguatera - GI and neuro (cold intolerance is key, also numbness and tingling)

Scombroid - histamine release, hypotension, respiratory, edema, GI

Question 9

Indications for DigiFab

Answer 9

Acute - dig level (>10), hyperkalemia

Chronic - clinical appearance / arrhythmia

Question 10

Heat Exhaustion v. Heat Stroke

Answer 10

Heat Exhaustion = dehydration, N&V, weakness

Heat Stroke = 104F + CNS dysfunction (Tx - rapid cooling to 39º: evaporative or cold water immersion - no anti-pyretics)

Question 11

Mgt of Lead Poisoning by Level

Answer 11

< 45 then draw venous and monitor

> 45 succimer

Question 12

2 Major Classes of Poisonous Snakes

Answer 12

Viperidae:
Depression between eyes
Significant local reaction → systemic toxicity
Compartment syndrome
Thrombocytopenia
Antivenin

Elapidae:
“Red on yellow kill a fellow, red on black venom lack”
Minimal local reaction → neurotoxicity
Respiratory paralysis
Due to scarcity of antivenin in US, give for symptomatic eastern coral snake bites, otherwise supportive treatment

Question 13

Cutis Marmorata

Answer 13

inflammation of skin from nitrogen during ascent after diving