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Emergency Medical Technician > Toxicology > Flashcards

Toxicology Flashcards

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Royal College: Emergency Medicine flashcards USMLE® Step 1 flashcards
1
Q

Chronic poisoning is often caused by ___

A

Long term abuse of medications, tobacco, and alcohol

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2
Q

The term poisoning includes ___

A

Acute and chronic poisonings

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3
Q

You may be able to prevent death caused by the acute affects of a poison, simply by ___

A

Providing airway management and symptomatic care during transport

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4
Q

The study of toxic or poisonous substances

A

Toxicology

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5
Q

Any substance whose chemical action can damage body structures or impair body function

A

Poison

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6
Q

A poisonous substance produced by bacteria, animals, or plants that acts by changing the normal metabolism of cells or by destroying them

A

Toxin

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7
Q

The misuse of any substance to produce a desired effect

A

Substance abuse

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8
Q

A common complication of substance abuse

A

Overdose

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9
Q

When a patient takes a toxic or lethal dose of a substance

A

Overdose

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10
Q

Primary responsibility to a patient who has been poisoned

A

Recognize that a poisoning has occurred

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11
Q

Swallowing of a substance

A

Ingestion

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12
Q

If you have even the slightest suspicion that an ingestion or exposure to a toxic substance has occurred, ___

A

Notify medical control and begin emergency treatment immediately

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13
Q

If respiration is depressed or difficult, ___ may occur

A

Cyanosis

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14
Q

The presence of burning or blistering in the mouth strongly suggest the ___

A

Ingestion of the poison

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15
Q

Questions to ask a suspected poisoning

A
  1. What substance did you take?
  2. When did you take it (or become exposed to it)?
  3. How much did you ingest?
  4. Did you have anything to eat or drink before or after you took it?
  5. Has anyone given you an antidote or any substance orally since you ingested it?
  6. How much do you weigh?
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16
Q

What to do with any suspicious material you find near a poisoning?

A

Place it in a plastic bag and take it with you to the hospital, along with any containers that you find

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17
Q

If the patient vomits, ___

A

Examine the contents for pill fragments. Note and document anything unusual that you see

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18
Q

Signs and symptoms of opiate or opioid overdose

A
  1. Hypoventilation or respiratory arrest
  2. Pinpoint pupils
  3. Sedation or coma
  4. Hypotension
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19
Q

Signs and symptoms of sympathomimetics overdose

A
  1. Hypertension
  2. Tachycardia
  3. Dilated pupils
  4. Agitation or seizures
  5. Hyperthermia
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20
Q

Signs and symptoms of sedative-hypnotics overdose

A
  1. Slurred speech
  2. Sedation or coma
  3. Hypoventilation
  4. Hypotension
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21
Q

Signs and symptoms of anticholinergics overdose

A
  1. Tachycardia
  2. Hyperthermia
  3. Hypertension
  4. Dilated pupils
  5. Dry skin and mucous membranes
  6. Sedation, agitation, seizures, coma, or delirium
  7. Decreased bowel sounds
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22
Q

Signs and symptoms of cholinergics overdose

A
  1. Airway compromise
  2. SLUDGEM
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23
Q

SLUDGEM

A
  1. Salivation, sweating
  2. Lacrimation
  3. Urination
  4. Defecation, drooling, diarrhea
  5. Gastric upset and cramps
  6. Emesis
  7. Muscle twitching/miosis
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24
Q

Lacrimation

A

Excessing tearing of the eyes

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25
Q

Emesis

A

Vomiting

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26
Q

Miosis

A

Pinpoint pupils

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27
Q

Substance that will counteract the effects of a particular poison

A

Antidote

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28
Q

Most common antidote available to EMTs

A

Naloxone (Narcan)

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29
Q

Narcan is used to ___

A

Reverse the effects of an opioid overdose

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30
Q

In general, the most important treatment you can perform for a poisoning is to ___

A

Dilute and/or physically remove the poisonous agent

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31
Q

Four routes of poisoning

A
  1. Inhalation
  2. Absorption
  3. Ingestion
  4. Injection
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32
Q

Poison control number

A

1-800-222-1222

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33
Q

When contacting poison control, relevant information includes ___

A
  1. When the poisoning occurred
  2. Evidence found at the scene
  3. Description of the suspected poison
  4. Amount of poison involved
  5. Patient’s size, weight, and age
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34
Q

A physician who specializes in caring for patient’s who have been poisoned

A

Medical toxicologist

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35
Q

Medical toxicologists work in special facilities called ___

A

Medical toxicology treatment centers

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36
Q

Patient’s who have inhaled poison should be ___ immediately

A

Moved to fresh air

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37
Q

Depending how long the inhaled poison patient was exposed, they may require ___

A

Supplemental oxygen

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38
Q

If you suspect the presence of toxic gas ___

A

Call for specialized resources such as the HAZMAT team

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39
Q

After the patient has been removed from the toxic gas environment, ___ before you can administer emergency treatment

A

The patient’s clothing should be removed because they may contain trapped toxic gasses

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40
Q

___ readings may be inaccurate with some inhaled poisons

A

Pulse oximetry

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41
Q

Anytime there is more than one patient and no evidence of the mechanism of injury or nature of illness, be suspicious of ___

A

Toxic fumes

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42
Q

Absorption of toxic substances through the skin in a common problem in the ___ industries

A

Agriculture and manufacturing

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43
Q

Signs and symptoms of absorbed poisons

A
  1. History of exposure
  2. Liquid or powder on a patient’s skin
  3. Burns
  4. Itching
  5. Irritation
  6. Redness of skin
  7. Typical odors of the substance
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44
Q

Emergency treatment for a typical contact poisoning (2 steps)

A
  1. Avoid contaminating yourself or others
  2. While protecting yourself from exposure, remove the irritating or corrosive substance from the patient as rapidly as possible
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45
Q

___ all clothing that has been contaminated with poisons or irritating substances

A

Remove

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46
Q

Skin that has a dry powder on it should be ___

A

Flushed with clean water for 15 to 20 minutes, and then washed with soap and water

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47
Q

Skin that has a liquid material on it should be ___

A

Flooded with water for 15 to 20 minutes

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48
Q

If the patient has a chemical agent in the eyes, ___

A

Irrigate them quickly and thoroughly

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49
Q

How to avoid contaminating the other eye as you irrigate the affected eye

A

Make sure the fluid runs from the bridge of the nose outward

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50
Q

When to irrigate the eye

A

Initiate on the scene and continue it during transport

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51
Q

With contact poison, make sure you, the team members, and the exposed patient are ___ before transport

A

Thoroughly decontaminated

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52
Q

Obtain the ___ from industrial sites and transport it with the patient (poison)

A

SDS

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53
Q

This will help to ID and quickly make available specific interventions and potential antidotes

A

SDS

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54
Q

Small children may respond by crying if the poison is ___

A

An acid or alkaline

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55
Q

When the patient has ingested a toxin, some EMS systems allow EMTs to administer ___ by mouth

A

Activated charcoal

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56
Q

Injected poisons cannot be diluted or removed from the body in the field because they ___

A

Are usually absorbed quickly into the body or cause intense local tissue destruction

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57
Q

If you suspect that rapid absorption has occurred ___

A
  1. Monitor the patient’s airway
  2. Provide high-flow oxygen for any patient with respiratory distress or signs of hypoxia
  3. Be alert for nausea and vomiting
  4. Remove watches, rings, and bracelets from areas around the injection site if swelling occures
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58
Q

Questions to ask yourself when arriving on the scene of a poisoning

A
  1. Is there an unpleasant or odd odor in the room?
  2. Are there medication bottles near the patient or the scene?
  3. Is there medication missing that might indicate an overdose?
  4. Are there alcoholic beverage containers present?
  5. Are there syringes or other drug paraphernalia on the scese?
  6. Is there a suspicious odor and/or drug paraphernalia present that may indicate the presence of an illegal drug laboratory?
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59
Q

A primary assessment that reveals a patient with signs of ___ gives you early confirmation that the poisonous substance is causing systemic reactions

A

Distress and/or altered mental status

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60
Q

In situations where a patient may have an inhalation injury, place the patient on high-flow oxygen regardless of the ___

A

Pulse oximetry reading

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61
Q

If the patient is unresponsive to painful stimuli, consider ___

A

Inserting an airway adjunct to ensure an open airway

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62
Q

Keep what available for a patient who has been poisoned?

A

Suction

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63
Q

Medications hat promote vasodilation or bleeding can speed up the development of shock due to ___

A

Hypovolemia

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64
Q

Questions to ask in addition to the SAMPLE history for poisoning

A
  1. What is the substance involved?
  2. When did the patient ingest or become exposed to the substance?
  3. How much did the patient ingest or what was the level of exposure?
  4. Over what period did the patient take or was the patient exposed to the substance?
  5. Has the patient or a bystander performed any intervention on the patient? Has the intervention helped?
  6. How much does the patient weigh?
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65
Q

If the patient has consumed a harmful or lethal dose of the poisonous substance, reassess the vital signs at least every ___

A

5 minutes

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66
Q

If the poison or the level of exposure is unknown, ___ is mandatory

A

Careful and frequent reassessment

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67
Q

Activated charcoal is not indicated, nor will it be effective, for patients who have ingested ___

A

Alkali poisons, cyanide, ethanol, iron, lithium, methanol, mineral acids, or organic solvents

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68
Q

Form of activated charcoal if carried

A

Plastic bottles of premixed suspension containing up to 50 g of activated charcoal

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69
Q

Common trade names for the suspension of activated charcoal

A

InstaChar, Actidose, LiquiChar

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70
Q

Usual dose of activated charcoal for an adult or child

A

1 g of activated charcoal per kilogram of body weight (more if food is present)

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71
Q

Usual adult dose of activated charcoal

A

30 to 100 g

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72
Q

Usual pediatric dose of activated charcoal (younger than 13)

A

15 to 30 g

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73
Q

Before you give a patient charcoal, obtain ___

A

Approval from medical control

74
Q

In most cases, activated charcoal should be used within ___ of ingestion

A

1 hour

75
Q

Adverse effects of ingesting activated charcoal

A

Constipation and black stools

76
Q

If the patient vomits after taking the activated charcoal ___

A

The dose will have to be repeated

77
Q

How does activated charcoal work?

A

Binds to specific toxins, and prevents their absorption by the body, carried out of the body in the stool

78
Q

Routinely misusing a substance may need increasing amounts of it to achieve the same result

A

Tolerance

79
Q

An overwhelming desire or need to continue using the substance, at whatever the cost, which a tendency to increase the dose

A

Addiction

80
Q

Substance that decreases activity and excitment

A

Sedative

81
Q

Alcohol is a powerful ___ depressant

A

CNS

82
Q

Induces sleep

A

Hypnotic

83
Q

You should assume that all intoxicated patients are experiencing a ___

A

Drug overdose

84
Q

Severe acute alcohol ingestion may cause ___

A

Hypoglycemia

85
Q

If a patient exhibits signs of serious CNS depression, ___

A

Provide respiratory support

86
Q

Depression of the respiratory system can also cause ___

A

Emesis

87
Q

Bloody vomiting

A

Hematemesis

88
Q

Why can excessive alcohol cause hematemesis?

A

Large amounts of alcohol irritate the stomach

89
Q

Frightening hallucinations experienced by a patient in alcohol withdrawal

A

Delirium tremens (DTs)

90
Q

Approximately ___ days after a person stops drinking or when alcohol consumption levels are decreased suddenly, DTs may develop

A

1 to 7

91
Q

___ often precede DTs

A

Auditory and visual hallucinations

92
Q

Signs and symptoms of alcohol withdrawal

A
  1. Agitation and restlessness
  2. Fever
  3. Sweating
  4. Tremors
  5. Confusion and/or disorientation
  6. Delusions and/or hallucinations
  7. Seizures
93
Q

Hypovolemia may develop with DTs because of ___

A

Sweating, fluid loss, insufficient fluid intake, or vomiting

94
Q

In alcohol withdrawal, if you see signs of hypovolemic shock ___

A

Clear the airway and turn the patient’s head to one side to minimize the chance of aspiration during transport

95
Q

A drug that produces sleep or altered mental consciousness

A

Narcotic

96
Q

A type of narcotic medication used to relieve pain

A

Opioid

97
Q

A subset of the opioid family, refers to natural nonsynthetic opioids

A

Opiate

98
Q

What opiates are derived from the opium in poppy seeds?

A

Codeine and morphine

99
Q

Common synthetic opioids

A

Hydromorphone, oxycodone, hydrocodone, methadone

100
Q

Common opioids and opiates

A
  1. Butorphanol (Stadol)
  2. Codeine
  3. Fentanyl (Sublimaze)
  4. Heroin
  5. Hydrocodone (Vicodin)
  6. Hydromorphone (Dilaudid)
  7. Morphine
  8. Methadone (Dolophine)
  9. Oxycodone hydrochloride (OxyContin)
  10. Oxymorphone (Opana)
101
Q

Opioids and opiates are ___ depressants and can cause severe ___ depression

A
  1. CNS
  2. Respiratory
102
Q

Opioids or opiates with ___ administration produce a characteristic “high” or “kick”

A

IV

103
Q

Pinpoint pupils is a classic sign of ___ intoxication

A

Opiate

104
Q

Patients who abuse opioids via IV injection are at a high risk for ___

A

Hepatitis C and HIV

105
Q

Narcan can be administered ___

A

Intravenously, intramuscularly, or intranasally

106
Q

Venous scarring is called ___

A

Track marks

107
Q

Preferred route of Narcan

A

Intranasally

108
Q

Narcan should only be used when the patient has ___

A

Agonal respirations or apnea

109
Q

Place an ___ and ___ prior to administering naloxone

A
  1. Oral or nasal airway
  2. Ventilate the patient using a bag-mask device
110
Q

Adequate ventilation while you prepare to administer naloxone decreases the risk of ___

A

Permanent brain damage related to hypoxia

111
Q

Barbiturates and benzodiazepines are ___ depressants and alter the ___, with effects similar to ___

A
  1. CNS
  2. Level of consciousness
  3. Alcohol
112
Q

In general, sedative-hypnotic drugs are taken by ___

A

Mouth

113
Q

Patients who have attempted suicide with sedative-hypnotic drugs will often have ___

A

Marked respiratory depression and may be in a coma

114
Q

Sedative-hypnotic drugs commonly used to incapacitate people without their knowledge

A
  1. Chloral hydrate
  2. Flunitrazepam (Rohypnol or roofies)
  3. Ketamine (Ketalar or Special K)
115
Q

General treatment of patients who have overdosed with sedative-hypnotics and have respiratory depression

A
  1. Ensure the airway is patent
  2. Assist ventilations
  3. Give supplemental oxygen when appropriate
  4. Provide prompt transport
  5. Closely monitor the patient’s mental status
  6. Watch for vomiting
116
Q

Categories of sedative-hypnotic drugs

A
  1. Barbiturates
  2. Benzodiazepines
  3. Others
117
Q

Common materials that are inhaled

A
  1. Acetone
  2. Toluene
  3. Xylene
  4. Hexane
  5. Gasoline
  6. Halogenated hydrocarbons (Freon or difluoroethane)
118
Q

Inhaled sedative-hypnotics can often cause ___

A

Seizures

119
Q

Halogenated hydrocarbon solvents can make the heart ___

A

Hypersensitive to the patient’s own adrenaline, putting the patient at a high risk for sudden cardiac death because of ventricular fibrillation

120
Q

Highly toxic, colorless, and flammable gas with a rotten-egg odor

A

Hydrogen sulfide

121
Q

Hydrogen sulfide has the most impact on the ___

A

Lungs and CNS

122
Q

Hydrogen sulfide used for suicide is referred to as ___

A

Chemical or detergent suicide

123
Q

Chronic exposure to hydrogen sulfide can lead to ___

A
  1. Eye, nose, and throat irritation
  2. Headaches
  3. Bronchitis
  4. Inability to smell the gas
124
Q

Patients exposed to a high concentration of hydrogen sulfide, they will experience ___ and may experience ___

A
  1. Nausea and vomiting
  2. Confusion
  3. Dyspnea
  4. Loss of consciousness
  5. Seizures
  6. Shock
  7. Coma
  8. Cardiopulmonary arrest
125
Q

CNS stimulants that mimic the effects of the sympathetic nervous system

A

Sympathomimetics

126
Q

Sympathomimetics frequently cause ___

A
  1. Hypertension
  2. Tachycardia
  3. Dilated pupils
127
Q

An agent that produces an excited state

A

Stimulant

128
Q

___ are common symptoms of sympathomimetic abuse

A

Paranoia and delusions

129
Q

Phentermine hydrochloride is an ___ suppressant

A

Appetite

130
Q

Acute cocaine overdose patients are at a high risk of ___

A

Seizures, cardiac dysrhythmias, and stroke

131
Q

Acute cocaine overdose patients can BPs as high as ___

A

250/150 mm Hg

132
Q

Synthetic Cathinones are known as ___

A

Bath salts

133
Q

Bath salts are similar to ___

A

MDMA

134
Q

Brand names of bath salts

A

Ivory Wave
Cloud Nine

135
Q

Bath salts produce ___

A

Euphoria, increased mental clarity, and sexual arousal

136
Q

Most bath salts are taken by ___

A

Snorting or insufflate the powder nasally

137
Q

The effects of bath salts last as long as ___

A

48 hours

138
Q

Adverse effects of bath salts

A

Teeth grinding, appetite loss, muscle twitching, lip-smacking, confusion, GI conditions, paranoia, headache, elevated heart rate, and hallucinations

139
Q

Some bath salt patients may require ___ to facilitate safe transport

A

Chemical restraint

140
Q

Alters a person’s sensory perceptions

A

Hallucinogen

141
Q

A patient having a “bad trip” will usually have ___

A

Hypertension, tachycardia, anxiety, and paranoia

142
Q

Commonly abused hallucinogens

A
  1. Bufotenine (toad skin)
  2. Datura stramonium (jimsonweed)
  3. Dextromethorphan (DXM)
  4. Dimethyltryptamine (DMT)
  5. Ketamine
  6. LSD
  7. Mescaline (peyote)
  8. Morning glory
  9. Nutmeg
  10. PCP
  11. Psilocybin (mushrooms)
  12. Salvia
143
Q

Do not use restraints for a patient on hallucinogens unless ___

A

You or the patient is in danger of injury

144
Q

Medications that block the parasympathetic nerves

A

Anticholinergic agents

145
Q

Signs and symptoms of anticholinergic agent overdose

A
  1. Hyperthermia
  2. Dilated pupils
  3. Dry skin and mucous membranes
  4. Reddened skin
  5. Agitation or delirium
146
Q

Common drugs with a significant anticholinergic effect

A
  1. Atropine
  2. Antihistamines such as diphenhydramine (Benadryl)
  3. Datura stramonium (jimsonweed)
  4. Certain tricyclic antidepressants such as amitriptyline (Elavil)
147
Q

It is often difficult to distinguish between an anticholinergic overdose and a ___ overdose. Both groups of patients may ___

A
  1. Sympathomimetic
  2. Be agitated and have tachycardia and dilated pupils
148
Q

Tricyclic antidepressant overdose may cause more serious and life-threatening effects because the medication may ___

A

Block the electrical conduction system in the heart, leading to cardiac dysrhythmias

149
Q

Patient’s with tricyclic antidepressant overdose may appear normal, but seizure and death can occur within ___

A

30 minutes

150
Q

Medications that overstimulate the normal body functions controlled by the parasympathetic nervous system

A

Cholinergic agents

151
Q

Cholinergic agents are used in ___

A
  1. Chemical warfare
  2. Organophosphate insecticides
152
Q

Signs and symptoms of cholinergic agent overdose

A
  1. Excessive salivating
  2. Mucous membrane oversecretion, resulting in rhinorrhea
  3. Excessive urination
  4. Excessive tearing of the eyes
  5. Uncontrolled diarrhea
  6. Abnormal heart rate
153
Q

Mnemonic to remember signs and symptoms of cholinergic drug poisoning

A

DUMBELS

154
Q

DUMBELS

A

Diarrhea
Urination
Miosis, muscle weakness
Bradycardia, bronchospasm, bronchorrhea
Emesis
Lacrimation
Seizures, salivation, sweating

155
Q

Miosis

A

Constriction of the pupils

156
Q

Bronchorrhea

A

Discharge of mucus from the lungs

157
Q

Emesis

A

Vomiting

158
Q

Lacrimation

A

Excessive tearing

159
Q

Alternative mnemonic to remember signs and symptoms of cholinergic drug poisoning

A

SLUDGEM

160
Q

SLUDGEM

A

Salivation, sweating
Lacrimation
Urination
Defecation, drooling, diarrhea
Gastric upset and cramps
Emesis
Muscle twi

161
Q

SLUDGEM

A

Salivation, sweating
Lacrimation
Urination
Defecation, drooling, diarrhea
Gastric upset and cramps
Emesis
Muscle twitching/miosis

162
Q

The most important consideration in caring for a patient who has been exposed to a cholinergic agent is to ___

A

Avoid exposure to yourself

163
Q

For a patient who has cholinergic agent poisoning, ___ will take priority of prompt transport to the ED

A

Decontamination

164
Q

To care for a patient exposed to cholinergic agents ___

A

Can use the anticholinergic drug atropine to dry up the patient’s secretions, followed by the use of pralidoxime to reverse the nerve agent’s effect on the patient’s nervous system. After decontamination decrease the secretions in the mouth and trachea and provide airway support

165
Q

Most common kit to antidote cholinergic agents

A

DuoDote Auto-Injector

166
Q

The military form of the DuoDote Auto-Injector

A

Antidote Treatment Nerve Agent Auto-Injector (ATNAA)

167
Q

Single auto-injector containing 2 mg of atropine and 600 mg of pralidoxime

A

DuoDote Auto-Injector

168
Q

If a known exposure to nerve agents or organophosphates with manifestation of signs and symptoms has occurred, us the antidote kit ___

A

Only on yourself

169
Q

Aspirin poisoning may result in ___

A
  1. Nausea and vomiting
  2. Hyperventilation
  3. Ringing in the ears
  4. Anxiety
  5. Confusion
  6. Tachypnea
  7. Hyperthermia
  8. Seizures
170
Q

Two main types of food poisoning

A
  1. The organism itself causes disease
  2. The organism produces toxins that cause disease
171
Q

Salmonellosis is characterized by ___

A

Severe GI symptoms within 72 hours, nausea and vomiting, abdominal pain, and diarrhea. May be systemically will with fever and generalized weakness

172
Q

Common culprit of bacteria producing toxins in old food

A

Staphylococcus

173
Q

Staphylococcal food poisoning symptoms usually start within ___

A

2 to 3 hours or as long as 8 to 12 hours

174
Q

Most severe form of toxin ingestion with food poisoning

A

Botulism

175
Q

Bacteria that produces botulism

A

Clostridium

176
Q

Symptoms of botulism

A

Neurologic:
-Blurring of vision
-Weakness
-Difficulty in speaking and breathing

can also cause:
-Muscle paralysis

177
Q

Botulism is typically fatal when it ___

A

Reaches the muscles of respiration

178
Q

Symptoms of botulism may develop ___

A

As long as 4 days or as early as the first 24 hours

179
Q

Do not try to determine the specific cause of acute GI conditions, instead ___

A

Gather as much history as possible from the patient and transport them promptly to the hospital

180
Q

When two or more people in one group have the same illness, take along some of the ___ to the hospital (food poisoning)

A

Suspected food

181
Q

In advanced cases of botulism, you may have to ___

A

Assist ventilation and give basic life support

182
Q

Emergency medical treatment of dieffenbachia poisoning ___

A

Maintaining an open airway, giving oxygen when necessary, and transporting the patient promptly to the hospital for respiratory support

Emergency Medical Technician (100 decks)

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