Toxicology

Question 1

What diagnostic test should all reported overdoses receive?

Answer 1

EKG

QRS prolongation –> cocaine, BB, TCAs
Tachycardia –> cocaine, PCP
V Tach and V Fib –> amphetamines, cocaine, TCA, CCBs
QT prolongation –> Methadone

Question 2

What toxins will cause bradycardia or AV block?

Answer 2

Opioids, Clonidine, BB, TCAs

Question 3

What EKG changes are seen with Methadone?

Answer 3

QT prolongation

Question 4

For a patient who has overdosed and has a seizure, what is the treatment?

What are some common causes of seizure in these patients?

Answer 4

Benzos, Benzos, Benzos
Barbituates are second line

Hypoglycemia, Hyponatremia, ETOH withdrawal, benzo withdrawal

Question 5

What is the role of activated charcoal?

When should it be given?

Answer 5

Charcoal absorbs toxin to prevent absorption from GI tract, binds the toxin and helps move through bowel

Should be given within 60 minutes of ingestion

Question 6

What are the main contraindications to activated charcoal?

Answer 6

Altered loss of consciousness to prevent aspiration

Question 7

What are the side effects associated with activated charcoal?

Answer 7

• Constipation
• Impaction
• Stomach cramps
• Abdominal distention
• Vomiting

Question 8

What is the toxidrome for cholinergics?

Answer 8

SLUDGE

Salivation
Lacrimation
Urination
Defecation
Gastroenteritis
Emesis
Miosis

Question 9

Fentynal can lead to what respiratory complication?

Answer 9

Rigid Chest Syndrome

Question 10

What is the antidote for benzodiazepines?

Answer 10

Flumazenil