Toxicology

Question 1

Tx for acetaminophen OD

Answer 1

Nac! Harmless so don’t wait, iv if vomiting
+/- charcoal

Question 2

Aspirin/salicylates presenting sx, labs, tx

Answer 2

Sx: hypervent, ards, metabolic acidosis, kidney damage, elevated pt, ams, fever

Labs: cbc, bmp, coags, abg, level

Tx: alkalinize urine

Question 3

Burns management

Answer 3

Give 100% O2 for CO poisoning
Intubate if resp injury (if hds, fiber optic laryngoscopy to see if need to intubate)
High volume fluids based on weight and burn surface area

Question 4

Digoxin sx and tx

Answer 4

GI, blurred yellow vision, arrhythmia, enceph

Tx antibodies to bind dig

Question 5

Methgb

Answer 5

Hgb locked in oxidized state so cyanotic etc

From nitrates, anesthetics like lidocaine, dapsone, etc

Tx 100% O2 and methylene blue

Question 6

Serotonin syndrome vs nms vs maoi toxicity

Answer 6

Ser: agitation, hyper reflex, hyperthermia, mm rigidity; tx cyproheptadine and ivf

Nms: fever, tachy, rigidity, ams, elevated cpk; tx bromocriptine, mm relax, dc ap

Maoi: htn, caused by maoi + decongestant, antihist, tyramine rich foods —> displace norepinephrine from storage vesicles

Question 7

Acute MS change of unknown etiology - what to do?

Answer 7

Give thiamine, dextrose and narcan

Question 8

TCA od sx

Answer 8

Arrhythmias, seizures
Also antichol

Question 9

Altitude sickness tx

Answer 9

Acetazolamide

Question 10

Hypothermia sx

Answer 10

Arrhythmia (get ekg)

Question 11

Fire, worry about…

Answer 11

Cyanide (inhibits mitochondrial oxidative phosphorylation, cells can’t use oxygen so stays in venous blood) —> lactic acidosis, hypoxia, metabolic acidosis

CO - binds hemoglobin and reduces O2 delivery

Supportive care, hydroxocobal (for cyanide) and sodium thiosulfate (for cyanide)

Question 12

Cocaine treatment of CV effects

Answer 12

Nitro and benzos
CCBs for persistent chest pain
Phentolamine (alpha antag) for persistent htn

Question 13

Rabies prophylaxis

Answer 13

If preventative, give vaccine
If patient has been exposed and never been vaccinated, give vaccine and immunoglobulin to give some protection before vaccine works
If patient has been exposed and vaccinated, give only abbreviated vaccine. Immunoglobulin impairs antibody response from prior vaccine.

Question 14

Someone presents unresponsive, what do you order?

Answer 14

• utox, ekg, CO, methemoglobin, ethanol, salicylates, acetaminophen, tca level, abg and pulse ox, glucose, heent exam, lactate, ck
• tx: charcoal once awake, o2
  — b1 then dextrose if alcohol
  — naloxone
  — IVF