Toxicology Flashcards
What are the top 5 substances adults are exposed to
Analgesics, Cosmetics, Cleaning substances, Sedative/Hypnotics/Antipsychotics, Foreign bodies
What are the top 5 substances pediatrics are exposed to
Cosmetics, Analgesics, Cleaning substances, foreign bodies, Topical preparations
What are the top 10 substances involved in fatalities
-Sedatives/Hypnotics/ Antipsychotics
-Cardiovascular drugs
-Opioids
-Acetaminophen combinations
-Stimulants/Street drugs
-Acetaminophen alone
-Alcohol
-Antidepressants
-SSRIs
-Antihistamines
What’s a toxidrome
A collection of findings that suggests a substance or substance class
SS of opioid toxidrome
Miosis, Hypoventilation, Coma, Bradycardia, Hypotension
Cholinergic toxidrome
Sialorrhea, Lacrimation, Urination, Diarrhea, Gastric upset, Emesis, Bradycardia, Bronchorrhea, Bronchospasm, Miosis
Anticholinergic toxidrome
Tachycardia, HTN, Urinary retention, decreased bowel sounds, dry skin, seizures, hyperthermia
Sympathomimetic toxidrome
Diaphoresis, Mydriasis, Tachycardia, Hypertension, Hyperthermia, Seizures
What can be used to counter Opioid overdose?
Naloxone
GI decontamination drug
Activated charcoal
Benzos, Ketamine, and propofol can treat
Agitation
Calcium Channel blockers can treat
Tachycardia
Atropine can treat
bradycardia
Benzos can treat
Seizures
A poison is classified as
any substance that
produces harmful physiological or
psychological effects.
List the 4 routes of entry
Inhalation, Absorption, Injection, Ingestion
Inhaled poisons damage is directly proportional to
the concentration
Early injuries from inhaled toxins
Soluble chemicals
Inhaled toxins that mut be metabolized prior to damage
Insoluble chemicals
Simple asphyxiants:
Lower O2 concentration
Chemical asphyxiants
Cause systemic toxicity
Irritants or corrosives
Destroy cells on contact
What route are organophosphates typically taken in
Absorption
What are the two most common spider bites in the US
Black widow and Brown recluse
The black widows bite is
a neurotoxin
The brown recluses bite causes
Localized tissue necrosis
Black widow bite S/S
Spasms, Cramps, Burning, Pain, Headache, Dizziness, nausea, Vomiting, Edema, Salivation
Bark scorpion stings affect
the neuromuscular system
What are the two most common types of snake bite
Pit viper, coral snake
How do you treat snake bites?
ABCs, immobilize extremity, keep patient resting, Constricting bands, Bring snake (If dead)
What are the four methods of decontaminating the gut
Ipecac, gastric lavage, activated charcoal, whole bowel irrigation
Most poisonings are in
children
True or false: You should bring ALL the pill bottles in
True
Prolonged QRS may be caused by
*TCAs
*Phenothiazines
*Calcium channel
blockers
Sinus Brady or AV block may be caused by
*Beta
blockers, calcium
channel blockers
*TCAs
*Digoxin
*organophosphates
V-Tach may be caused by
*Cocaine, amphetamines
*Chloral hydrate
*Theophylline
*Digoxin
*TCAs
What separates Anticholinergic and sympathomimetic toxidromes
Sympathomimetics cause sweating
What is a downside of Narcan
May cause acute withdrawal in addicts
Activated charcoal is not good for
Lithium, Iron, Alcohols, lead, Hydrocarbons, Caustics
Your patient is a 22-year-old female who has increased her daily dose of lithium without her physician’s knowledge. She is complaining of generalized weakness, vomiting, and diarrhea. You notice that her speech is slurred. Heart rate = 68 and irregular, respirations = 16, blood pressure = 104/70, SaO2 = 97% on room air, and the monitor shows a sinus rhythm with PACs and PJCs. Which of the following would be most beneficial to this patient?
Sodium Bicarbonate
You are presented with a 25-year-old male complaining of mouth and stomach pain after accidentally ingesting approximately 8 ounces of benzene. Physical examination reveals irritation to the oral mucosa, skin warm and slightly diaphoretic, and lungs clear and equal bilaterally. HR = 100, BP = 118/66, RR = 14, SaO2 = 99%. Based on the clinical exam findings, treatment would consist of all of the following EXCEPT:
administration of activated charcoal
Your patient is a 40-year-old male who ingested 30 tablets of Lexapro and 24 tablets of Tylenol PM. Which of the following is the most important question you should ask?
“How long ago did you take these medications?”
Your patient is a 27-year-old male who has possibly overdosed on heroin. He is unresponsive and bradypneic. Which of the following is appropriate?
2 mg of naloxone
A 19-year-old male has ingested fifty 325 mg aspirin tablets 20 minutes before your arrival. He is alert and complaining of burning abdominal pain. Which of the following is appropriate in the prehospital management of this patient?
Activated charcoal
Which of the following medication combinations is beneficial for a lithium overdose?
Mannitol and sodium bicarbonate
Your patient is an alcoholic who stopped drinking three days ago. Which of the following should concern you the most in the care of this patient?
Potential for seizures
LSD and PCP are examples of:
hallucinogens.
You are presented with a 42-year-old male who is unconscious with snoring respirations after a heroin overdose. HR = 64, BP = 98/50, RR = 6 and shallow, SaO2 = 91%. Which of the following is the most appropriate initial treatment
IV access, administer naloxone
Mushrooms from the class ________ are responsible for over 90 percent of deaths from mushroom toxicity.
Amanita
Your patient is a 45-year-old female who became hypertensive after eating some cheese and drinking wine. Which type of medication would most likely account for this reaction?
Monoamine oxidase inhibitors
Inhaled toxins:
cause damage and edema in the lungs.
Your patient is a 60-year-old male complaining of chills, fever, joint pain, and vomiting. He states he was bitten by a spider yesterday morning, and now he thinks the bite might be infected. The patient has an ulcerated wound on his left leg. The best treatment for this patient would include:
supportive management.
It is the middle of winter and you are called to a scene for a “sick family.” As you arrive, the husband meets you at the road and states he has a headache but also that he returned home this morning and found his wife and two children lying on the couch all complaining of nausea/vomiting, headaches, and inability to stand. What would be an appropriate action at this time?
Call the fire department and have them retrieve the family with breathing equipment on
A patient has accidentally ingested about 4 ounces of drain cleaner. Your primary concern should be
Potential airway compromise
A 54-year-old female is conscious and alert and in significant pain after a rattlesnake bite to her hand. You note two small puncture wounds surrounded by a swollen, red area. She states that she is nauseous and has chills. Your management of this patient should include immobilization of the affected arm and:
Placing it at the level of the heart
What is a group of signs and symptoms and/or characteristic effects associated with exposure to a particular substance or class of substance called?
Toxidrome
What is the process of passing a tube into the stomach and repeatedly filling and emptying the stomach with water or saline?
Gastric lavage
What is the basic purpose of poison control centers (PCC)?
To provide information about poisonings and treatment recommendations for health care providers
Which of the following routes of toxic exposure is most common?
Ingestion
Individuals engaged in agricultural and food handling industries are most likely to have what type of mechanism behind a toxic exposure?
Absorption
Although toxic exposures can have immediate and delayed effects, what type of exposure mechanism would likely start out with pulmonary findings such as tachypnea, wheezing, or inspiratory crackles?
Inhalation
What route of toxic exposure would most likely cause systemic effects?
Injection
You are called for a “possible overdose.” Examination reveals that the patient has a pulse of 112 per minute. Of the following, which is most likely to have caused the tachycardia?
Cocaine
Symptoms that include protruding tongue, twisted neck, deviated gaze, and abdominal rigidity should suggest which diagnosis?
Dystonic reaction
“Huffers” will commonly complain of all the following EXCECPT:
diarrhea, muscle cramps.
Toxic overdoses of acetaminophen can cause damage and necrosis to what organ of the body?
Liver
What is the underlying pathophysiology that creates the clinical findings consistent with toxic exposure to a caustic substance?
Burn injuries at site of contact
Which drug in the lily kit is given in order to produce methemoglobin, which binds cyanide.
Sodium thiosulfate
You have a patient who was exposed to cyanide. During your management of this patient, which of the following drugs would not be part of the cyanide antidote kit?
Sodium thiosulfate
If a patient presents with findings consistent with serotonin syndrome following ingestion of a prescription antidepressant, what was the likely agent he overdosed on?
Zoloft
You are contemplating the use of activated charcoal in a patient that has just ingested a large quantity of pills 20 minutes before your arrival. For which of the following ingested agents is activated charcoal not recommended?
Iron pills
What is the first priority when dealing with a patient suffering from a toxic inhalation?
Remove the patient from the source as soon as it is safe to do so
Which of the following is the definition of decontamination?
The process of reducing the amount of toxin absorbed into the body
The need for an increased amount of a drug to obtain effects previously attained from a lower dose of the same drug is called:
tolerance
The majority of adult poisonings and overdoses are:
intentional
If a child has experienced an accidental ingestion once, what is the likelihood that he will have another exposure within one year?
Definitely likely (25 percent)
Your patient has ingested cyanide in a suicide attempt. Which of the following is the primary threat to life you should anticipate?
Cellular asphyxia
Your patient is a 44-year-old male who has been in jail for three days after being arrested for driving while intoxicated. He now presents with diaphoresis, anxiety, hallucinations, insomnia, and tremors. HR = 142, BP = 132/94, RR = 34, blood glucose = 85 mg/dL. Which of the following is appropriate?
Thiamine 100 mg IV
The American Association of Poison Control Centers estimates that more than ___________ poisonings occur annually.
3 million
Which of the following is a common inhaled poison?
Carbon tetrachloride
The use of which of the following is the most effective and widely used method of reducing absorption of toxins?
Activated charcoal
Amitriptyline, amoxapine, clomipramine, doxepin, imipramine, and nortriptyline are common agents called
tricyclic antidepressants.
Which medication will likely be used by a patient diagnosed with bipolar disorder?
Lithium
Which is the most common pit viper?
Rattlesnake
Because of the presence of neurotoxin, coral snake venom primarily affects which type of tissue?
Nervous
What is the most common substance of abuse in the United States and most of the world?
Alcohol
In cases of poisoning, patient histories are often unreliable because of
all of the above.
Which of the following toxic/ abuse situations is incorrectly paired with its prehospital management?
TCAs: flumazenil
Your patient is a 24-year-old male complaining of a headache for the past two days. He states he has taken aspirin but cannot get rid of the headache. The patient lives in a basement apartment, which you observe is very chilly. The patient states his furnace hasn’t been working and he had to use the oven to help heat the apartment. Which other findings and complaints are most likely?
Nausea, vomiting, confusion, tachypnea
A 32-year-old female is conscious and alert at a group home for recovering alcoholics and states, “I’m having rum fits.” Counselors from the home tell you that she is a chronic alcoholic who entered their program three days ago and has not had a drink since. Physical examination reveals cool, diaphoretic skin; dilated pupils bilaterally that are responsive to light; and obvious anxiety. HR = 122, BP = 156/104, RR = 20, SaO2 = 99%, blood glucose = 62 mg/dL. Based on the clinical exam findings, all of the following should be part of your patient management EXCEPT:
metoprolol IV.
A patient has accidentally ingested about 4 ounces of drain cleaner. Your primary concern should be:
potential airway compromise
Cocaine overdose may be treated with
Diazepam
In addition to determining potential toxicity based on the type of agent, poison control centers are able to:
guide the paramedic in starting definitive treatment in the field
Your patient is a two-year-old male who is alert and crying after ingesting bathroom cleaner. Physical examination reveals no obvious burns or irritation to his oropharynx, and his skin is cool and dry. HR = 112, BP = 108/60, RR = 24,
SaO2 = 99 percent. Which of the following is most appropriate?
transport
A patient has overdosed on TCA antidepressants in an attempt to end his life. The blood pressure is low despite repeated fluid boluses. You contact medical direction for additional orders to help raise the blood pressure. What medication will you likely be told to administer?
norepinephrine
