Toxidromes And Levels Of Consciousness

Question 1

Levels of consciousness in order

Answer 1

alert, lethargic or somnolent, obtunded, stupor or semi-coma, coma

Question 2

Coma cocktail

Answer 2

Thiamine 100mg slow IV push
D50 50ml IV over 3-5 minutes
Naloxone 0.8-2mg IV push

Question 3

ABC’s?

Answer 3

Airway
Breathing
Circulation
Disability
Exposure

Question 4

Symptoms of cholinergic (organophosphate) poisoning

Answer 4

salivation, lacrimation, urination, defecation, GI pain, Emesis, bradycardia, bronchorrhea, bronchospasms

Question 5

Treatment of cholinergic (organophosphate) poisoning

Answer 5

2-PAM (pralidoxime) or Atropine

Question 6

Common causes of anti-cholinergic poisoning

Answer 6

TCA, antipsychotics, antihistamines

Question 7

Symptoms of anti-cholinergic poisoning

Answer 7

flushing (red as a beet)
fever (hot as a hare)
urinary retention, dry mucous membranes (dry as a bone)
toxic psychosis (mad as a hatter)

Question 8

Symptoms of TCA poisoning

Answer 8

Pulmonary edema, anti-cholinergic effects, AV blocks, hypotension, confusion, agitation, hallucination, seizure or coma

Question 9

Treatment of TCA poisoning

Answer 9

ECG monitoring, charcoal, sodium bicarbonate, benzodiazepines

Question 10

Opioid (Heroin, morphine) poisoning symptoms

Answer 10

CNS depression, miosis, respiratory depression

Question 11

Treatment of opioid poisoning

Answer 11

Naloxone and ventilation

Question 12

Sympathomimetics (cocaine, meth) poisoning symptoms

Answer 12

psychomotor agitation, mydriasis, diaphoresis (sweating), tachycardia, hypertension

Question 13

Treatment of sympathomimetic poisoning

Answer 13

Cooling, sedation (benzodiazepines), hydration

Question 14

Antidote to acetaminophen

Answer 14

Acetylcysteine

Question 15

Antidote to anti-cholinergics

Answer 15

Physostigmine

Question 16

Antidote to benzodiazepines

Answer 16

Flumazenil

Question 17

Antidote to beta-blockers

Answer 17

Glucagon

Question 18

Antidote to calcium channel blockers

Answer 18

Calcium

Question 19

Antidote to digoxin

Answer 19

Digibind

Question 20

Antidote to heavy metals

Answer 20

chelating agents

Question 21

Antidote to narcotics

Answer 21

naloxone

Question 22

Symptoms of withdrawal from sedative hypnotics

Answer 22

agitation, tremor, N/V, tachycardia, hallucinations, flushing

Question 23

Treatment of withdrawal from sedative hypnotics

Answer 23

introduce pentobarbital, switch to phenobarbital PO then taper slowly over 10 days

Question 24

90% of withdrawal seizures occur how long after abstinence?

Answer 24

6 to 48 hours
these seizures are usually focal seizures
if repetitive (DT) , tx is Valium or Phenobarbital IV

Question 25

Most common electrolyte abnormality

Answer 25

Hyponatremia | Na < 120 mEq/L; pts present with delirium, drowsiness, lethargy and can progress to seizures and coma

Question 26

How to distinguish psychotic and organic altered mental status?

Answer 26

difficult orientation to person is rare in organic disease psychotic patient usually have recent memory and can perform single calculations

Question 27

Presentation of strokes

Answer 27

Altered mental status, dysphasic or slurred speech, loss of movement/strength of one or both sides of the body, asymmetrical facial features.

Question 28

Thrombotic Thrombocytiopenia Purpura: presentation and tx

Answer 28

neurologic changes, acute fever, bleeding/rash, renal failure Women 20-40; related to pregnancy, lupus, von Willebrand factor clots Tx: plasma exchange and steroids

Question 29

You CANNOT clear a C-spine if:

Answer 29

``` intoxication distracting injuries midline posterior point tenderness any alteration in mental status focal neurological deficits ```

Question 30

Presentation of Hypothermia

Answer 30

skin temp near 91 F peripheral vasoconstriction, shivering, altered mental status, apathy, lethargy, ataxia (loss of control of body movements)

Question 31

Presentation of heat exhaustion

Answer 31

Core temperature is normal or less than 106 F | orthostatic hypotension, tachycardia, sweating

Question 32

Presentation of heat stroke

Answer 32

Core temperature is above 106 F; | orthostatic hypotension, tachycardia, CNS dysfunction, may lose the ability to sweat.

Question 33

Presentation of acute alcohol intoxication

Answer 33

Peripheral vasodilatation, tachycardia, hypotension, hypothermia Stupor occurs when blood alcohol level reaches 250-300 mg/dL

Question 34

Presentation and treatment of Wernicke's Encephalopathy

Answer 34

Caused by acute thiamine deficiency + carbohydrates, associated with alcoholism, malnutrition; nystagmus, palsy of CN 6 - opthalmoplegia; truncal ataxia, unsteady gait; confusion, delirium, apathy, tachycardia, DOE, orthostatic hypotension, peripheral neuropathy; Tx: Thiamine 100 mg IV slow push STAT; continued IV infusion + vitamins (magnesium), "banana bag," bedrest

Question 35

Presentation of Delirium Tremens

Answer 35

Appears 3-4 days after abstinence form alcohol in alcoholics; profoundly delirious state, tremulousness, agitation, excessive motor activity, purposeless activity; hallucinations, tachycardia, dilated pupils, fever, excess sweating, not orientated to situation. Tx: Librium, thiamine, multivitamin