toxicologyflashcards.txt


What does PHAILS stand for?


PesticidesHydrocarbonsAcids, Alkalis, AlcoholIronLithiumSolvents


What is the acronym PHAILS used for?


Recalling the substances poorly absorbed by activated charcoal


What three drugs make up the antidote kit for cyanide poisoning?


Amyl nitrite (inhaled)Sodium nitrite (IV)Sodium thiosulfate (IV)


What are the other names for the Cyanide Antidote Kit?


Taylor KitLilly KitPasadena Kit


What is the pathophysiology behind cyanide poisoning?


Cyanide interrupts the electron transport chain in the mitochondria greatly reducing the number of ATP that can be manufactured.Cyanide combines with enzyme cytochrome oxidase, which inhibits cellular oxygenation, leading to anaerobic metabolism, then to metabolic acidosis, then cellular death.


How does the Cyanide Antidote Kit work?


Changes the chemical structure of hemoglobin by adding an iron molecule, making methemoglobin.Methemoglobin is incapable of carrying oxygen, but it draws out the cyanide from the cytochrome oxidase.The sodium thiosulfate that is given then detoxifies the cyanide in the blood, just like the body normally does.


What is a major side effect that should be expected with the Cyanide Antidote Kit?


HypotensionPatient should be lying down if possibleMCEP may order vasopressors


How is cyanide poisoning sometimes treated in the field?


Hydroxycobalamin (AKA Cyanokit)


How does Hydroxycobalamin work?


Binds to cyanide and forms cyanocobalamin instead of methemoglobin, which does not lower the oxygen carrying capacity of the blood


What are the expected side effects of Hydroxycobalamin?


Transient hypertensionReddish discoloration of the skin


Activated charcoal removes toxins by the process of:


Adsorption (binding)


The drug of choice for carbamate poisonings is:


Atropine


The mnemonic device SLUDGE helps you to remember the:


Signs of organophosphate poisoning


You are called to a local park where several people attending a family reunion report stomach pain, nausea, and vomiting. Patients report that lunch was served 2 hours ago. This time frame would lead you to suspect that the cause of the food poisoning was:


Bacterial toxin


You are called to a local beach to treat a man who stepped on a starfish. He now has a painful wound in which a piece of the starfish is still intact. Treatment for this patient includes:


Immerse the foot in very warm water


Sedative-hypnotic drugs include:


Benzodiazepines and barbiturates


Most poisonings in the United States occur:


In the home


You are called to a local woodshop where a man was found seizing, immediately after working with a paint-removal product. The man was not wearing gloves. He is now confused and lethargic. He is tachypneic and complains of abdominal pain. After protecting his airway, treatment for this patient may include:


Ethanol


If the stinger is left in the wound after a sting by a honey bee, you should:


Scrape the stinger from the wound


Drug therapy for patients with organophosphate poisoning:


Should be administered if the patient has two or more symptoms of respiratory distress


The most commonly ingested NSAID in overdose is:


Ibuprofen


Acetaminophen overdose leads to toxicity of the:


Liver


The mnemonic device CHAMP helps you remember:


Which hydrocarbons may benefit from gastric lavage


You are called to treat a 2-year-old child who has just ingested lye. The child is conscious and cooperative. The poison control center may advise you to administer what oral solution?


Milk


What medication can you use to prevent exacerbation of Wernicke-Korsakoff syndrome?


Thiamine


Activated charcoal is most effective when the:


Poison was ingested less than an hour before the administration of charcoal


The most common route of mercury poisoning is:


Inhalation


The pharmacological management of choice for a symptomatic overdose of a tricyclic antidepressant is:


Sodium bicarbonate


Syrup of ipecac is :


Not recommended for routine use in the prehospital setting


Most poisoned patients require what type of therapy in the prehospital setting?


Supportive care


An employee in a pest-control business is found unconscious on a garage floor. You find him drooling and diaphoretic. The most appropriate medication for this patient is:


Atropine


A chemical that may be produced when nylon and polyurethane burn and is of particular concern in any fire environment is:


Cyanide


Disulfiram is a medication taken by alcoholics to prevent:


Alcoholic intake


Which of the following is an early sign of toxicity in reaction to a tricyclic antidepressant?


Blurred vision


A reasonable approach in an adult who has taken an overdose of pills would be:


1. Lavage followed by two glasses of milk 3. Charcoal followed by two glasses of water 4. Lavage followed by charcoal


The most common cardiovascular complications of poisoning by ingestion is:


Rhythm disturbances


The preferred method of keeping a poison from entering the small intestine is:


Use of activated charcoal


Organophosphates affect primarily which neurotransmitter?


Acetylcholine


You find your 22-year-old patient unconscious and breathing six times per minute. His pupils are equal and pinpoint. Your partner begins ventilation and oxygenation using a bag-mask. You are unable to establish vascular access by IV or IO. Which of the following interventions has the highest priority?


Administer naloxone 2 mg IM

Activated charcoal should be withheld if the ingestion occurred :Within 1 or more hours before EMS arrival


Any substance that produces harmful physiological or psychological effects is called a(n):


Poison


Alcohol withdrawal can lead to hallucinations in _____ hours.


24 to 36

The most commonly ingested NSAID in overdose is:Ibuprofen


Among a patient?s prescription medications, you find a bottle of lithium, leading you to suspect that the patient has:


Bipolar disorder

What finding would lead you to eliminate a spider bite as the cause of an injected poison?Multiple bites
Management of a patient bitten by a pit viper should include:Immobilizing the limb


Minor symptoms of alcohol withdrawal usually:


Peak within 24 to 36 hours


Medical direction may advise you to promote gastric emptying in a patient who has ingested lead or mercury because:


The risk for systemic toxicity outweighs the risk for aspiration


The absorption of toxins takes place primarily in the:


Small intestine


How should the envenomation site of a jellyfish sting be treated?


Apply isopropanol and baking soda


Most accidental poisonings in children from 1 to 3 years of age occur by means of:


Ingestion


The antidote for benzodiazepine overdose is:


Flumazenil


You are called to a local woodshop where a man was found seizing, immediately after working with a paint-removal product. The man was not wearing gloves. He is now confused and lethargic. He is tachypneic and complains of abdominal pain. You suspect this patient has been poisoned by:


Methanol


Which drug is found in the Pasadena cyanide antidote kit?


Amyl nitrite


You find your 22-year-old patient unconscious and breathing six times per minute. His pupils are equal and pinpoint. Your partner begins ventilation and oxygenation using a bag-mask. You are unable to establish vascular access by IV or IO. Which of the following interventions has the highest priority?


Administer naloxone 2 mg IM


Cocaine is a(n):


CNS stimulant


You respond to a call for an overdose. When you arrive, you find a teenage girl who is drowsy and snoring, but arouses to sternal pressure. Her friends think she took some Vicodin and Valium 40 minutes ago and drank some vodka. Her vital signs are BP 98/70 mmHg, P. 116 bpm, R 16/min., SaO2 97%. Which of the following interventions would be appropriate?


Insert a nasal airway and administer naloxone 0.4 mg IV


The drug of choice to treat an overdose of opiates is:


Naloxone


Which of the following organs is most likely to show the effects of poisoning first?


Heart


Most pediatric lead poisonings occur as a result of:


Ingestion of paint chips


What are the four routes through which poisons may enter the body?


InhalationAbsorptionIngestionInjection


What percentage of all accidental ingestion of poisons occurs in children 1 to 3 years of age?


80%


What is the first priority in managing a poisoned patient after scene safety?


Securing a patent airway


What are the specific questions that should be asked as part of the history of a poisoned patient?


What?When?How much?Antidote been given?Psychiatric history/suicide attempts?


What is a cathartic?


An agent that causes bowel evacuation


What are the main goals (2) in managing a poisoned patient?


Managing symptomsPreventing absorption


What does CHAMP stand for?


CamphorHalogenatedAromaticMetal-containingPesticide-containing


How quickly do symptoms appear in cases of chemical food poisoning?


Within 30 minutes


How quickly do symptoms appear in cases of food poisoning caused by bacterial toxins?


1 to 12 hours


How quickly do symptoms develop in cases of food poisoning caused by viral or bacterial infections?


12 to 48 hours


What is a direct-acting chemical?


Chemical capable of producing injury without first being transformed or changed i.e. hydrofluoric acid


A cyanide antidote kit should not be given to a patient who is suspected to be suffering from cyanide poisoning due to what circumstance?


Smoke inhalationCarbon monoxide poisoning already limits oxygen carrying capabilityPatient could die from anoxious brain injury


What is the only hymenopteran species with venom that results in necrotic activity?


The imported fire ant