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:


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


What is the definition of the term "drug abuse"?


The use of prescription drugs for nonprescribed purposesor the use of drugs that have no prescribed medical use


Heroin accounts for what percentage of opiod abuse in the US?


90%


Which commonly prescribed pain medication is most commonly abused?


Vicodin (Hydrocodone)


What is PCP psychosis?


usually acute onsetmay mimic schizophreniacan occur after a single low-dose exposure to PCPmay not be apparent until several days after exposure


What is the pathophysiology behind tricyclic antidepressant toxicity?


Sodium channel blockade in the myocardiumBlockade of blood vesselsCausing:Anticholinergic effects and seizures


What are the early SXS of a TCA overdose?


Dry mouthBlurred visionConfusionInability to concentrateOccasionally visual hallucinations


What are some later severe symptoms of a TCA overdose?


DeliriumDepressed respirationsHypertension/HypotensionHyperthermia/HypothermiaSeizuresComaTachycardia/BradycardiaProlonged QRS complexGCS less than 8


What are the SXS of a black widow bite?


Pin prick to painful biteCramps usually abdominalRarely hypertension, paralysis, respiratory distress


How do we treat a black widow bite?


Treat SXSPain medicationsWash woundTransport


What are the SXS of a brown recluse bite?


Necrotic tissue effectLocal reactionBulls eye lesion (irregular shape)


How do we treat a brown recluse bite?


Clean woundTransport


How do we treat a tarantula bite?


IceAnalgesicRemove urticating hair


How do we treat bee and wasp stings?


Remove stingerAnalgesicEpinephrine and antihistamine for anaphylaxis if needed


What are the SXS of a scorpion sting?


Immediate intense painMild inflammationParaesthesiaHyperesthesiaDifficulty swallowing/speechRestlessness/anxietyUrinary retentionRespiratory paralysis


How do we treat a scorpion sting?


Ice on siteAnalgesic OTCMonitor cardiac functionMonitor respirations, speech, dysphagiaClean wound


What are the five poisonous snakes in the US?


RattlesnakesCopperheadWater MoccasinCottonmouthCoral Snake


What are the SXS of a snakebite?


Bloody wound discharge with fang marks in the skinSkin discoloration and local tissue deathNumbness and tingling and swelling at the siteSevere pain and burningBlurred vision, dizziness, WeaknessNausea, vomiting, diarrheaFainting, fever, convulsionsExcessive sweating and increased thirstRapid pulseMetallic tasteLoss of muscle coordination


How do we treat a snakebite?


Limit venom spread with immobilization and lymphatic restricting bandsEvacuationBLSIVMorphineMCEP/Poison ControlAnaphylax Tx if necessary


What are the "DO NOT"s of snakebites?


DO NOT allow the person to become over-exertedDO NOT apply a tourniquetDO NOT apply cold compressDO NOT cut into bite or suctionDO NOT give the person stimulantsDO NOT give the person anything PODO NOT raise the site above the level of the heart


What creatures use offensive neurotoxins?


Spiders (paralyze prey to minimize web destruction or harm to self)Marine (paralyze prey to facilitate rapid feeding and minimize harm to self)TarantulasScorpionsCoral snake


What creatures use offensive hemotoxins?


Pit vipers


What creatures use defensive neurotoxins?


Bees Wasps Hornets and Ants


What creatures use Anticoagulant toxins?


Mosquitos, ticks


What does AABCDE stand for specific to poisoning?


Alter absorptionAntidoteBasics (ABCs)Change catabolismDistribute differentlyEnhance elimination


What is toxicodynamics?


What the poison does to the body


What is toxicokinetics?


What the body does to the poison


What is the mneumonic device we use to remember the SXS of an anticholinergic poisoning?


Mad as a hatterRed as a beetHot as a hareBlind as a batDry as a bone


What toxins cause miosis?


Opiate NarcoticsDepressantsCholinergicsNicotinePhenothiazines


What toxins cause mydriasis?


HallucinogensStimulantsAnticholinergicSympathomimeticsWithdrawal


What toxins cause hyperthermia?


AnticholinergicsMAOIsMetalsPCPSalicylatesSympathomimeticsPhenothiazinesWithdrawal


What toxins cause hypothermia?


Beta BlockersCOCholinergicsEthanolHypoglycemicsSedative Hypnotics


What toxins cause hypertension?


AnticholinergicsAntihistaminesPCPSympathomimeticsStimulantsWithdrawal states


What toxins cause hypotension?


COTCAsIronOpiodsNitritesPhenothiazinesSedative HypnoticsTheophylline


What toxins cause decreased respiratory effort?


AlcoholBarbituatesBenzosOpiods


What toxins cause increased respiratory effort?


Systemic asphyxiantsSimple asphyxiants


what are some specific SXS of Anticholinergics?


Decreased bowel soundsUrinary retensionHypertension


What are some specific SXS of hydrogen sulfide poisoning?


Rotten egg smellBrownish colored bloodWhole body cyanosis"Gas Eye"


What is the adult dose of Hydroxycobalamine?


5g IV over 30 mins


What is the pediatric dose of Hydroxycobalamine?


<70 kg is 70mg/kg IV


What does MTWHF stand for?


MydriasisTachycardiaWeaknessHypertensionFAsciculations


What is MTWHF associated with?


Cholinergic toxidromeEARLY SXS of poisoning


What does DUMBELS stand for?


DiarrheaUrinationMiosisBradycardia/BronchospasmEmesisLacrimationSalivation/Sweating


What is the adult dose for Atropine for Cholinergic poisoning?


1-2mg IVP q 5-15 mins


What is the pediatric dose of Atropine for Cholinergic poisoning?


0.02-0.05 mg/kg q 1-4 hrs


What is the adult dose for Pralidoxime?


600 mg autoinjector or 1-2g IVP over 15-30 mins


What is the pediatric dose for Pralidoxime?


20-50 mg/kg over 15-30 mins


What are some common SXS specific to LSD/Hallucinogens?


Nausea, loss of appetiteChills, flushingShakingAbdominal discomfortNumbness/numbing of the mouth


What do all irritant gases form when mixed with water?


Acids


The more water soluble an irritant gas is, the higher or lower in the respiratory system you will see SXS?


Higher


What three areas of chemical burns may there be depending on the water solubility of an irritant gas?


Upper airway (stridor, conjunctivitis)Bronchi (wheezing)Alveoli (flash pulmonary edema)


What is the descriminating factor between SXS of Opiate/Narcotic or alcohol toxicity and Sedative/Hypnotic toxicity?


Respiratory depression will generally only occur in Opiate/Narcotic and alcohol toxicityAlcohol toxicity will also lower body temperature; Sedative/Hypnotics do not


What is thought to be the adult fatal dose of cocaine?


1200 mg (25-30 has been fatal due to arrhythmias)


What are the 3 components of the "Deadly Triangle" associated with sympathomimetics?


Cardiac DysrhythmiasHyperthermiaDehydration


What are the four stages of ETOH Withdrawal Syndrome?


Minor reactionsHallucinationsAlcohol Withdrawal SeizuresDelirium Tremens


When do minor reactions of ETOH withdrawal start and how long do they last?


Start 6 to 8 hours after cessationLast up to 10-14 days


When do hallucinations generally start in ETOH withdrawal?


24-36 hours after cessation


When do alcohol withdrawal seizures usually occur?


7 to 48 hours after cessationGrand MalGroups of 2 to 6


When do DTs begin in ETOH withdrawal?


72 to 96 hours after cessationMay be delayed up to 14 daysSingle episode may last 1-3 days


What is the pediatric dose for Thiamine?


10-25 mg SIVP or IM


What things is Ethylene Glycol found in?


Windshield deicerAntifreezeRadiator fluid


As little as _________ ml can cause death from ethylene glycol.


60


What is the time range for the onset of SXS of ethylene glycol toxicity?


1 to 72 hours


How many stages are there in ethylene glycol toxicity? Name them.


3 stagesStage 1 CNS systemStage 2 Cardiopulmonary systemStage 3 Renal system


How do we treat ethylene glycol toxicity?


ABCsCardiac monitorAcitvated Charcoal - removes 50%Sodium BicarbThiamineCalcium prepsSeizure control


What dosage of iron is considered severe?


20mg/kg


What are some specific SXS of iron toxicity?


HematemesisMelenaAbdominal pain


What is considered a potentially lethal dose of isopropanol in an adult?


150 to 240 mL


What is the biggest concern in isopropanol poisoning?


Respiratory depressionOnset of SXS 30 mins after ingestion


What two organ systems are the heavy metals most likely to affect?


CNS GI/GU


What is a major permanent disability caused by methanol toxicity?


Blindness/ permanent nerve damage


As little as _____ mL of methanol can cause blindness.


4 mL


What is the time range for the onset of SXS of methanol toxicity?


40 mins to 72 hours


What is a major specific SXS of NSAID toxicity?


Tinnitus


What dose is considered a severe toxicity of NSAIDs?


MOre than 300 mg/kg


What dose is considered mild toxicity of NSAIDs?


Less than 150 mg/kg


What dose is considered moderate toxicity of NSAIDs?


150 - 300 mg/kg


What dose is considered fatal toxicity of NSAIDs?


More than 500 mg/kg