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:


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:


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:


Acetaminophen overdose leads to toxicity of the:


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?


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


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:


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:


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


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?


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):


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:


The antidote for benzodiazepine overdose is:


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:


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:


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


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?


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


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?


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?


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?


What toxins cause hyperthermia?


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?


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?


What is MTWHF associated with?

Cholinergic toxidromeEARLY SXS of poisoning

What does DUMBELS stand for?


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?


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


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.


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?


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?


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?


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