Environmental/Toxicology

Question 1

Normal body temperature

Answer 1

37. 0 C

98. 6 F

Question 2

Mild hypothermia temperature (C), common signs

Answer 2

32-36 C

slowing heart rate, shivering

Question 3

Moderate hypothermia temperature (C), common signs

Answer 3

28-32 C

loss of shivering, altered LoC, reduced drug metabolism

Question 4

Severe hypothermia temperature (C), common signs

Question 5

Two major causes of heat loss

Answer 5

evaporation, radiation

Question 6

Thermoregulation ceases at what temp

Answer 6

28 C

Question 7

What is the appropriate and inappropriate drug for treating stimulant overdose (cocaine, meth)?

Answer 7

Appropriate: benzodiazepines, nitro
Inappropriate: B-blockers

Question 8

Signs of digoxin toxicity

Answer 8

Blurry vision, including green/yellow halos
Abnormal EKG, prolonged PR

“Dig-dip” is not sign of toxicity, only that PT is on digoxin

Question 9

Acetaminophen overdose proceeds in how many distinct stages? Each lasting about how long?

Answer 9

4 stages

24 hrs

Question 10

The most common drug overdose in the USA is:

Answer 10

Acetaminophen - responsible for the most ED visits and most admissions to ICU

Question 11

Describe stage 1 of acetaminophen overdose

Answer 11

0-24hrs
GI upset (N/V), may be asymptomatic

Question 12

Describe stage 2 of acetaminophen overdose

Answer 12

24-48 hrs

N/V, RUQ pain, elevation of liver enzymes

Question 13

Describe stage 3 of acetaminophen overdose

Answer 13

48-96 hrs

Acute liver failure (jaundice, abnormal coags, encephalopathy)

Question 14

Describe stage 4 of acetaminophen overdose

Answer 14

> 96 hrs

Death from liver failure or recovery (full recovery up to 3 months)

Question 15

Describe the initial presentation of acetylsalicylic acid (aspirin) overdose

Answer 15

N/V, headache, tinnitus, tachypnea

Question 16

Tylenol overdose is any ingestion greater than

Answer 16

200mg/kg

Question 17

Aspirin overdose is any ingestion greater than

Answer 17

approx 150mg/kg

Question 18

The antidote for tylenol overdose is

Answer 18

N-acetylcysteine (NAC aka Mucomyst)

Question 19

Defibrillation of a hypothermia PT is often not effective until body temperature is

Answer 19

30 degC

Question 20

Define afterdrop in the hypothermic patient

Answer 20

Prehospital external warming results in cold blood returning to core, increased risk of dysrhythmia

Question 21

What transfusion reaction occurs within minutes of administration?

Answer 21

Acute hemolytic reaction - donor blood rapidly destroyed by host antibodies, usually caused by ABO type incompatibility

Question 22

Anaphylactic reaction to blood transfusion most often occurs after how long

Answer 22

> 30 minutes

Question 23

The antidote for coumadin toxicity is

Answer 23

Vitamin K, FFP

Question 24

Treatment for digitalis toxicity includes

Answer 24

Digibind, pacing for severe bradycardia

Question 25

The antidote for malignant hyperthermia is

Answer 25

Dantroline

Question 26

What are the signs of malignant hyperthermia in the vented patient?

Answer 26

Recent administration of succinylcholine or anesthetic gas Rapid, uncorrectable elevation of ETCO2 May see elevated temp, muscle rigidity

Question 27

The most critical, life-saving treatment for heat stroke is

Answer 27

Rapid, active external cooling (submersion, ice sheets)

Question 28

The most common type of decompression injury from diving is

Answer 28

Pulmonary (the "chokes") - presents like PE | May also cause neuro symptoms

Question 29

How can arterial gas embolism (AGE) may be differentiated from decompression illness (DCI)?

Answer 29

AGE is rapid onset (

Question 30

Two types of decompression illness are:

Answer 30

The "bends" - severe joint pain | The "chokes" - respiratory or neuro symptoms

Question 31

What gas law describes how gases in the lungs expand when a scuba diver ascends?

Answer 31

Boyle's Law (P = 1/V)

Question 32

Describe hypoxic hypoxia

Answer 32

Reduced alveolar oxygen exchange (low FiO2, APE, lung disease)

Question 33

Describe hypemic hypoxia

Answer 33

Reduced oxygen carrying capacity of the blood (anemia, CO poisoning, sulfa/nitrate drug use)

Question 34

Describe stagnant hypoxia

Answer 34

Reduced cardiac output (PPV, PE, heart failure)

Question 35

Describe histotoxic hypoxia

Answer 35

Poisoning of cytochrome oxidase system, resulting in metabolic disorder (CN/CO/EtOH toxicity)

Question 36

Hallucinations are most common with what street drug poisonings?

Answer 36

PCP, LSD

Question 37

Treatment of organophosphate poisoning includes

Answer 37

Atropine, Pralidoxime | Benzodiazepines (for seizures)

Question 38

The antidote for benzodiazepine overdose is

Answer 38

Romazicon

Question 39

The antidote for ethanol toxicity is

Answer 39

Fomepizole

Question 40

The antidote for B-blocker overdose is

Answer 40

Glucagon

Question 41

A patient with ethylene glycol ingestion would initially present with

Answer 41

Nystagmus, headache, elevated anion gap, confusion

Question 42

The antidote for heparin overdose is

Answer 42

Protamine sulfate

Question 43

What is the antidote for iron overdose? How do you know treatment is effective?

Answer 43

Deferoxamine | Pink urine

Question 44

An elevated BUN may indicate

Answer 44

Dehydration, Renal failure, Intra-abdominal hemorrhage

Question 45

The antidote for carbon monoxide poisoning is

Answer 45

High FiO2, hyperbaric chamber

Question 46

The antidotes for cyanide poisoning are

Answer 46

Cyanokit (Amyl nitrate, sodium nitrite, sodium thiosulfate) | Hydroxycobalamin