Toxicologic Emergencies

Question 1

coma cocktail

Answer 1

dextrose (for hypogylcemia)
naloxone (opiod OD)
thiamine (prevent wernickes encephalopathy)

Question 2

common anticholinergic agents

Answer 2

antihistamins
antispasmotics
atropine
TCAs
Jimson weed

Question 3

anticholinergic findings

Answer 3

“Dry as a bone”
“Mad as a hatter”
“Red as a beet”
“Blind as a bat”
“Hot as a hare”

Question 4

anticholinergic exam findings
VS
CNS
Pupils
Skin
Gi/GU

Answer 4

VS: hyperthermia, tachycardia, hypertensive
CNS: agitation, delirium, hallucinations, mumbling speech, unresponsive
Pupils: mydriasis
Skin: dry, warm, flushed
GI/GU: diminished BS, ileus, urinary retention

Question 5

cholinergic toxidromes

produce same effects as the parasympathetic nervous system

Answer 5

Organophosphates and carbamate insecticides
Cholinesterase inhibitors
Muscarinic and nicotinic effects
Nerve agents

Question 6

cholinergics exam findings

VS
CNS
Pupils
Skin
Gi/GU

Answer 6

VS: bradycardia, high or low BP, tachypnic or bradypnic
CNS: agitation, confusion, seizures, coma
Pupils: miosis, eye pain, lacrimation
Skin: diaphoresis
GI/GU: salivation, vomiting, diarrhea, incontinence

Question 7

sympathomimetic agents

Answer 7

Cocaine
Phencyclidine (PCP)
Amphetamines
Lysergic acid diethylamide(LSD)
Bath Salts (PABS)

Question 8

sympathomimetics exam findings

VS
CNS
Pupils
Skin
GI/GU

Answer 8

VS: hyperthermia, tachycardia, hypertension
CNS: enhanced alertness, agitation, delirium, seizure, coma
Pupils: mydriasis
Skin: diaphoretic, hot
GI/GU: normal, active

Question 9

opioid toxidromes

Answer 9

Opium
Morphine
Heroin
Synthetic and semi-synthetic:
       Hydrocodone (Vicodin)
       Oxycodone
       Fentanyl (used to cut a lot of products)

Question 10

opioid PE

VS
CNS
Pupils
Skin
GI/GU
Neuro

Answer 10

VS: hypothermia, bradycardia, normal or low BP-suppress
breathing and HR for a period of time (itll probs be
low when they come in), bradypnea
CNS: lethargy, coma
Pupils: miosis (exceptions: meperidine-demerol, DXM-
cough supressant)
Skin: cool, pale or moist, evidence of recent or remote
needle injection
GI/GU: hypoactive BS, constipation-HUGE SE
Neuro: hyporeflexia
Key finding

Question 11

sedative hypnotic toxidromes

Answer 11

Alcohol
Benzodiazepines
Barbiturates
Zolpidem

Question 12

sedative hypnotics toxidromes

VS
CNS
Pupils
Skin
GI/GU
Neuro

Answer 12

VS: hypothermia, normal or bradycardia, hypotension,
bradypnea
CNS: drowsy, dysarthria, ataxia, lethargy, coma
Pupils: midsize or miosis, nystagmus
Skin: dry, normal
GI/GU: normal to hypoactive BS
Neuro: hyporeflexia

Question 13

Sweating differentiates __ and __ toxidromes

Answer 13

sympathomimetic and anticholinergic

Anticholinergic = dry
Sympathomimetic = diaphoretic

Question 14

sympatholytic toxidromes

Answer 14

Antihypertensive agents:
        β-blockers (selective and non-selective)
                 Carvedilol, labetalol, propranolol, metoprolol, 
                  atenolol
        α-blockers
                 Prazosin, doxazosin
         Alpha2- adrenergic agonists
                 clonidine

Question 15

sympatholytic PE

VS
CNS
pupils

Answer 15

VS: bradycardia, hypotension, bradypnea, hypopnea
CNS: normal, lethargy, coma, seizure
Pupils: mid-size to miotic

Question 16

Serotonin Syndrome Toxidromes

Answer 16

MAOIs
SSRIs
NSRIs
Dextromethorphan
Trazadone
Linezolid-anti MRSA abx

Question 17

Serotonin Syndrome Toxidromes PE

VS
CNS
Pupils
Skin
Neuro

Answer 17

VS: hyperthermia, tachycardia, hypertension, tachypnea
CNS: confusion, agitation, lethargy, coma
Pupils: mydriasis
Skin: diaphoretic, flushed
Neuro: hyperreflexia, tremors, clonus, rigidity

Question 18

acetaminophen antidote

Answer 18

N-acetylcysteine

Question 19

anticholinergic antidote

Answer 19

Physostigmine

Question 20

benzodiazepine antidote

Answer 20

Flumazenil

Question 21

Beta or Calcium channel blockers antidote

Answer 21

glucagon + insulin

Question 22

hydrofluoric acid antidote

Answer 22

calcium gluconate

Question 23

opioid antidote

Answer 23

naloxone