Chapter 176: General Management of Poisoned Patients

Question 1

The key element in reducing unintentional poisoning death

Answer 1

Prevention

Question 2

Criteria used to determine whether the exposure is nontoxic are

Answer 2

1. Unintentional exposure to a clearly identified single substance
2. Estimate of dose is known
3. Recognized information source confirms the subtance as nontoxic in the reported dose

Question 3

The first priority in any poisoned patients

Answer 3

Resucitation

Question 4

First line to treatment for hypotension with poisoning?

Answer 4

IV crystalloid bolus of 10 - 20ml/kg

Question 5

If the patient is still hypotensive even after fluids were given. what is the next step?

Answer 5

Antidote

Question 6

Empirical management for patients with poisoning and altered mental status

Answer 6

• Oxygen
• Thiamine
• Glucose
• Naloxone

Question 7

Cardiac arrhythmias induced by sodium channel-blocker should be given with

Answer 7

Sodium bicarbonate

Question 8

Cardiovascular complication of sodium bicarbonate

Answer 8

wide QRS complex tachydysrhythmias

Question 9

All drug induced seizure are treated with IV benzodiazepine except?

Answer 9

Isoniazid-induced seizure that requires pyridoxine

Question 10

This class of drug shown no role in treatment in toxin-induced seizures

Answer 10

Phenytoin

Question 11

Second line of treatment for agigation

Answer 11

Antipsychotics

Question 12

Treatment for calcium channel blocker and beta blocker toxicity

Answer 12

High dose insulin infusion

Question 13

Treatment for patient with calcium channel blocker toxicity and hypermanesemia

Answer 13

Calcium gluconate
0.5 - 45ml/kg IV for pedia
10 - 30ml/kg IV for adult

Question 14

Component of cyanide antidote kit

Answer 14

• Amyl nitrate
• Sodium nitrite
• Sodium thiosulfate

Question 15

Dose of dextrose (glucose) in insulin or oral hypoglycemic drug toxicity

Answer 15

0.5 - 1.09g/kg IV - pedia

1g/kg IV- adult

Question 16

Treatment for Benzodiazepine toxicity

Answer 16

Flumazenil

0. 01mg/kg IV for pedia
1. 2mg/kg IV for adult

Question 17

Patients with core temperatures of ____ require aggressive active cooling measures to prevent complications

Answer 17

Patients with core temperatures of >39°C (>102.2°F) require aggressive active cooling measures to prevent complications

Question 18

A core temperature ____ is an indication for active rewarming

Answer 18

A core temperature <32°C (<90°F) is an indication for active rewarming

Question 19

Nontoxic, diagnostic, and therapeutic antidote. It is a competitive opioid antagonist administered IV, IM, or intranasally

Answer 19

Naloxone

0. 01mg IV for pedia
1. 1-0.4mgIV for adult

Question 20

Predictor of response to naloxone

Answer 20

Respiratory rate of <12 breaths/min

Question 21

How many hours should the patient be observe after administration of IV Naloxone?

Answer 21

2-3 hours

Question 22

IV lipid emulsion should be used as part of management of cardiac arrest in?

Answer 22

IV lipid emulsion should be used as part of management of cardiac arrest in bupivacaine toxicity

Question 23

IV lipid emulsion can be considered as a potential rescue therapy in life- threatening cardiotoxicity caused by ____ that is resistant to conventional therapies

Answer 23

IV lipid emulsion can be considered as a potential rescue therapy in life- threatening cardiotoxicity caused by lipophilic cardiotoxins that is resistant to conventional therapies

Question 24

A routine screening test in poisoned patients

Answer 24

A serum Acetaminophen concentration

Question 25

Goal of pH in ocular decontamination

Answer 25

pH between 7.2 and 7.4

Question 26

Whole bowel irrifation is used in

Answer 26

- Iron ingestion >60mg/kg - life threatening Diltiazem or Verapamil and Lithium - Lead ingestion

Question 27

Dose of activated charcoal and whole-bowel irrigation

Answer 27

- Activated Charcoal Adults 50 grams orally, children 1 gram/kg orally - Whole-Bowel Irrigation Polyethylene glycol 2 L/h in adults, children 25 mL/kg per hour (maximum 2 L/h)

Question 28

Multidose activated charcoal should not be given when ____?

Answer 28

Multidose activated charcoal should not be given when bowel sounds are absent

Question 29

Complication of urinary alkalinization

Answer 29

- Hypokalemia - Volume overload - Alkalemia - Hypocalcemia (usually mild)

Question 30

A toxin must possess a number of properties to be effectively removed by an extracorporeal technique, which are?

Answer 30

- Low volume of distribution (<1.0 L/kg) - Low molecular weight (<500 Da) - Low protein binding - Low endogenous clearance