Emergency Toxicology

Question 1

UDS for diagnosis of narcotics

Answer 1

positive for 36-48 hours (won’t guide initial tx though)

Question 2

diagnostics for Narcotics

Answer 2

UDS, CBC, CMP, ASA, acetaminophen, ABG, CXR to check fo raspiration, and EKG

Question 3

management of narcotic overdose

Answer 3

pre-hospital- airway, resuscitation. ED management- narcan 0.4-2 mg every 2-3 mins (max of 10 mg), activated charcoal within 2 hours of ingestion, orogastric lavage

Question 4

half life of narcan

Answer 4

30 minutes

Question 5

narcotics MOA

Answer 5

opiates bind the mu opioid receptor to cause pain relief, decreased GI motility (constipation), respiratory depression, mood alteration, cough suppression, ACTH suppression, miosis, N/V, pruritus

Question 6

effect of benzos on NT

Answer 6

increase circulating GABA

Question 7

effect of benzo overdose

Answer 7

can cause CNS depression, coma, respiratory failure

Question 8

most prescribed benzo in U.S.

Answer 8

alprazolam (xanax)

Question 9

most toxic benzo

Answer 9

xanax (alproazolam)

Question 10

alprazolam brand name and half life

Answer 10

xanax- 11 hours

Question 11

lorazepam brand name and half life

Answer 11

ativan - 12 hours

Question 12

midazolam brand name and half life

Answer 12

versed- 1-12 hours

Question 13

diazepam brand name and half life

Answer 13

valium- 20-70 hours (stays in body for long time!)

Question 14

ED tx for benzo overdose

Answer 14

airway management. charcoal only if co-ingestion (must be given within 2 hours), lavage not recommended unless co-ingestion is severe- do within first hour.

Question 15

half life of acetaminophen

Answer 15

1-4 hours

Question 16

acetominophen toxicity risk is increased by…

Answer 16

ETOH co- ingestion

Question 17

acetaminophen MOA

Answer 17

cox 2 inhibition without anti inflam effects of NSAIDS

Question 18

acetaminophen metabolized via

Answer 18

liver

Question 19

toxic dose acetaminophen

Answer 19

7.5-10 g over 24 hours. 150 mg/kg single toxid dose.

Question 20

recommended doses acetaminophen

Answer 20

kids- 15 mg/kg. adults - not more than 4 g/day

Question 21

tx acetaminophen toxicity

Answer 21

NAC (N acetyl cysteine) which inactivates NAPQI. IV load preferred 150 mg/kg over 1 hour. PO load is 70 mg/kg. max benefit within first 8 hours. Activated charcoal, transplant if too late in stage

Question 22

when do transaminase levels rise post acetaminophen toxic ingestion?

Answer 22

12 hours post-ingestion

Question 23

Phase 1 acetaminophen toxicity

Answer 23

rise in transaminase levels after 12 hours, pallor and diaphoresis

Question 24

phase 2 acetaminophen toxicity

Answer 24

RUQ pain, anorexia, N/V, continued rise in transaminase levels

Question 25

Phase 3 acetaminophen toxicity

Answer 25

centrilobular hepatic necrosis, tender hepatic edge, jaundice, coagulopathy. Death from multiorgan failure may occur in this stage

Question 26

negative prognostic factors in acetaminophen toxicity

Answer 26

pH less than 7.3 after adquate resuscitation, INR greater than 3, Creat greater than 2.6, Hepatic encephalopahty grades III or IV, hypoglycemia, thrombocytopenia

Question 27

diagnostics in stimulant overdose

Answer 27

EKG, Troponin, UDS, CMP, preg

Question 28

long term abuse of stimulants can cause

Answer 28

lasting psychosis

Question 29

tx of stimulant toxicity

Answer 29

sometiems none. sedation, monitoring, BB - CI in chest pain with cocaine abuse

Question 30

antidote for anticholinergic poisoning

Answer 30

physostigmine

Question 31

cholinergic and anticholingergic syndrome diagnostics

Answer 31

EKG, ABG, chemistry, UDS, CBC

Question 32

cholinergic syndrome symptoms

Answer 32

SLUDGE (salivation,lacrimation, Urination, defecation, GI distress, emesis

Question 33

tx of cholinergic syndrome

Answer 33

airway, decontamination, atropine 1-2 mg IV

Question 34

jimson weed causes

Answer 34

anticholinergic syndrome

Question 35

"red as a beet, dry as a bone, blind as a bat, mad as a hatter, hot as a hare"

Answer 35

anticholinergic syndrome

Question 36

anticholingergic tx

Answer 36

IV, airway, rapid transport. physostigmine, sodium bicarbonate if QRS prolonged, charcoal

Question 37

anion gap acidosis

Answer 37

MUDPILES- methanol (10-20 mL), uremia, Diabetic ketoacidosis, propylene glycol, idiopathic/isoniazid, lactic acidosis, ethylene glycol (antifreeze), salicylates

Question 38

AGMA presentation

Answer 38

dehydration, fruity breath, kussmaul breathing

Question 39

ED management of AGMA

Answer 39

correct underlying condition, fluids, sodium bicarb rarely, hemodialysis

Question 40

carbon monoxide risks

Answer 40

cold season, factory/smelting occupation

Question 41

everyone if house with headache. Winter began 2 weeks ago. N/V, weakness, dizziness. PE shows cherry red uvula and retinal hemorrhages. automatically think...

Answer 41

carbon monoxide poisoning

Question 42

carbon monoxide diagnostics

Answer 42

ABG

Question 43

ED tx carbon monoxide

Answer 43

oxygen via non-rebreather takes 80 minutes compared to 320 minutes (carboxyhemoglobin back to hemoglobin)

Question 44

alcohol blood level over 400 mg/dL

Answer 44

respiratory failure, coma, death

Question 45

legal alcohol driving limit

Answer 45

over 80 is illegal

Question 46

synthetic cannibinoid receptor agonist similar to THC

Answer 46

K2

Question 47

cathinones produce significant stimulatn, amphetamine effect

Answer 47

bath salts

Question 48

varieties of K2

Answer 48

spice, genie, yucatan fire

Question 49

case reports of death from K2 most often related to

Answer 49

CNS, CV, or psychiatric complications

Question 50

K2 and bath salts consequences

Answer 50

hypertensive emergency, tachycardia, severe hallucinations, seizues, scleral injection, prolonged hangover period, N/V