MTB

Question 1

How long after pill ingestion can gastric lavage be attempted

Answer 1

2 hours after ingestion

Question 2

Toxicities that cause Miosis

Answer 2

Clonidine
Barbs
Opiates 
Cholinergics
Pontine stroke

Question 3

Toxicities that cause Mydriasis

Answer 3

Sympathomimetics

Anticholinergics

Question 4

Toxicity with dry skin

Answer 4

Anticholinergics

Question 5

Toxicity seen with wet skin

Answer 5

Anticholinergics

Sympathomimetics

Question 6

Toxicity seen with blisters

Answer 6

Barbituates

CO poisoning

Question 7

When is gastric lavage dangerous

Answer 7

AMS - Aspiration

Caustic ingestion - burning of esophagus/oropharynx

Question 8

What percentage of pills are removed with gastric lavage

Answer 8

1 hour = 50%

2 hour = 15%

Question 9

When do we use Ipecac in the ER

Answer 9

Never

Question 10

Wrong answers in ER questions

Answer 10

Ipecac
Cathartics
Forced diuresis = almost always wrong
Whole bowel irrigation - almost always wrong

Question 11

When do we do whole bowel irrigation and what do we use

Answer 11

Polyethylene glycol-electrolyte solution
Massive Iron ingestion
Lithium
Swallowing drug filled packets

Question 12

When answer is not clear and cause of OD is asked, answer

Answer 12

1. Acetaminophen
2. ASA
   MCC death by OD

Question 13

Best initial management in pt with AMS and toxicity

Answer 13

Opiate antagonist - naloxone

Glucose

Question 14

Presentation of acute benzo withdrawl

Answer 14

Seizures

Question 15

CI in benzo withdrawl

Answer 15

Flumazenil

Question 16

When do we give charcoal
MOA
Route of admin

Answer 16

Can be given to anyone w pill OD - benign
Blocks absorption of poisons
Given thru NG tube

Question 17

What amount of acetaminophen causes toxicity

Fatality?

Answer 17

8-10 grams

Fatality if greater than 12-15 grams

Question 18

Next step in management if a clearly toxic amount of acetaminophen has been ingested

Answer 18

N-Acetylcysteine

Question 19

Next step in management if a clearly toxic amount of acetaminophen has been ingested and it is over 24 hours

Answer 19

Nothing

Question 20

Next step in management if amount of acetaminophen that has been ingested is unclear

Answer 20

Get drug level

Question 21

Does charcoal make N-acetylcysteine ineffective

Answer 21

No

Question 22

Does alcohol increase or decrease amount of acetaminophen needed to cause toxicity

Answer 22

Decreases amount

Question 23

ASA Overdose Presentation

Answer 23

Tinnitus
Hyperventilation 
Resp Alkalosis progressing to Metabolic Acidosis 
Increased Anion gap
Renal toxicity 
AMS

Question 24

ASA effect on coagulation

Answer 24

Increases PT

Question 25

TX for ASA toxicity

Answer 25

Alkalinize the urine to increase rate of excretion

Question 26

Blood gas in ASA toxicity

Answer 26

Varies depending on time

Question 27

Benzos and TCA effect taken together

Answer 27

Benzos can prevent seizures from TCA toxicity

Question 28

TCA toxicity finding on EKG

Answer 28

Widening of QRS complex

Question 29

TCA Toxicity Presentation

Answer 29

Seizures Arrhythmia Dry mouth, Constipation, Urinary retention

Question 30

TX for TCA Toxicity

Answer 30

Sodium Bicarbonate | Bicarb protects the heart

Question 31

Caustic ingestion damages what

Answer 31

Mechanical damage to oropharynx, esophagus, stomach | Perforation

Question 32

Management for Caustic ingestion

Answer 32

Flush out w high volume water | Endoscopy to assess degree of damage

Question 33

Management for Caustic ingestion

Answer 33

1. ABC 2. Remove contaminated clothing and irrigate exposed skin, Flush out w high volume water 3. Endoscopy to assess degree of damage

Question 34

MCC of death in fires

Answer 34

CO poisoning

Question 35

Management for Caustic ingestion Perforation

Answer 35

1. ABC 2. Remove contaminated clothing and irrigate exposed skin, Flush out w high volume water 3. CXR if Respiratory Sx's 4. Endoscopy to assess degree of damage within 24 hrs

Question 36

CO poisoning HX

Answer 36

Gas heaters Wood-burning stoves Automobile exhaust

Question 37

ABG in CO Poisoning

Answer 37

Causes lactic acidosis pH Low pCO2 Low HCO3 Low

Question 38

Most accurate DX test for CO Poisoning

Answer 38

Carboxyhemoglobin Level

Question 39

Best initial TX for CO Poisoning

Answer 39

Remove pt from exposure Give 100% Oxygen Hyperbaric oxygen if severe

Question 40

Severe Sx's of CO Poisoning

Answer 40

CNS Sx's Cardiac Sx's Metabolic Acidosis

Question 41

What causes methemoglobinemia

Answer 41

Benzocaine + other anesthetics Nitrites + Nitroglycerin Dapsone

Question 42

Presentation of methemoglobinemia

Answer 42

``` Dypsnea Cyanosis HA, confusion, seizures Metabolic Acidosis (SAme as CO poisoning) ```

Question 43

Difference b/t methemoglobinemia and CO poisoning

Answer 43

CO: Blood is RED Meth: Blood is BROWN

Question 44

What is pCO2 in methemoglobinemia

Answer 44

Normal

Question 45

Most accurate test for methemoglobinemia

Answer 45

Methemoglobin level

Question 46

Best initial TX for methemoglobinemia

Answer 46

100% oxygen

Question 47

Most effective TX for methemoglobinemia

Answer 47

Methylene Blue

Question 48

Cyanosis + Normal pO2

Answer 48

methemoglobinemia

Question 49

Presentation of Organophosphate poisoning

Answer 49

``` Salivation Lacrimation Polyuria Diarrhea Bronchospasm, bronchorrhea, Resp arrest ```

Question 50

Management of Organophosphate poisoning

Answer 50

1. Atropine 2. Remove clothing, wash patient 3. Pralidoxamine = reactivates acetylcholinesterase

Question 51

MOA Atropine

Answer 51

Blocks effects of acetylcholine that is already in body | Dries up respiratory secretions

Question 52

Indications for Dialysis

Answer 52

``` Renal Failure CHF ARDS Persistent CNS sx's Hemodynamic Instability Severe acid/base or electrolyte imbalance Hepatic Failure w coagulopathy Salicylate level > 100 mg/dL ```