Toxidromes

Question 1

What is the first line treatment for sympathomimetic overdose?

Answer 1

Benzo

Question 2

What is the treatment for a wide QRS for any intoxication?

Answer 2

Sodium bicarb

Question 3

What kills cholinergic intoxication?

Answer 3

Bronchorrea

Question 4

What are the s/sx of nicotinic toxidrome? (MTWHF)

Answer 4

• Mydriasis
• Tachy
• Weakness
• HTN
• Fasciculation

Question 5

What is the treatment for nicotinic intox? (2)

Answer 5

• Atropine, doubling every 5 minutes until s/sx resolve

- 2-PAM

Question 6

What intoxication does belladonna cause?

Answer 6

Anticholinergic

Question 7

When is physostigmine contraindicated in anticholinergic overdose?

Answer 7

TCA overdose

Question 8

When is the pupil reactive: sympathomimetic OD over anticholinergic?

Answer 8

Sympathomimetic

Question 9

What is the narcotic that can cause serotonin syndrome?

Answer 9

Meperidine

Question 10

What is the HARMED mnemonic for serotonin syndrome?

Answer 10

• hyperthermia
• Autonomic instability
• R
• M
• E
• D

Question 11

What is the toxic metabolite of acetaminophen?

Answer 11

NAPQI

Question 12

What is a single toxic dose of acetaminophen?

Answer 12

150 mg/kg

Question 13

How many hours after tylenol ingestion do you measure tylenol levels in the blood to use the nomogram?

Answer 13

4 hours

Question 14

What defines stage 1 tylenol overdose?

Answer 14

N/V

Elevated serum acet concen

Question 15

What defines stage 2 tylenol overdose?

Question 16

What defines stage 3 tylenol overdose?

Question 17

What defines stage 4 tylenol overdose?

Question 18

What is the best predictor of outcome for tylenol overdose?

Answer 18

INR

Question 19

What is the role of APAP levels and the nomogram with chronic ingestions?

Answer 19

None

Question 20

What is the recommended max adult dose of tylenol?

Answer 20

4000 mg /day

Question 21

What is the loading dose for NAC?

Answer 21

150 mg/kg over 15-60 minutes

Question 22

After how many hours should the loading dose of NAC be given before the results of levels come back?

Answer 22

After 8 hours

Question 23

What is the major downside of giving NAC?

Answer 23

Anaphylactoid reaction

Question 24

When can you stop NAC?

Answer 24

If levels normalize

Question 25

When is the IV NAC the only solution to a tylenol OD?

Answer 25

If liver failure occurs

Question 26

What single ingestion in mg/kg of tylenol that is toxic?

Answer 26

150 mg/kg

Question 27

What is the threshold for the nomogram for toxicity?

Answer 27

150 microgram/mL

Question 28

What is the initial loading dose of NAC?

Answer 28

150 mg/kg

Question 29

What are the CXR findings of an ASA overdose?

Answer 29

Noncardiogenic pulmonary edema

Question 30

What is the single toxic dose of ASA?

Answer 30

150-200 mg/kg

Question 31

What is the first metabolic derangement with ASA intoxication?

Answer 31

respiratory alkalosis, followed by metabolic acidosis

Question 32

What causes seizures with ASA?

Answer 32

Acidosis or hypoglycemia

Question 33

What is the classic triad of ASA intoxication?

Answer 33

Tinnitus Hyperventilation Abdominal pain

Question 34

When should a post ingestion level of ASA be obtained?

Answer 34

at least 6 hours post ingestion

Question 35

What is the serious, life threatening level in mg/dL for ASA levels?

Answer 35

100 mg/dL

Question 36

How well do serum salicylate levels correspond to intoxication?

Answer 36

Not well

Question 37

What is the best way to determine how toxic a patient is with an ASA overdose?

Answer 37

Acidosis

Question 38

What is the treatment for ASA overdose?

Answer 38

- Bicarb - IVFs - dialysis - GSC

Question 39

What is the target IVF rate for ASA overdose?

Answer 39

2 ml/kg/hr

Question 40

How does bicarb work to eliminate ASA?

Answer 40

alkalinization of the urine

Question 41

At what serum level of ASA should you give a bicarb drip?

Answer 41

35 mg/dL

Question 42

How do you make a bicarb drip?

Answer 42

-One bag of saline, take out 150mL, add 3 amps of bicarb. Run 1-1.5x maintenance fluid rate

Question 43

What is the target urine and serum pH for ASA overdoses?

Answer 43

``` Urine = 8 Serum = 7.4 ```

Question 44

Why must K be normal for ASA overdose?

Answer 44

If K is low, kidneys will exchange H+ to maintain K

Question 45

How often should you monitor ASA OD pts labs?

Answer 45

q1 hour unil normal

Question 46

When is dialysis indicated for ASA overdose?

Answer 46

coma intubation level over 100 Not doing well

Question 47

How is ASA eliminated?

Answer 47

Renally and hepatically

Question 48

What usually causes chronic salicylism?

Answer 48

Usual dose of ASA, and hepatic or renal disease occurs

Question 49

Which alcohol does not cause a metabolic acidosis?

Answer 49

isopropyl alcohol

Question 50

What is propylene glycol, and what does it metabolize to?

Answer 50

Diluent, causes lactic acidosis

Question 51

What is the average amount of liquid that an adult mouth can hold?

Answer 51

30 mL

Question 52

What is time button batteries need to come out?

Answer 52

2 hours

Question 53

What are the three different hang up spots for swallowed object?

Answer 53

cricopharyngeal muscle left bronchus GE junction

Question 54

Which side does the battery cause burns on: positive of negative?

Answer 54

Negative

Question 55

Acid burns - necrosis?

Answer 55

Coag

Question 56

Alkali burns = necrosis?

Answer 56

Liqufactive

Question 57

What is the inhalant in whippits?

Answer 57

Nitrous oxide

Question 58

What is the treatment for cyanide poisoning?

Answer 58

Amyl nitrite

Question 59

What is the general toxidrome for inhalants?

Answer 59

Like Drunk

Question 60

What is sudden sniffing death syndrome? Treatment?

Answer 60

- ? | - esmolol

Question 61

What are the two major cholinergic pesticides?

Answer 61

- Carbamates | - Organophosphates

Question 62

What is the MOA of cholinergic poisoning?

Answer 62

Inhibits acetylcholinesterase

Question 63

What is the MOA of 2-pam?

Answer 63

Kicks off organophosphate of acetylcholinesterase

Question 64

What lab abnormality is seen with dextromethorphan?

Answer 64

high Cl due to high bromides from DXM being counted as Cl

Question 65

What does benzocaine metabolize to?

Answer 65

methhemoglobinemia