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60 Cards in this Set
- Front
- Back
What should you think about in all overdose patients?
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child abuse and suicidal ideation
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How do you differentiate the sympathomimetic and anticholinergic toxidrome?
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skin exam and bowel sounds: diaphoresis and increased bowel sounds with sympathometitic
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How can a narcotic ingestion be manifested
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coma, hypotension, miosis and hypoventilation
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An osmolal gap occurs with
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alcohol ingestion
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What is the coma cocktail?
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glucose, thiatmine, oxygen, naloxone
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Is lavage useful
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rarely
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What is one of the more important clues to diagnosis of poisoning?
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vital signs
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What should always be considered with nonspecific flu-like symptoms that occur in families in colder months?
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carbon monoxide poisoning
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WHen is hyperbaric oxygen indicated for CO poisoning?
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with patietnes with neuropsychiatric abnormalities, or cardiovascular instability, CoHb>25% and pregnancy and CoHb>15%
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How does cyanide work?
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binds to cytochrome oxidase resulting in cellular sphyxia
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What are the signs and symptoms of cyanide poisoning?
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headache, dizziness, weakness, SOB,
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How does the cyanide antidote kit work?
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Inducing methemoglobinemia and then producing sodium thiocyanate. The components are amyl nitrite, Na Nitrite and sodium thiosulfate
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If ethanol level is <300 and coma?
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Consider another cause of coma
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WHat does chronic toluene abuse produce?
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distal renal tubular acidosis
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What should be considered in patients with visual symptoms, acidosis and elevated osmolal gap?
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methanol poisoning
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What is the antidote for INH?
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pyridoxine
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When should you consider hemodialysis in methanol/ethylene glycol poisonings?
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when there is metabolic acidosis, renal compromise, visual symptoms (methanol), electrolyte imbalances unresponsive to conventional therapy or a blood level of either substance that is >20-25 mg/dl
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What should be considered in patients with GI symptoms and mixed repiratory alkalosis and metabolic acidosis?
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salicylate toxicity
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WHat should be done in any symptomatic salicylate toxicity?
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alkalinization of the urine
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When should dialysis be considered in salicylate poisoning?
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levels >100 mg/dL coma, renal, hepatic failure, pulmonary edema, severe acid-base disturbances, rising levels in toxic patients, failure to repsond to more conservative methods
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What is rotary nystagmus classic for?
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PCP
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What is the best treatment for cocaine toxicity?
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benzodiazepines
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What do most drugs of abuse present as?
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sympathomimetic toxidrome
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What should be considered in any patient who presents with chest pain?
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cocaine use
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Is LSD detected on the toxicology screen?
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no
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How long should patients who responded to naloxone therapy be observed for?
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3-4 hours
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Are fentany derivates detected on the tox screen?
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No and they can require large doses of naloxone for reversal
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What is MPTP?
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A meperidine analog that can cause irreversible parkinsonism
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What is the toxic dose of acetaminophen
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140 mg/kg
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How often shoudl acetaminophen levels be checked in OD patients?
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q4 hours
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Do you treat pregnant patients differently after acetaminophen and iron ingestion?
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no
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Does charcoal admin prohibit NAC administration?
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no and it does not require a does adjustment
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Can patients with acetaminophen toxicity be asymptomatic initially?
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yes
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Which is worse chronic or acute lithium toxicity
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chronic (same with salicylate and theophylline)
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Are lithium and iron on routine tox screen?
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no
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When is dialysis indicated for patients with lithium toxicity?
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with severe neurologic toxicity, cardiac dysthrhymias, and renal failure
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Which toxicity can be seen on xray?
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iron
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What is the treatment for iron poisoning?
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deveroxamine if significant symptoms
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What can hydrocarbons cause?
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aspiration pneumonitis and various systemic effects (CNS and cardiac)
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What can lead to sudden sniffing death?
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solvent inhalation
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How do carbamates differ from organophosphates?
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duration of symptoms. They cause reversible inhibition of acetylcholinesterase and do not require 2-PAM
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What is most common mistake in treating insecticide toxicity?
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under atropinization
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When does scombroid poisoning occur?
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when fish is not properly stored/refrigeratoed and is the result of histamine ingestion
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With hydrocarbon exposure what should be avoided?
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epinephrine and isoproterenol unless required for cardiac resuscitation
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Are corticosteroids and antibiotics been shown to be beneficial in patients with hydrocarbon aspiration?
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no
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Is their an antidote or antagonist to PCP?
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no
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What should you get with theophylline overdose?
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serial levels
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What is the most common ECG abnormality with digoxin?
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PVCs, MCC of PAT with block is dig toxicity
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What should be avoided in treatment of hyperkalemia from dig toxicity?
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Ca
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How do you make diagnosis of serotonin syndrome?
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It is clinical: AMS, autonomic instability, neuromuscular abnormalities
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What is the DONT for AMS
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Dextrose, oxygen, naloxone, thiamine
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What are the seizure causing substances?
(WITH LA COPS) |
Withdrawl
Isoniazide THeophyline, TCA Hypoglycemia, hypoxia Lead, lithium, local anesthetics Anticholinergics CO, cocaine, cyanide, cholinergics Organophosphates PCP, propoxyphene Salicyclates, strychnine, sympathometics |
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Substances causing nystagmus
(SALEM TIP) |
Sedative hypnotics, solvents
Alcohols Lithium Ethylene glycol, ethanol methanol Tegretol, thiamine depletion Isopropanol PCP, phenytoin |
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Radiopaque substances
(BET A CHIP) |
Barium
Enteric coated tablets TCA Antihistamines Condoms, chloral hydrate, calcium Heavy metals Iodine K, phenothiazines, Play-Doh, PetpoBismol |
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Dangerous addition to hydrocarbons
(CHAMPS) |
Camphor
Halogenated hydrocarbons Aromatics Metals Pesticides |
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Cholinergic ingestion symptoms
DUMBBELSS |
Defecation, diaphoresis
Urination Miosis Bradycardia Bronchospasm Emesis Lacrimation Salivation,secretions, sweating Seizures |
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Agents removed by hemodialysis
(I STUMBLE) |
Isopropanol
Salicyclates Theophyline Uremia Methanol Barbiturates Lithium Ethylene glycol, ethanol |
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What causes an osmolal gap
(MAD GAS) diff. between measured osmolal and calculated osmolol |
Mannitol
Alcohols DMSO Glycerol Acetone Sorbitol |
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Anion gap acidosis
A MUD PILE CAT |
Alcohol
Methanol intoxication Uremia DKA Paraldehyde ingestion 1NH, iron intoxication Lactic Acidosis Ethylene glycol intoxication Carbon monoxide/cyanide Aspirin intoxication Toluene exposure |
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Substances not absorbed by charcoal
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Caustics, corrosives
Heavy metals Alcohols and glycols Rapidly absorved substances Cyanide other insoluble drugs aliphatic hydrocarbons laxatives |