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20 Cards in this Set
- Front
- Back
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1. A46 woman is brought to the emergency department by her husband after suicide attempt. She's confused, lethargic and disoriented. Respiratory rate is 8, and her blood pressure is 120/80. What is the most important step?
a. Oxygen b. bolus of normal saline c. naloxone, thiamine, dextrose d. endotracheal intubation e. gastric emptying f. urine toxicology screen. |
1. Answer: C- . The most important step for an acute change in mental status of unclear etiology is to administer antidotes such as naloxone dextrose, and thiamine. Oxygen does not make a specific difference.
2. When you have a acute change in mental status, hypoglycemia is very common, as is a opiate overdose. 3. On a CCS case, given naloxone, thiamine, and dextrose, and give oxygen and saline, while checking the toxicology screen- all at the same time. |
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2. When you answer gastric emptying?
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a. This response is almost always wrong. Castro emptying is only useful in the first hour after an overdose.
b. One hour: 50% of pills can be removed c. 1-2 hours: 15% of pills can be removed d. 2 hours: it is useless. |
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3. Can you perform gastric emptying when caustics (acids and alkalis) have been ingested?
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a. No, never.
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4. Note: ipecac can never be used in a patient with altered mental status, because the patient will aspirate. Ipecac is always wrong and children.
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4. Note: ipecac can never be used in a patient with altered mental status, because the patient will aspirate. Ipecac is always wrong and children.
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5. Note: intubation and lavage can really be performed. The patient has ingested the substance within the last 1-2 hours and there is no response to naloxone, dextrose, and thiamine.
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5. Note: intubation and lavage can really be performed. The patient has ingested the substance within the last 1-2 hours and there is no response to naloxone, dextrose, and thiamine.
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6. When do answer naloxone, thiamine, and dextrose?
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a. These medications are used for an acute mental status change of unclear etiology.
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7. When do I answer charcoal?
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a. Charcoal not harm anyone. In other words, give it.
b. Charcoal can help, and most overdose cases. c. If you have a toxicology case do not know what to do- give charcoal. |
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8. CCS tip: in overdose cases, do multiple things simultaneously. If there is a change in mental status from an overdose, give naloxone, thiamine, and dexterous at the same time as checking a toxicology screen, giving oxygen, and checking routine labs.
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8. CCS tip: in overdose cases, do multiple things simultaneously. If there is a change in mental status from an overdose, give naloxone, thiamine, and dexterous at the same time as checking a toxicology screen, giving oxygen, and checking routine labs.
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9. Acetaminophen antidote?
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a. N acetyl cysteine.
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10. Aspirin antidote?
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a. Bicarbonate- to alkalinize the urine.
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11. Benzo antidote?
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a. Do not give flumazenil; it may precipitate a seizure.
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12. Carbon monoxide antidote?
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a. 100% oxygen, hyperbaric chamber in some cases.
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13. Digoxin antidote?
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a. Digoxin binding antibodies
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14. ethylene glycol antidote?
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a. Fomepizole or ethanol.
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15. Methanol antidote?
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a. Fomepizole or ethanol
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16. methemoglobin anemia antidote?
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a. Methylene blue
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17. neuroleptic malignant syndrome antidote?
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a. Bromocriptine
b. dantrolene |
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18. opiate antidote?
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a. Naloxone
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19. organophosphate antidote?
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a. Atropine
b. Pralidoxime |
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20. tricyclic antidepressant antidote?
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a. Bicarbonate- protects the heart.
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