EM Toxicology

EKGeez

100

Name the EKG finding/rhythm, and one possible medication overdose that it could be from. 

Mobitz (second degree) type I

Can be seen in beta blocker, CCB, amio, TCA, digoxin. A lot of them, along a spectrum of AV blockade. 

200

What overdose caused this EKG?

Digoxin Toxicity

Bidirecitonal VTach

300

What medication causes this EKG finding?

Digoxin 

Sagged ST segment/U wave most pronounced laterally

400

What overdose causes these EKG findings?

TCA toxicity 

Positive R wave in aVR and wide QRS complex

500

What condition does this patient have, and what medications should be avoided? (name one)

Brugada syndrome. 

Avoid TCAs, flecainide, procainamide, lithium, cocaine. 

Antidotes

100

What antidote, if given too quickly, or if not cautiously dosed, could result in a fleeing combative patient that is having diarrhea and causing your nurse to dislike you?

Naloxone

200

If a patient falls to the wrong side of the Rumack-Matthew nomogram, which antidote should they receive? 

NAC (N-acetyl cysteine) for APAP overuse.

300

Refractory seizures after isoniazid overdose are treated with gram-for-gram replacement of this vitamin.

Vitamin B6 (pyridoxine) 

You will need a lot. You may need to combine resources from various local hospitals/health centers. 

400

Following the 9/11 attacks, there was a surge in strategic stockpiling of this antidotes that require cool storage conditions. What were the two main components found in this antidote, which went by the name of chempacks, Mark-Is, or duodotes?

2-PAM, Atropine

It's mostly expired but still taking up space in your local DRC! 

500

This chelating agent binds iron and creates “vin rose” colored urine during treatment.

Deferoxamine

Plants

100

Jimson weed/belladonna causes what type of toxidrome?

Anticholinergic 

DUMBBELLS

200

What should you give a patient who is suffering toxicity from this beautiful plant?

Digifab

For cardiac glycoside toxicity. Efficacy less reliable and dosing not well known as digifab is created precisely for digoxin. 

300

The firestick plant leads to patients coming in with what type of symptoms?

Painful chemical conjunctivitis from sap. 

Often refractory to topical anesthetics. Can expedite clearance with oil based products such as erythromycin ointment or other types of ointment.

Irrigation encouraged but often does not adequately relieve symptoms. 

400

What is this mushroom, and what state has the highest recorded cases of poisonings from it?

Amanita philloides (deathcap, the only mushroom in all of emergency medicine)

California highest reported, but most are probably not reported or rural. Still exceedingly rare, often less than 15 per year, and California has 40 million people.

500

Beans from this plant create what compound that can lead to multiorgan failure within days and has been used as a bioterrorism weapon?

Ricin, made from castor beans

Causes ribosomal failure which leads to widespread cellular damage and then breakdown. 

Famous Poisonings

100

The Tylenol murders involved lacing of tablets with what substance led to the deaths of numerous consumers in Chicago, ultimately resulting in modern tamper laws?

Cyanide

200

In 2006, Alexander Litvinenko, and outspoken critic of the Kremlin, was assassinated in London by what additive to his tea (not sugar).

Radioactive polonium

300

In 2017 Kim Jong Nam (eldest son of the late Kim Jong-Il, prior ruler of North Korea) was famously approached by 2 women in an airport and conspicuously and fatally dosed in the face with what?

VX nerve agent

An organophosphate/cholinesterase inhibitor.

400

While officially killed by complications of stomach cancer, what is unofficially surmised to have contributed to the demise of Napolean?

Chronic arsenic poisoning

Interferes with ATP production. 

500

What poison was used to kill Socrates?

Hemlock

A neuromuscular acetylcholine binder (much like succinylcholine), causing weakness, respiratory depression, and death.