TOXINS #1
You are caring for a patient with a known narcotic overdose. The patient is unresponsive and apneic. Your EMS team has decided to administer naloxone. What is a major concern for you related to giving this medication?
A. This drug often produces vomiting
B. These patients often awaken violently.
C. Rarely do you carry enough of the drug.
D. You don’t know if this patient is allergic to this drug
B. Patients often are violent upon arousal.
Administration of this drug must be titrated slowly to wake the patient enough so that they are breathing but less than fully conscious. Careful restraints must be used to keep the patient safe during arousal. Typically only small amounts of the drug are necessary and rarely does it produce vomiting.
Encountered with a patient with a large chemical powder exposure, the correct treatment intervention would be:
A: Cleaning with a pressurized air hose, disrobing, and oxygen.
B: Leaving the chemical on clothing for analysis, oxygen, and IV.
C: Brushing off chemical, disrobing, and treatment per signs and symptoms experienced.
D: The progression of acetaminophen
D.
Chemical exposures, especially dry chemicals, should be handled carefully. Do not add water without first knowing what the chemical is and its react-ability with water. Not all patients may require IV therapy and oxygen; treat as complaints arise.
Presented with a patient with an ingestion poisoning, which of the following factors would be a contraindication to inducing vomiting?
A: History of epilepsy
B: Ingestion of tablets and pills
C: Combativeness and uncooperativeness.
D: Altered level of consciousness and diminished gag reflex
The induction of vomiting is rarely ever recommended. It is clearly contraindicated in cases where the patient has a diminished level of consciousness and could aspirate the vomit.
While assessing an 18-year-old male for an overdose, you prepare to check his pupils for reactivity. Which guidelines would you follow to properly check his pupils if you suspect drug use and are in a normally-lit room?
A: Start by covering both eyes with cupped hands
B: First note pupil size before you shine any light in them.
C: Have the patient blink several times before inspecting pupil size
D: Tell the patient to stare straight at the pen light before activating it
B.
Inspection of the patient's eyes should include checking them for size and shape before shining a light source into them. The other descriptions are not necessary or are improper techniques.
Which of the following is the antidote given first for cases of ingested cyanide poisoning?
A: Flumazenil
B:Sodium nitrite.
C: Amyl nitrite.
D: Naloxone.
C.
Sodium nitrite should follow administration of amyl nitrite. Flumazenil is an antidote for benzodiazepine ingestion and Naloxone is a drug for reversal of opiate poisoning
The progression of acetaminophen toxicity ultimately results in which of the listed conditions?
A: Nausea and vomiting
B: Progressive liver failure
C: Kidney necrosis and death.
D: Abdominal pain and decreased urine output.
D.
Acetaminophen toxicity will ultimately destroy the liver. Its progression though appears in four stages, over time:
Stage 1 – ½ to 24 hours Nausea and vomiting.
Stage 2 – 24 to 48 hours Abdominal pain, decreased urine & elevated liver enzymes.
Stage 3 – 72 to 96 hours Liver function disruption
Stage 4 – 4 to 24 days Gradual recovery (with treatment) or progressive liver failure.
You are called to a residence where a 27-year-old male has just been removed from the building by the fire department. The patient has soot about his nose and mouth. Which of the following is your MOST immediate concern?
A: Hypotension.
B: Swelling airway.
C:Burns to the body.
D: Poisoning through inhalation
B
A swelling airway would be your most immediate concern followed by poisoning through inhalation.
Poisoning from a pharmacological substance in excess of that usually prescribed is referred to as which of the following?
A: Abuse.
B: Addiction.
C: Overdose.
D: Tolerance.
C.
Drug overdose is the term used when a person takes a pharmacological substance in excess.
The goal for treating ingestion of toxins is to prevent the toxin from reaching which of the following?
A:The stomach.
B: The brain.
C: The small intestine.
D: The liver.
C.
The ultimate goal is to prevent absorption of any toxin. Absorption occurs primarily in the small intestine.
You have responded to a patient with a suspected heroin overdose. Which of the following signs and symptoms would you MOST likely expect?
A:Excitement, dilated pupils, and rapid heart rate.
B: Tachypnea, dilated pupils, and excessive salivation.
C: Depressed respirations, constricted pupils, and excited speech pattern.
D: Depressed respirations, lowered level of consciousness, and constricted pupils
D.
Heroin is a narcotic, so you should expect to find depressed respirations, diminished level of consciousness, and constricted pupils.
What is your field impression and probable treatment of this patient? Assessment reveals slurred speech, drowsiness, droopy eyelids, BP is 118/54, pulse 56, and respirations are 8. The patient has vomited copiously.
A:Possible narcotic overdose; oxygen, IV Narcan 2 mg.
B: Possible amphetamine overdose; oxygen, IM Narcan 4 mg.
C: Possible narcotic overdose; oxygen, IV, and Romazicon 2 mg.
D: Possible amphetamine overdose; IV, Thiamin 100 mg, Narcan 2 mg, and Dextrose 25 grams.
A.
The patient has most likely overdosed on a narcotic agent.
Romazicon will not work on narcotics.
Which of the following are indicative of Beta Blocker abuse?
A: Bradycardia, hypotension, and coma.
B: Tachycardia, hyperthermia, and coma.
C: Tachycardia, restlessness, and blurry vision.
D: Bradycardia, constricted pupils, and dry mouth
A
Beta blockers will interfere with the sympathetic nervous system and result in bradycardia, hypotension, and possibly coma.
Using a pharmacological substance for purposes other than medically defined reasons would be the definition of which of the following?
A:Abuse
B: Addiction.
C: Overdose.
D: Alcoholism
A.
Abuse occurs when a person uses a pharmacological substance for a reason that is not medically indicated.
What signs and/or symptoms are most commonly associated with a patient who has been exposed to a pesticide?
A:Local burns to the skin.
B: Respiratory tract burns.
C: Diarrhea and vomiting.
D: Decreased LOC and hypoxia
C.
Pesticides most commonly cause SLUDGE: salivation, lacrimation, urination, diarrhea, gastrointestinal motility increase, and emesis.
Which of the following is typical with ingested poisoning cases?
A: Pupil changes.
B: Stridorous respirations.
C: Rapid cardiac arrest.
D: Abdominal muscle relaxation
A.
Pupil response and change is a common finding with ingested poisoning cases, especially with drug ingestion, which accounts for a majority of ingested poisonoing cases. Though some ingested poisons can cause an airway response, stridor is more commonly associated with inhalation injuries and poisonings. Rapid cardiac arrest is uncommon in ingested poisonings due to the time necessary for GI absorption. Abdominal muscle tension would be much more likely than relaxation
Surface absorption poisonings MOST commonly occur in which of the following settings?
A: Agricultural settings with pesticides.
B: Households with cleaning chemicals.
C: Manufacturing settings with chemicals
D: Mechanics' garages with gasoline and exhaust
A.
Most surface absorption poisonings occur in an agricultural setting and involve pesticides and fertilizers.
What is the MOST important aspect to consider when dealing with inhaled poisons?
A: Identifying the source.
B: Providing for rescuer safety
C: Wearing protective clothing.
D: Providing high-concentration oxygen
B
Providing for the safety of the rescuers is your greatest concern when dealing with inhaled poisoning cases.
During assessment, your patient reveals cardiac dysrhythmias and shortness of breath. While on non-rebreather oxygen en route to the emergency department, the patient develops worsening dyspnea and begins to exhibit bigeminal PVCs. What would these assessment findings reveal?
A: Respiratory exposure to CO
B: Respiratory exposure to Paraquat.
C: Inhalation exposure to anhydrous ammonia.
D: Significant dermatological exposure to mercury
B
While anhydrous ammonia and CO can cause respiratory issues, they are usually improved after oxygen. Paraquat signs and symptoms are worsened with exposure to oxygen. Dermatological exposure to mercury (even in large amounts) takes a considerable time to develop signs and symptoms and typically does not affect the respiratory or cardiac system.
Which of the following reasons best explains why Syrup of Ipecac is no longer carried on most ambulances?
A:Inducing vomiting is a high-risk procedure without a secure airway.
B: Syrup of Ipecac was found to be very toxic to some patients.
C: The Ipecac dose varies too much between patients.
D: The Ipecac has a very short-term shelf life.
A
Inducing vomiting is high risk without a secure airway. In most EMS systems, the induction of vomiting is done only in the hospital where there are plenty of personnel to manage the airway and monitor the patient. Most often this now is done with gastric lavage. There is the potential for some toxicity if an overdose of Ipecac is taken.
You are dispatched to a farmhouse for an unresponsive patient. The patient has recently returned from his field and is profusely diaphoretic, has constant diarrhea, and is producing copious amounts of saliva. Which of the following would be the MOST appropriate intervention?
A:Sodium bicarbonate 1 mEq/kg.
B: Atropine 0.5-1.0 mg.
C: Atropine 2.0-5.0 mg.
D: Magnesium sulfate 1-2 g.
C.
Atropine at higher doses will counteract the effects of the parasympathetic nervous system by blocking muscarinic receptor sites throughout the body.
Identify the signs and symptoms connected to carbon monoxide poisonings.
A: SLUDGE.
B: Blurred vision, nausea, and vomiting.
C: Headache, nausea, dizziness, and weakness.
D: Increased respiratory drive, euphoria, and loss of consciousness
C
Carbon monoxide will actually cause a depression in the respiratory drive.
Phenobarbital is a/an:
A: Narcotic
B:Barbiturate.
C: Hallucinogen.
D: Amphetamine
B
Phenobarbital is a barbiturate.
You are assessing a patient you suspect has overdosed on cocaine. What type of pupils would you suspect to find?
A:Both pupils dilated.
B: Both pupils constricted.
C: Both pupils normal size
D: One pupil dilated and one constricted
A
The best answer is that both pupils would be dilated because cocaine is classified as a stimulate. This type of drug will cause the pupils to enlarge even in a well-lit room
During treatment of an 89-year-old male who accidentally overdosed on his benzodiazepine medication called Librium. What should you suspect will be your MOST common side effect that will need to be dealt with during transport?
A:Respiratory compromise.
B: Hypertensive crisis.
C: Tachyarrhythmias.
D: Convulsions.
A
A common side effect of benzodiazepines, even at therapeutic dosing, is lethargy. If a patient overdoses on this type of medication, you must be alert for respiratory compromise. The other complications are possible, but they are less likely to occur or present themselves prehospital.
Half of all poisonings occur in which of the following age groups?
A: 18-29.
B: 65 and over.
C: 1-5.
D: 29-34
C
These poisonings are generally accidental and only account for about 10% of hospital admissions.