Smoke and Mirrors
Delusions of Grandeur
Heartbreakers
Bad Blood
Not Just a Hangover
100
A 42M factory worker presents to the ED w/ shortness of breath, chest tightness, and skin burning over the past 6 hours. At work, he spilled liquid phosgene on himself but initially had no symptoms. What is the first step in his management?
What is decontamination?
100
What class of psychiatric medication in overdose would most classically cause these ECG findings?
What are tricyclic antidepressants
100
Team question: You are caring for a patient presenting for a beta blocker overdose. After going through the ACLS bradycardia algorithm, and starting an epinephrine drip, what other medication can you consider?
What is glucagon, insulin, another pressor, fluids, methylene blue, intralipid
100
This treatment, used in severe cyanide poisoning, works by binding cyanide and converting it into a nontoxic compound that is excreted in urine.
What is hydroxycobalamin (cyanokit)
100
This opioid can lead to QTc prolongation and torasades de pointes.
What is methadone
200
This is a group question. Each contestant to name one physical exam finding concerning for smoke inhalation.
What are singed nasal airs, facial burns, soot in nose and pharynx, stridor, voice hoarseness, wheezing or rhonchi, black sputum
200
What is the main risk of administering flumazenil in benzodiazepine overdose?
What are seizures
200
You are managing a patient with a quinidine (class IA anti-arrhythmic) overdose. Their ECG is as shown. What medication is immediately indicated.
What is sodium bicarbonate?
200
A 27-year-old pregnant female is brought to the ED after being found unconscious at home. Her husband reports that she had been complaining of a severe headache, nausea, and dizziness earlier before she collapsed. You suspect carbon monoxide poisoning. Besides 100% on nonrebreather, what therapy may be indicated?
What is hyperbaric oxygen.
200
A 35M presents code 3 for shortness of breath, cyanosis, and an O2 saturation of 84% despite 15L on a nonrebreather. Prior to symptom onset, he used a medication he purchased at a gas station in order to enhance sexual pleasure. This part of an ABG (without cooximetry) can help reveal the diagnosis.
What is the PaO2?
300
Mixing bleach and ammonia may release this toxic gas, which can cause severe respiratory distress when inhaled in confined spaces.
Chlorine gas
300
Name an ECG finding in bupropion overdose?
What is sinus tachycardia (most common), QRS prolongation, QT prolongation
300
79F p/w bradycardia and hypotension. You are unable to clarify her medication list or medical history. Based on her ECG below, what treatment may be indicated.
What is Digifab/Digibind
300
What is an alternative IV treatment to methylene blue in the management of methemoglobinemia?
What is ascorbic acid (Vitamin C)
300
This recreational drug which has become increasingly popular over the past 2 years, is clinically similar to clonidine or dexmedetomidine, sometimes used as an adulterant to fentanyl, causes bradycardia, respiratory depression, and hypotension?
What is Xylazine, or tranq
400
A 34F is admitted to SICU at SCVMC for burns after a house fire. She is intubated for airway edema. On day 2 of hospitalization, she develops progressively worsening hypoxia. What is the most likely cause of her worsening respiratory status?
What is ARDS
400
This partial mu receptor agonist, in overdose, is most commonly associated with serotonin syndrome.
What is tramadol.
400
This antiarrhythmic is more often used for its antiepileptic properties. Even in overdose it is typically not severely cardiotoxic, but causes nystagmus, ataxia and diplopia.
What is phenytoin?
400
This is a team question: These are indications for hyperbaric treatment.
LOC. Severe metabolic acidosis. Neurologic abnormalities. Cardiovascular dysfunction. Exposure > 24 hrs. COHgb > 25%. Pregnancy.
400
In a small mixing bowl, add 40 mg ketamine, 80 mg MDMA, 200 mg methamphetamine, 100 mcg fentanyl, 100 mg cocaine, and pink food coloring. Mix thoroughly. (Then discard). What do you get?
What is pink cocaine, pink panther, Tusi, 2C