Acetaminophen
The toxic dose of acetaminophen for pediatrics
What is 150 mg/kg (peds) or 7.5-10 grams (adults)
The antidote in benzodiazepine toxicity
What is flumazenil
The most common cause of cyanide poisoning
What is house fire
Ethylene Glycol or Methanol can be found in which products
What is antifreeze, refrigerants, windshield washer fluid
The Ohio Poison Control phone number
What is 1-800-222-1222
Acetylcystine is hepatoprotective by restoring what substance enhancing the nontoxic sulfate conjugation of acetaminophen
What is glutathione
The reason why the antidote is not often indicated (significant caution for use)
What is precipitate acute withdrawal or precipitate seizures
The first-line antidote for cyanide poisoning
What is hydroxocobalamin
An important initial step if a patient presents with dermal contact of ethylene glycol or methanol
Decontamination/remove clothing
A 53-year-old male arrives to the ED confused and disoriented. He cannot provide any information about his condition or PMH. Vital signs: BP 85/50 mmHg, HR 120 BPM, RR 28, temp 99.2°F, O2 sat 89% on RA. On physical exam, an unmarked pill bottle is found in his pocket. Two tablets remain, and a possible drug overdose is suspected. Which is most appropriate to do first for this patient?
What is stabilize the patient’s ABC
A 42-year-old male presents to the ED with family due to confusion and lethargy. His symptoms include n/v, severe RUQ abdominal pain, and confusion. The family found an empty bottle of acetaminophen beside his bed. The family believes the patient took acetaminophen approximately 6 hours ago. His vital signs are as follows: BP 128/72 mmHg, HR 104 BPM, RR 14, temp 98.2°F. Labs show an acetaminophen concentration of 143 mcg/mL, AST 518, and ALT 288. Should this patient be treated for acetaminophen toxicity?
What is YES (based on Rumack-Matthew Nomogram)
The dose of the antidote for benzodiazepine toxicity can be repeated. No improvement in what could indicate an additional dose is needed?
What is level of consciousness
Out of the following antidotes, which one does the pharmacy not stock? Acetylcysteine, naloxone, flumazenil, fomepizole, sodium thiosulfate, deferoxamine, CroFab
What is CroFab
A 35-year-old male presents to the ED appearing inebriated. He is alert but oriented only to person. His vital signs are BP 122/80 mmHg, HR 82 BPM, and RR 25. His serum ethanol concentration is 20 mg/dL, and his ethylene glycol concentration is elevated at 100 mg/dL. Which is the most appropriate therapy at this time?
What is Fomepizole
The optimal timeframe to administer activated charcoal
What is within 60 minutes of ingestion
A 68-year-old female (weight 176 lbs) presents to the ED with a chief complaint of flu-like symptoms. Her symptoms include HA, congestion, severe n/v, abdominal pain, and confusion. She has been taking acetaminophen 500 mg caplets as needed for her symptoms, but she just ran out of the bottle she purchased yesterday. On presentation, she is alert and oriented. Her vital signs are as follows: BP 135/90 mmHg, HR 83 BPM, RR 18, temp 101.8°F. An acetaminophen concentration was 192 mcg/mL, AST 560, and ALT 310. Oh no, EPIC is down... the doses for NAC using the 3-bag method are...
What is acetylcysteine 12,000 mg (150 mg/kg) IV over 1 hour, followed by 4,000 mg (50 mg/kg) IV over 4 hours, followed by 8,000 mg (100 mg/kg) IV over 16 hours
An 84-year-old male presents to the ED with AMS from an outside facility with concerns of a benzodiazepine overdose. Due to a medication error, the patient was receiving lorazepam 8 mg IV every 2-3 hours for the past 12 hours. When transcribed, the intended dose of 3 mg was incorrectly given as 8 mg. What additional lab parameter(s) are important to order for a benzodiazepine overdose from IV lorazepam?
What is serum osmolality (for osmolar gap) and lactate (to assess for lactic acidosis)
A 36-year-old male presents to the ED for hypotension. Vital signs are BP 92/60 mmHg, HR 122 BPM, RR 30, O2 sat 100% on RA. On PE, the skin is cherry red, and there is soot in his nose and mouth area. His pupils are dilated, and he appears intoxicated. Lab results are Na 146 mEq/L, K 5.5 mEq/L, CO2 12 mEq/L, BUN 8 mg/dL, Cr 1.96 mg/dL, AG 32.6, Hgb 13.2 mg/dL, AST 151 U/L, CK 2095 U/L, ammonia 23 U/L, and lactate 16.0 mmol/L. ABG includes a pH of 6.67, CO2 of 84 mmHg, PO2 of 157 mmHg, and HCO3 level at 9.7 mEq/L. Which lab value has the highest sensitivity in confirming cyanide poisoning?
What is lactate value
A 58-year-old female presents to the ED after consuming antifreeze 12 hours ago. Her exam is significant for AMS, n/v, depressed reflexes, and nystagmus. Initial vitals are as follows: BP 142/98 mmHg, HR 134 BPM, RR 24, 93% on RA. BMP is significant for Na 148 mEq/L, Cl 112 mEq/L, Cr 1.2 mg/dL, CO2 12 mEq/L. The anion gap is...
What is 24
AG = Na - (Cl + HCO3); 148 - (112 + 12) = 24
Deferoxamine is the antidote for what toxicity?
What is acute iron toxicity
An adjunctive therapy that poison control may recommend for acetaminophen toxicity
What is fomepizole
A 32-year-old female presents to the ED with a suspected overdose. The patient presents with AMS, mydriasis, shallow breathing, and bradycardia. She presents with empty bottles of alprazolam 0.25 mg (#30, prescribed 1 week ago), amitriptyline 25 mg (#60, prescribed 2 weeks ago), clonidine 0.1 mg (#30, prescribed 2 weeks ago), and losartan 25 mg (#30, prescribed 1 month ago). Which one of the co-ingestants is a contraindication to the benzodiazepine antidote?
What is amitriptyline (TCA)
A 23-year-old male patient presents the ED following a rattlesnake bite. The puncture site is on the left lower extremity. The patient is complaining of pain, nausea, and 3 episodes of emesis prior to arrival. On physical exam, there is bleeding at the puncture site, but the entire extremity is erythematous and swollen. Initial vital signs are as follows: BP 98/52 mmHg, HR 102 BPM, RR 18, O2 sat 98% on RA. Would antivenin be indicated in this patient?
What is yes
Which two vitamins are recommended as adjunctive therapy in ethylene glycol toxicity? These vitamins are required cofactors in the formation of the nontoxic metabolites of ethylene glycol
What is thiamine (B1) and pyridoxine (B6)
A patient is in the emergency department being treated for a calcium channel blocker overdose. As your co-resident is providing sign-out, they report that the patient received calcium gluconate and is currently on a high-dose insulin infusion, D5 @ 100 mL/hr, and norepinephrine. As you are thinking ahead, what would be a last-line option for refractory shock due to CCB toxicity.
What is intralipids