Toxidromes
Shallow respirations, bradycardia, altered mental status, pinpoint pupils
Opiates
3yo patient ingests an unknown amount of father's diabetes medication. When the family brings the pill bottle, the medication is found to be glipizide. You start the patient on glucose infusion. This antidote is used in addition to dextrose to prevent recurrent hypoglycemia
Octreotide
The hymenoptera species causes the most envenomation deaths per year in the US. What creatures are included in this class? Name 2 of 3.
What are bees, wasps/yellow jackets/hornets, and ants
N-acetylcysteine improves glutathione production and scavenges free radicals as its mechanism to treat toxicity and prevent liver failure from overdosage of this medication
Acetaminophen
This reversal agent can be used for respiratory depression due to benzodiazepine use/overdose, but it should be used with caution due to risk of seizures and vomiting
Flumazenil
Hypertension, tachycardia, agitation, dilated pupils, diaphoresis
Sympathomimetic Toxidrome
A patient presents in status epilepticus and standard therapy does not work. Upon further history, you find that the patient's grandmother is taking medications for tuberculosis. Name the antidote and drug causing this clinical presentation.
Vitamin B6 or pyridoxime (Isoniazid toxicity)
A 6yo boy was in the garage and felt something 'bite' his finger when reaching behind a box. 1 hour later, he experiences diffuse muscle cramping, abdominal pain, and tachycardia. Name the causative organism.
Black Widow Spider
A teenage patient presents with a stumbling gait, slurred speech, vomiting, and altered mental status. Tox screen is negative. EtOH level is undetectable. CT head is negative. There are no signs of trauma. The patient then begins to complain of blurred vision and difficulty seeing, dizziness, and headache. Additional labs are obtained and show an anion-gap acidosis. What is the causative ingestion?
Methanol (wood alcohol poisoning)
This flowering plant that grows well in the Inland Empire of California and causes a classic Anticholinergic Toxidrome
Jimson Weed
Hypertension, tachycardia, agitation, dilated pupils, urinary retention, dry skin
Anticholinergic Toxidrome
Patient ingests a small amount of blue liquid from the garage and presents with somnolence, Kussmaul breathing, anion gap acidosis, and urine that fluoresces with a wood’s lamp. This antidote is the standard of care.
Fomepizole (4-MP) (ethylene glycol ingestion)
A 11mo boy arrives by EMS with eye deviation, vomiting, and abnormal movements. EMS and parents are concerned for seizure activity. On exam, the child is agitated, tachycardia, drooling, warm to the touch, experiencing roving eye movements, and having myoclonus/abnormal movements including back arching. Name the causative organism and its antidote.
Bark Scorpion, Anascorp
You are single coverage in a rural pediatric emergency department with the ability to rapidly transport only 1 patient. Two children arrive simultaneously. One drank several mouthfuls of Drain-O drain cleaner. The other ingested a similar amount of car battery fluid. This is the child who requires immediate evaluation and transfer to a higher level of care.
Drain-O (alkaline) ingestion.
This is the reversal agent for Heparin overdose
What is Protamine Sulfate
Arrhythmia, small pupils, urinary incontinence, diarrhea, hypersalivation, bronchorrhea
Cholinergic Toxidrome
Patient intentionally overdoses on her migraine medication, Amitryptiline, and presents with altered mental status, hypotension, and QRS widening on EKG. This is the first line therapy for care of this overdose.
Sodium Bicarbonate
When stung by a jellyfish or sea urchin, the best way to deactivate the nematocysts that are imbedded into the skin is by using: salt water, fresh water, urine, or vinegar?
Vinegar (acetic acid)
A child is making "potpourri" for his mother. His brother states the patient may have "tasted" a few of the flowers or leaves. The child is altered and unbalanced. Rhythm strip from EMS shows frequent PVCs. This is the treatment for this ingestion.
Digitalis Fab Fragments (Digibind) for treatment of Oleander (cardiac glycoside) ingestion
High dosages of this commonly used and readily available medication may be needed in cases of refractory calcium channel blocker overdose to treat and prevent ongoing bradyarrhythmias and hypotension.
Insulin
Pinpoint pupils, shallow respirations, bradycardia out of proportion to remainder of exam, hypotension. UDS is negative for all drugs; fentanyl subtesting negative. Name the causative drug.
Clonidine
An infant is teething and parents have been using over-the-counter gels on the gums for comfort, but they now feel he is having bluish lips and skin. He is tired-appearing on exam with pulse oximetry 85-90% on room air. He has no respiratory distress. During your evaluation, the infant begins to seize. Name the medication required to reverse these symptoms.
What is Methylene Blue (Methemoglobinemia from benzocaine/ora-jel ingestion).
Crofab antivenom is used to treat Crotalid snake envenomations and is now widely available at most hospitals. Name 2 of the 3 types of snakes included in the Crotalid family against which the antivenom is effective
Rattlesnakes (Western Diamondback, Eastern Diamond Back, Mojave), Cottonmouths, Copperheads
Patient appears intoxicated and has a fruity smelling breath. Labs show non-anion gap acidosis but elevated serum osmolar gap. Patient ingested this.
Isopropyl Alcohol
Patient develops fever to 106F, tachycardia, altered mentation, muscular rigidity, clonus, and blood pressure lability. He was taking Paroxetine (Paxil), then was given a cough medication containing dextromethorphan. Name the antidote for this syndrome.
Cyproheptadine (Serotonin Syndrome)