Under Pressure
Titration of atropine for weaponized organophosphate poisoning relies on tracking this specific clinical endpoint rather than HR.
What are respiratory secretions (or bronchorrhea)?
A severe HAGMA, high LA, & a completely normal PaO2 is a triad seen in this toxidrome.
What is cyanide poisoning?
A pt who wakes up following a dose of naloxone but lapses back into hypoventilation 45 mins later demonstrates this phenomenon.
What is re-narcotization?
When a pt w/ a severe TCA OD exhibits a systemic pH above 7.55, NaHCO3 should be stopped & switched to this specific solution.
What is 3% hypertonic saline (HTS)?
When differentiating b/w these 2 life-threatening hypermetabolic states, there is heavy reliance on finding LE clonus & hyperreflexia vs dry, flushed skin.
What is serotonin syndrome (SS) vs anticholinergic toxicity?
a 35 yr old woman with fibromyalgia started on a new med by her PCP presents with nausea, vomiting, febrile anuric and dry mucosal surfaces. EKG shows a monomorphic wide complex tachycardia. Can you diagnose her?
What is anticholinergic toxicity?
The biochemical arrest of aerobic metabolism seen in cyanide poisoning occurs b/c the toxin binds to the Fe core w/i this specific mitochondrial enzyme complex.
What is cytochrome c oxidase (or Complex IV)?
If the chemical bond b/w an organophosphate & acetylcholinesterase undergoes this time-dependent structural change, the enzyme becomes permanently inactivated.
What is enzymatic aging?
Activated charcoal can safely be omitted in pts w/ toxic CV collapse if they present past this standard post-ingestion window.
What is 4 hrs?
Non-selective BBs (like propranolol) should be avoided to manage severe cocaine-induced HTN d/t the risk of triggering this dangerous physiological feedback.
What is unopposed alpha-vasoconstriction?
This IV hormone infusion acts as a metabolic rescue agent to bypass non-functioning beta receptors & restore cardiac output.
What is glucagon?
Ingesting 30 grams or more of this substance can induce rapid CNS depression & metabolic acidosis w/i 24 hrs via direct mitochondrial toxicity.
What is acetaminophen?
While a pt in this specific phase of acetaminophen toxicity may appear clinically stable, their transaminases, bilirubin, & PT continue to peak.
What is Stage 2 (24 to 72 hrs)?
In cases of massive, high-risk acetaminophen ingestions progressing to FLF & deep metabolic acidosis, this therapy may be required to clear toxic metabolites before a transplant eval.
What is HD (or CRRT)?
This historical 1984 NY medical case involved a fatal drug interaction featuring severe hyperpyrexia, ultimately leading to a landmark law that restructured resident physician duty hour regulations.
What is the Libby Zion case?
This rescue infusion acts as a "lipid sink", partitioning lipophilic cardiotoxins away from myocardial tissue receptors.
What is IV lipid emulsion (ILE)?
This antidote uses a ligand exchange reaction to scavenge intracellular cyanide ions, converting the toxin into a water-soluble molecule.
What is hydroxocobalamin?
What is the Matthews-Rumack nomogram?
For profound shock following a cardiac med OD, high doses of this specific hormone should be initiated to provide an immediate carbohydrate substrate to myocardial cells.
What is insulin (or HIET)?
For a pt in severe autonomic crisis w/ a core body temp climbing past 38.5 C, the immediate ICU priority includes active cooling combined w/ these 2 distinct critical interventions to prevent rhabdo & MOF.
What are ET intubation & NM blockade (paralysis)?
This advanced mechanical modality serves as the definitive bridge to drug clearance when a pt remains in refractory toxic shock despite max medical therapy.
What is VA-ECMO?
-This silent killer has 200 times the affinity for Hb compared to oxygen
-It causes a leftward shift in the oxyhemoglobin curve
-it binds to cytochrome c oxidase
What is carbon monoxide
This life-saving antidote replenishes liver glutathione stores & can provide a therapeutic benefit when initiated up to 24 hrs after an acute ingestion.
What is N-acetylcysteine (NAC)?
Use with caution! this antidote has a propensity to precipitate seizures when treating OD with anxiety medication
What is flumazenil?
This common OTC med has an unadvertised secondary mechanism as an NSSRI, which can interact w/ antidepressants causing a dangerous hyperthermic & hyperactive condition
What is dextromethorphan (DXM)?