EMT Chapter 21: Toxicology
it is MOST important to determine a patients weight when asking questions pertaining to a toxic ingestion because
activated charcoal is given based on a patients weight
a state of overwhelming obsession or physical need to continue the use of a drug or agent
addiction
A 4-year-old, 15-kg male ingested an unknown quantity of acetaminophen (Tylenol). The child's mother states that she does not know when the ingestion occurred. The child is conscious and alert and in no apparent distress. The EMT should:
administer 15 g of activated charcoal.
after administering activated charcoal to a patient, it is MOST important to
be alter for vomiting
Activated charcoal is given to patients who have ingested certain substances because it:
binds to the substance and prevents absorption.
activated charcoal is given to patients who have ingested certain substance because because it
binds to the substance and prevents absorption.
The major side effect associated with administration of activated charcoal is:
black stools
the major side effect associated with ingestion of activated charcoal is:
black stools
The major side effect associated with administration of activated charcoal is
black stools.
The major side effect associated with ingestion of activated charcoal is:
black stools.
A construction worker complains of intense pain after a bag of dry powder was spilled on his arm. The EMT should:
brush the chemical from his arm and then flush the skin with water.
Localized signs and symptoms of absorbed poisoning include:
burns, irritations of the skin
Syrup of ipecac is no longer recommended to treat patients who have ingested a poisonous substance because it:
may result in aspiration of vomitus.
Alcohol is a powerful central nervous system depressant. It:
slows reflexes
Characteristics of carbon monoxide include all of the following EXCEPT:
smells like rotten eggs
_______________ crack produces the most rapid means of absorption and therefore the most potent effect.
smoked
an agent that produces an excited state
stimulant
the misuse of any substance to produce some desired effect
substance abuse
Activated charcoal is in the form of a(n)
suspension
Medical problems that may cause the patient to present as intoxicated include all of the following, EXCEPT:
syncope
Sympathomimetics are CNS stimulants that frequently cause:
tachycardia
signs and symptoms of a sympathomimetic drug overdose includes
tachycardia
Signs and symptoms of a sympathomimetic drug overdose include:
tachycardia.
which of the following statements regarding the salmonella bacterium is correct
the salmonella bacterium itself causes food poisoning
phosphorus or elemental sodium should be brushed off the skin instead of irrigated with water because
these chemicals may ignite upon contact with water
Phosphorus or elemental sodium should be brushed off of the skin instead of irrigated with water because:
these chemicals may ignite upon contact with water.
You are dispatched to a local nursery for a 39-year-old female who is sick. When you arrive, you find the patient lying on the floor. She is semiconscious, has copious amounts of saliva coming from her mouth, and is incontinent of urine. You quickly feel her pulse and note that it is very slow. Immediate management for this patient should include:
thoroughly suctioning her oropharynx
a person who routinely misuses a substance and requires increasing amounts to achieve the same effect is experiencing an
tolerance
the need for increasing amounts of a drug to obtain the same effect
tolerance
A person who routinely misuses a substance and requires increasing amounts to achieve the same effect is experiencing a(n)
tolerance.
A person who routinely misuses a substance and requires increasing amounts to achieve the same effect is experiencing a(n):
tolerance.
A person who routinely misuses a substance and requires increasing amounts to achieve the same effect is experiencing:
tolerance.
Toxicology is best described as the study of _________.
toxic or poisonous substance
the study of toxic or poisonous substances
toxicology
a poison or harmful substance produced by bacteria, animals or plants
toxin
If you are uncertain how to treat a patient who has been poisoned or exposed to a specific substance, you should:
try to find the container the substance was in.
If the victim of a toxicologic emergency vomits, an EMT should _________.
use appropriate PPE and examine the vomitus for pill fragments or other clues for patient care.
The most commonly abused drug in the United States is
Alcohol
Anticholinergic
An agent that blocks parasympathetic nerves
Cholinergic
An agent that overstimulates body functions controlled by the parasympathetic nerves
Opioid (heroin, oxycodone) signs and symptoms
- hyperventilation or respiratory arrest -pinpoint pupils -sedation or coma -hypotension
Cholinergics (pilocarpine, nerve gas)
-excess defecation or urination -muscle fasciculations - pinpoint pupils -excess lacrimation (tearing) or salivation - airway compromise -nausea or vomiting
Sympathomimetics (epinephrine, albuterol, cocaine, methamphetamine) sign and symptoms
-hypertension -tachycardia -dilated pupils -agitation or seizures -hyperthermia
Sedative-hypnotics (diazepam[Valium], secobarbital [Seconal], flunitrazepam [Rohypnol]) Signs and symptoms
-slurred speech -sedation or coma -hypoventilation -hypotension
Anticholinergics (atropine, Jimson weed) signs and symptoms
-tachycardia -hyperthermia -hypertension -dilated pupils -dry skin and mucous membranes -sedation, agitation, seizures, coma, or delirium -decreased bowel sounds
If the patient has a chemical agent in the eyes, you should irrigate the eyes quickly and thoroughly for at least 5 to ____ minutes for acid substances.
10
the usual dose for activated charcoal is up to ____ for a pediatric patient and up to ____ for an adult patient.
12.5, 25g
The usual dose for activated charcoal is up to ______ for a pediatric patient and up to ______ for an adult patient.
25 g, 50 g
A 7-year-old, 25-kg child ingested two bottles of Tylenol approximately 30 minutes ago and medical control orders you to administer activated charcoal. You should administer:
25g
The effects of bath salts can last as long as:
48 hours
Which of the following is NOT considered a sign or symptom of alcohol withdrawal?
Chest pain
addiction
A state of overwhelming obsession or physical need to continue the use of a substance.
sedative
A substance that decreases activity and excitement.
EMTs are dispatched for a teenage male who is "not acting right." When they arrive, they are informed that the patient was huffing. Several cans of Freon are found near the patient. Which of the following is unique consideration for this patient?
A sudden adrenaline release can cause a fatal dysrhythmia.
Which of the following is NOT a part of treatment for patients who have overdosed?
Administer syrup of ipecac
_____ crack produces the most rapid means of absorption and therefore the most potent effect
Smoked
Which of the following is NOT a narcotic?
Ativan
Which of the following sets of vital signs would the EMT MOST likely encounter in a patient with acute cocaine overdose?
BP, 200/100 mm Hg; pulse, 150 beats/min
How do poisons typically act to harm the body?
By changing the normal metabolism of cells or by destroying them
a 49 year old male presents with confusion, sweating, and visual hallucinations. the patients wife tells you that he is a heavy drinker and thinks he had a seizure shortly before your arrival. this patient is Most likely experiencing
DT's
DUMBELS signs and symptoms of drug poisoning
Diarrhea Urination Miosis (constriction of the pupils), muscle weakness Bradycardia, bronchospasm, bronchorrhea (discharge of mucus from the lungs) Emesis (vomiting) Lacrimation (excessive tearing) Seizures, salivation, sweating
You are assessing a patient who presents with slurred speech, hypoventilation, and hypotension. Which of the following might the patient have taken?
Diazepam is a sedative-hypnotic and signs and symptoms include slurred speech, sedation or coma, hypoventilation, and hypoventilation.
common brand of naloxone (Narcan)
Evzio
Common names for activated charcoal include all of the following, EXCEPT:
Fructose.
You have responded to the home of a 26-year-old woman who has reportedly taken a large number of pills in an attempt to commit suicide. As you enter the living room, you see her sleeping in her chair, and several empty alcohol containers are present. She is breathing heavily. You are able to arouse her consciousness for a short period of time. Which course of action takes priority?
Have her take activated charcoal while she is conscious.
After administering activated charcoal to a patient, it is MOST important to:
be alert for vomiting.
You are assessing a 28-year-old patient and you notice he has pinpoint pupils. You suspect a drug overdose. What drug is the likely cause of this phenomenon?
Heroin
During your assessment of a 50-year-old male who was found unresponsive in an alley, you note that he has slow, shallow respirations; bradycardia; facial cyanosis; and pinpoint pupils. As your partner begins assisting the patient's ventilations, he directs your attention to the patient's arms, which have multiple needle tracks on them. Which of the following would MOST likely explain the patient's presentation?
Heroin overdose
The ingestion of marijuana can lead to a cannabinoid hyperemesis syndrome, resulting in extreme nausea and vomiting. How are these symptoms typically relieved?
Hot Showers
Which of the following statements regarding inhaled poisons is correct?
Lung damage may progress after the patient is removed from the environment.
Which of the following is NOT part of treatment of patients who have overdosed with sedative-hypnotics and have respiratory depression?
Meperedine (Demerol)
Which of the following is a frequently abused synthetic opioid?
Meperidine (Demerol)
What should you give a patient displaying respiratory depression and hypotension?
Naloxone
The "S" in the assessment acronym SLUDGEM refers to which of the following?
Salivation
SLUDGEM
Salivation, sweating Lacrimation (excessive tearing) Urination Defecation, drooling, diarrhea Gastric upset and cramps Emesis (vomiting) Muscle twitching/miosis (pinpoint pupils)
Which of the following types of food poisoning results from an organism?
Salmonella
Which of the following is a CNS stimulant?
Sympathomimetics (ie cocaine)
Which of the following statements regarding the Salmonella bacterium is correct?
The Salmonella bacterium itself causes food poisoning.
tolerance
The need for increasing amounts of a drug to obtain the same effect.
Which of the following statements regarding injected poisons is FALSE?
They are easily diluted once in the bloodstream
Victims of inhaled poisoning will require which of the following?
Transport to an emergency department for evaluation
Which of the following is NOT commonly associated with an overdose of a cardiac medication?
Urinary incontinence
Which of the following might make it difficult for you to establish an IV access in a patient with a drug abuse problem?
Venous scarring (or track marks) makes it difficult to establish IV access.
Which of the following questions would be LEAST pertinent during the initial questioning of a patient who ingested a substance?
Why was the substance ingested?
activated charcoal administration in contraindicated in patients who have ingested
acids or alkalis
Activated charcoal administration is contraindicated in patients who have ingested:
acids or alkalis.
Which of the following is true about the use of activated charcoal in treating poisoning?
You should contact medical control and you should not give activated charcoal to patients with altered LOC.
During your assessment of a 50-year-old man who was found unconscious in an alley, you note that he has slow, shallow respirations; significant bradycardia; facial cyanosis; and pinpoint pupils. As your partner begins assisting the patient's ventilations, he directs your attention to the patient's arms, which have multiple needle tracks on them. This patient's clinical presentation is MOST consistent with:
a heroin overdose
during your assessment of a 50 year old male who was found unconscious in an alley, you note that he has slow, shallow respirations, significant bradycardia, facial cyanosis, and pinpoint pupils. as your partner begins assisting the patients ventilations, he directs your attention to the patients arms, which have multiple needle tracks on them. this patients clinical presentation is MOST consistent with
a heroin overdose
a 4 year old male ingested an unknown quantity of acetaminophen (Tylenol). the child's mother states that the ingestion occurred approximately 20 minutes ago. the child is conscious and alert and in no apparent distress. after contacting medical control, you should
administer up to 25 g of activated charcoal
A 4-year-old male ingested an unknown quantity of acetaminophen (Tylenol). The child's mother states that the ingestion occurred approximately 20 minutes ago. The child is conscious and alert and in no apparent distress. After contacting medical control, you should:
administer up to 25 g of activated charcoal.
Treatment for ingestion of poisonous plants includes all of the following EXCEPT:
administering activated charcoal
Treatment for ingestion of poisonous plants includes all of the following, EXCEPT:
administering activated charcoal
Which of the following is NOT a typical ingested poison
aerosol propellants
Naloxone (Narcan) should only be used in a patient with suspected opiate or opioid overdose who has:
agonal respirations or apnea
DTs is a syndrome associated with withdraw from
alcohol
the most commonly abused drug in the united states is
alcohol
DTs is a syndrome associated with withdrawal from:
alcohol.
Delirium tremens (DTs) is a syndrome associated with withdrawal from:
alcohol.
Sympathomimetic and ________ overdoses are very similar because both may cause agitation, tachycardia, and dilated pupils.
anticholinergic
Antihistamines are an example of which of the following?
anticholinergic agents that block parasympathetic nerves.
a substance that is used to neutralize or counteract a poison
antidote
In general, injected poisons are impossible to dilute or remove because they
are usually absorbed quickly into the body.
In general, injected poisons are impossible to dilute or remove because they:
are usually absorbed quickly into the body.
in general, injected poisons are impossible to dilute or remove because they
are usually absorbed quickly into the body.
Activated charcoal may be indicated for a patient who ingested:
aspirin
Ringing of the ears is associated with an overdose of:
aspirin
a patient who presents with rapid breathing, nausea and vomiting, ringing in the ears, and a high fever should be suspected of ingesting a significant quantity of
aspirin
A patient who presents with rapid breathing, nausea and vomiting, ringing in the ears, and a high fever should be suspected of ingesting a significant quantity of:
aspirin.
A patient who presents with rapid breathing, nausea and vomiting, ringing in the ears, and hyperthermia should be suspected of ingesting a significant quantity of:
aspirin.
After administering activated charcoal to a patient, it is MOST important to
be alert for vomiting.
You and your paramedic partner are caring for a patient who ingested codeine, acetaminophen (Tylenol), and hydrocodone (Vicodin). The patient is unresponsive, his breathing is slow and shallow, and his pulse is slow and weak. Treatment for this patient should include:
assisted ventilation and naloxone (Narcan).
you are dispatched to a local nursery for a 39 year old female who is sick. when you arrive, you find the patient lying on the floor. she is semiconscious, has copious amounts of saliva coming from her mouth, and is incontinent of urine. you quickly feel her pulse and note that it is very slow. initial management for this patient should include
assisted ventilation with bag mask device
you and your paramedic partner are caring for a patient who ingested codeine, acetaminophen, and propoxyphene (daron). the patient is unresponsive , his breathing is slow and shallow, and his pulse is slow and weak. treatment for this patient with include
assisted ventilation, naloxone (narcan), and rapid transport
You respond to a college campus for a young male who is acting strangely. After law enforcement has secured the scene, you enter the patient's dorm room and find him sitting on the edge of the bed; he appears agitated. As you approach him, you note that he has dried blood around both nostrils. He is breathing adequately, his pulse is rapid and irregular, and his blood pressure is 200/110 mm Hg. Treatment for this patient includes:
attempting to calm him and giving him oxygen if tolerated.
your priority in caring for a patient with a surface contact poisoning is to
avoid contaminating yourself
Your priority in caring for a patient with a surface contact poisoning is to:
avoid contaminating yourself.
The MOST important consideration in caring for a patient who has been exposed to an organophosphate insecticide or some other cholinergic agent is to:
avoid exposure yourself
as you enter the residence of a patient who has possibly overdosed, you should
be alert for personal hazards
As you enter the residence of a patient who has possibly overdosed, you should:
be alert for personal hazards.
Chlorine:
causes pulmonary edema
Inhaled poisons include
chlorine
You can use the mnemonic DUMBELS to remember the signs and symptoms of which of the following?
cholinergic drug poisoning.
Which of the following drugs is NOT a sedative-hypnotic?
cocaine
which of the following drugs is NOT a sedative-hypnotic
cocaine
A 3-year-old female ingested several leaves from a plant in the living room. The child's mother is not sure what type of plant it is, stating that she bought it simply because it was pretty. After completing your initial assessment of the child, you should:
contact the regional poison control center.
A 3-year-old female ingested several leaves from a plant in the living room. The child's mother is not sure what type of plant it is, stating that she bought it simply because it was pretty. After completing your primary assessment of the child, you should:
contact the regional poison control center.
A 3-year-old girl ingested several leaves from a plant in the living room. The child's mother is not sure what type of plant it is, stating that she bought it simply because it was pretty. After completing your initial assessment of the child, you should:
contact the regional poison control center.
a severe withdrawal syndrome seen in alcoholics; characterized by restlessness, fever, sweating, disorientation, agitation and seizures; can be fatal if untreated
delirium tremens (DTs)
Medical problems that may cause the patient to present as intoxicated include all of the following EXCEPT:
diarrhea
Your paramedic partner administers atropine to a 49-year-old male with bradycardia. Which of the following side effects would you expect the patient to experience?
dry mucous membranes
your paramedic partner administers atropine to a 49 year old male with bradycardia which of the following side effects would you expect the patient to experience
dry mucous membranes
vomiting
emesis
It is important to remember that some chemicals ____ when they come in contact with water.
explode
agents that produce false perceptions in any one of the five senses
hallucinogens
vomited blood
hematemesis
____ is a highly toxic, colorless, and flammable gas with a distinctive rotten eggs odor
hydrogen sulfide
Naloxone (Narcan) would reverse the effects of:
hydromorphone (Dilaudid).
a sleep inducing effect or agent
hypnotic
"Nerve gases" overstimulate normal body functions that are controlled by parasympathetic nerves, causing:
increased salivation
a hypnotic drug is one that:
induces sleep
A hypnotic drug is one that:
induces sleep.
A hypnotic drug:
induces sleep.
Most poisonings occur via the __________ route.
ingestion
most poisonings occur via the ________ route
ingestion
swallowing; taking a substance by mouth
ingestion
The presence of burning or blistering of the mucous membranes suggests:
ingestion of poison
What is the most common route of poisoning?
ingestion.
you receive a call to a residence where a man found his wife unconscious on the couch. the patient is unresponsive, her respiratory rate is 8 breaths/min, her breathing is shallow, her heart rate is 40 beats per minutes, and her pulse is weak. the husband hands you an empty bottle of hydrocodone(vicodin) which was refilled the day before. you should:
initiate ventilator assistance
Which of the following is TRUE regarding injected poisons:
injected poisons cannot be diluted
A poison that enters the body by __________ is the MOST difficult to treat.
injection
Of the four avenues of poisoning, generally ___________ is the most worrisome in terms of treatment to the EMS provider.
injection
a poison that enters the body by ______ is the MOST difficult to treat.
injection
A 25-year-old man overdosed on heroin and is unresponsive. His breathing is slow and shallow and he is bradycardic. He has track marks on both arms. The EMT should:
insert a nasal airway and ventilate with a BVM
When caring for a known alcoholic patient with severe trauma to the chest and abdomen, you should be concerned that:
internal bleeding may be profuse because prolonged alcohol use may impair the blood's ability to clot.
when caring for a know alcoholic patient with severe trauma to the chest and abdomen, you should be concerned that
internal bleeding may be profuse because prolonged alcohol use may impair the bloods ability to colt
Which of the following is NOT considered a typical route of administration for naloxone
intradermal
the poison control center will be able to provide you with the most information regarding the appropriate treatment for a patient with a drug overdose if the center
is aware of the substance that is involved
The poison control center will be able to provide you with the most information regarding the appropriate treatment for a patient with a drug overdose if the center
is aware of the substance that is involved.
The poison control center will be able to provide you with the most information regarding the appropriate treatment for a patient with a drug overdose if the center:
is aware of the substance that is involved.
Toxicology
is the study of toxic or poisonous substances.
Substance abuse is MOST accurately defined as:
knowingly misusing a substance to produce a desired effect
substance abuse is MOST accurately defined as
knowingly misusing substances to produce a desired effect
An overdose on acetaminophen, the active ingredient in Tylenol, will MOST likely cause:
liver failure
an overdose on acetaminophen, the active ingredient in Tylenol, will most likely cause
liver failure
An overdose of acetaminophen, the active ingredient in Tylenol, will MOST likely cause:
liver failure.
which of the following statements regarding inhaled poisons is correct
lung damage may progress after the patient is removed from the environment
your unit is dispatched to the county jail for an intoxicated inmate. upon arrival, you find the patient, a 33 year old male. lying supine in a jail cell. he is responsive to painful stimuli only and has slow, shallow respirations. you should be MOST concerned that this patient
may vomit and aspirate
Your unit is dispatched to the county jail for an intoxicated inmate. Upon arrival, you find the patient, a 33-year-old male, lying supine in a jail cell. He is responsive to painful stimuli only and has slow, shallow respirations. You should be MOST concerned that this patient
may vomit and aspirate.
Your unit is dispatched to the county jail for an intoxicated inmate. Upon arrival, you find the patient, a 33-year-old male, lying supine in a jail cell. He is responsive to painful stimuli only and has slow, shallow respirations. You should be MOST concerned that this patient:
may vomit and aspirate.
Signs and symptoms of staphylococcal food poisoning include:
nausea, vomiting, and diarrhea
atropine sulfate and pralidoxime chloride are antidotes for
nerve gas agents
Atropine sulfate and pralidoxime chloride are antidotes for
nerve gas agents.
Atropine sulfate and pralidoxime chloride are antidotes for:
nerve gas agents.
before giving activated charcoal you should
obtain approval form medical control
Before giving activated charcoal, you should:
obtain approval from medical control.
Many inhaled poisons can be identified _________.
only with difficulty as they are colorless, odorless, and tasteless
Which of the following would NOT provide clues to the nature of the poison?
open windows
Heroin is an example of a(n)
opioid
heroin is an example of an
opioid
Heroin is an example of a(n):
opioid.
any drug or agent with actions similar to morphine
opioids
an excessive quantity of a drug which, when taken or administered, can have toxic or lethal consequences
overdose
Hypotension, hypoventilation, and pinpoint pupils would be expected following an overdose of:
oxycodone (Percocet).
hypotension,hypoventilation, and pinpoint pupils would be expected following an overdose of
oxycodone(Percocet)
Airborne substances should be diluted with:
oxygen
airborne substances are diluted with
oxygen
airborne substances should be diluted with
oxygen
Airborne substances are diluted with:
oxygen.
Anticholinergic medications have properties that block the _____________ nerves.
parasympathetic
The presence of burning or blistering of the mucous membranes suggests ingestion of
poison
a substance whose chemical action could damage structures or impair function when introduced into the body
poison
Signs and symptoms of chlorine exposure include all the following EXCEPT:
rales
the EMTs primary responsibility to the patient who has been poisoned is to
recognize that a poisoning has occurred
An EMT's primary responsibility to the patient who has been poisoned is to:
recognize that a poisoning occurred.
The EMT's primary responsibility to the patient who has been poisoned is to:
recognize that a poisoning occurred.
A man with a prolonged history of alcohol abuse fell from a second-story balcony. His BP is 80/60 mm Hg, his heart rate is 120 beats/min, and his skin is cool and pale. When caring for this patient, the EMT should recall that:
reduced blood clotting worsens internal bleeding.
Treatments for inhaled poisons include:
removing the patient from the exposure
The recommended treatment for absorbed or contact poisons includes _________.
safely removing or diluting the poisonous substance
a substance that decreases activity and excitement
sedative
Inhalant effects range from mild drowsiness to coma, but unlike most other sedative-hypnotics these agents may often cause:
seizures
In an apparent suicide attempt, a 19-year-old woman ingested a full bottle of amitriptyline (Elavil). At present, she is conscious and alert and states that she swallowed the pills approximately 30 minutes earlier. Her blood pressure is 90/50 mm Hg, her pulse is 140 beats/min and irregular, and her respirations are 22 breaths/min with adequate depth. When transporting this patient, you should be MOST alert for:
seizures and cardiac arrhythmias
in an apparent suicide attempt, a 19 year old female ingested a full bottle of amitriptyline (Elavil) at present, she is conscious and alert and states that she swallowed the pills approximately 30 minutes earlier. her blood pressure is 90/50 her pulse is 140 and irregular , and her respirations are 22 breaths with adequate depth. when transporting this patient, you should be most alert for
seizures and cardiac arrhythmias
In an apparent suicide attempt, a 19-year-old female ingested a full bottle of amitriptyline (Elavil). At present, she is conscious and alert and states that she swallowed the pills approximately 30 minutes earlier. Her blood pressure is 90/50 mm Hg, her pulse is 140 beats/min and irregular, and her respirations are 22 breaths/min with adequate depth. When transporting this patient, you should be MOST alert for:
seizures and cardiac arrhythmias.
Alcohol is a powerful CNS depressant. It:
slows reflexes
You receive a call to a residence where a man found his wife unresponsive on the couch. The patient's respiratory rate is 8 breaths/min, her breathing is shallow, her heart rate is 40 beats/min, and her pulse is weak. The husband hands you an empty bottle of hydrocodone (Vicodin), which was refilled the day before. You should:
ventilate her with a BVM.
vomited material
vomitus
you respond to a local motel for a young female who was sexually assaulted. the patient is conscious but confused, she tells you that the last thing she remembers was drinking beer at a club with her friends the night before, when she awoke, she was in the bed of the motel room. you should be most suspicious that this patient
was given flunitrazepam (Rohypnol)
You respond to a local motel for a young female who was sexually assaulted. The patient is conscious but confused. She tells you that the last thing she remembers was drinking beer at a club with her friends the night before. When she awoke, she was in the bed of the motel room. You should suspect that this patient:
was given flunitrazepam (Rohypnol).
Cocaine is called all of the following EXCEPT:
weed
which of the following questions would be LEAST pertinence during the initial questioning of a patient who ingested a substance
why was the substance ingested
