Chapter 21 - Toxicology

(T/F) Most poisons do not have an antidote.

True.

(T/F) Opioids, sedatives, and barbiturates slow breathing, so ventilatory complications are a concern.

True.

A 49-year-old male presents with confusion, sweating, and visual hallucinations. The patient's wife tells you that he is a heavy drinker and she thinks he had a seizure shortly before your arrival. This patient is MOST likely experiencing: - delirium tremens. - acute hypovolemia. - acute schizophrenia. - alcohol intoxication.

A 49-year-old male presents with confusion, sweating, and visual hallucinations. The patient's wife tells you that he is a heavy drinker and she thinks he had a seizure shortly before your arrival. This patient is MOST likely experiencing: *- delirium tremens.* - acute hypovolemia. - acute schizophrenia. - alcohol intoxication.

A person who routinely misuses a substance and requires increasing amounts to achieve the same effect is experiencing: - addiction. - tolerance. - dependence. - withdrawal.

A person who routinely misuses a substance and requires increasing amounts to achieve the same effect is experiencing: - addiction. *- tolerance.* - dependence. - withdrawal.

Activated charcoal is given to patients who have ingested certain substances because it: - decreases absorption of poisons into the lungs. - is a direct antidote for many toxic substances. - binds to the substance and prevents absorption. - induces vomiting and empties the stomach.

Activated charcoal is given to patients who have ingested certain substances because it: - decreases absorption of poisons into the lungs. - is a direct antidote for many toxic substances. *- binds to the substance and prevents absorption.* - induces vomiting and empties the stomach.

An overdose of acetaminophen, the active ingredient in Tylenol, will MOST likely cause: - liver failure. - CNS depression. - gastric ulcers. - kidney failure.

An overdose of acetaminophen, the active ingredient in Tylenol, will MOST likely cause: *- liver failure.* - CNS depression. - gastric ulcers. - kidney failure.

Antihistamines are an example of which of the following? - Anticholinergic agent - Cholinergic agent - Sympathomimetic - Synthetic cathinone

Antihistamines are an example of which of the following? *- Anticholinergic agent* - Cholinergic agent - Sympathomimetic - Synthetic cathinone *Antihistamines are an example of anticholinergic agents that block parasympathetic nerves.*

As you enter the residence of a patient who has possibly overdosed, you should: - be alert for personal hazards. - look for drug paraphernalia. - observe the scene for drug bottles. - quickly gain access to the patient.

As you enter the residence of a patient who has possibly overdosed, you should: *- be alert for personal hazards.* - look for drug paraphernalia. - observe the scene for drug bottles. - quickly gain access to the patient.

(T/F) Ingested poisoning is usually accidental in adults.

False. Ingested poisoning is usually accidental in *children and deliberate in adults.*

(T/F) When dealing with an absorbed poison, you should flush the skin of the affected area with an alcohol rinse for 15 to 20 minutes.

False. When dealing with an absorbed poison, you should flush the skin of the affected area with clean *water* (not alcohol) for 15 to 20 minutes.

For which of the following would you use a DuoDote Auto-Injector? - Sarin gas attack - Morphine overdose - Carbon monoxide poisoning - Acetaminophen overdose

For which of the following would you use a DuoDote Auto-Injector? *- Sarin gas attack* - Morphine overdose - Carbon monoxide poisoning - Acetaminophen overdose

Heroin is an example of a(n): - cholinergic. - sympathomimetic. - opioid. - hypnotic.

Heroin is an example of a(n): - cholinergic. - sympathomimetic. *- opioid.* - hypnotic.

How do poisons typically act to harm the body? - By causing a slowing of nearly all bodily functions - By changing the normal metabolism of cells or by destroying them - By causing burns and damage to either external or internal organs - By interfering with normal neurologic function

How do poisons typically act to harm the body? - By causing a slowing of nearly all bodily functions *- By changing the normal metabolism of cells or by destroying them* - By causing burns and damage to either external or internal organs - By interfering with normal neurologic function

Hypotension, hypoventilation, and pinpoint pupils would be expected following an overdose of: - crack cocaine. - amphetamine sulfate (Benzedrine). - oxycodone (Percocet). - ecstasy.

Hypotension, hypoventilation, and pinpoint pupils would be expected following an overdose of: - crack cocaine. - amphetamine sulfate (Benzedrine). *- oxycodone (Percocet).* - ecstasy.

If the victim of a toxicologic emergency vomits, an EMT should _________. - safely dispose of the vomitus as soon as possible and decontaminate the vehicle as necessary. - have the patient enclose the vomitus in a container and take it to the emergency department. - use appropriate personal protective equipment and examine the vomitus for pill fragments or other clues for patient care. - not approach the vomitus.

If the victim of a toxicologic emergency vomits, an EMT should _________. - safely dispose of the vomitus as soon as possible and decontaminate the vehicle as necessary. - have the patient enclose the vomitus in a container and take it to the emergency department. *- use appropriate personal protective equipment and examine the vomitus for pill fragments or other clues for patient care.* - not approach the vomitus.

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. - a sudden outburst of violence. - acute respiratory depression. - an increase in her blood pressure.

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.* - a sudden outburst of violence. - acute respiratory depression. - an increase in her blood pressure.

Most poisonings occur via the __________ route. - ingestion - injection - inhalation - absorption

Most poisonings occur via the __________ route. *- ingestion* - injection - inhalation - absorption

Of the four avenues of poisoning, generally ___________ is the most worrisome in terms of treatment to the EMS provider. - ingestion - injection - absorption - inhalation

Of the four avenues of poisoning, generally ___________ is the most worrisome in terms of treatment to the EMS provider. - ingestion *- injection* - absorption - inhalation

Sympathomimetic and ________ overdoses are very similar because both may cause agitation, tachycardia, and dilated pupils. - Anticholinergic - Cholinergic - Sedative-hypnotic - Opiate

Sympathomimetic and ________ overdoses are very similar because both may cause agitation, tachycardia, and dilated pupils. *- Anticholinergic* - Cholinergic - Sedative-hypnotic - Opiate

The recommended treatment for absorbed or contact poisons includes _________. - safely removing or diluting the poisonous substance - collecting and transporting the poisonous substance to the emergency department for identification - transporting the patient to the emergency department with the poisonous substance in place - neutralizing the poisonous substance with a chemical

The recommended treatment for absorbed or contact poisons includes _________. *- safely removing or diluting the poisonous substance* - collecting and transporting the poisonous substance to the emergency department for identification - transporting the patient to the emergency department with the poisonous substance in place - neutralizing the poisonous substance with a chemical

Victims of inhaled poisoning will require which of the following? - An oropharyngeal or nasopharyngeal device to maintain an airway - Suctioning to clear the airway - Ventilation with a bag-valve mask - Transport to an emergency department for evaluation

Victims of inhaled poisoning will require which of the following? - An oropharyngeal or nasopharyngeal device to maintain an airway - Suctioning to clear the airway - Ventilation with a bag-valve mask *- Transport to an emergency department for evaluation*

What is the most common route of poisoning? - Absorption - Ingestion - Inhalation - Injection

What is the most common route of poisoning? - Absorption *- Ingestion* - Inhalation - Injection

What should you give a patient displaying respiratory depression and hypotension? - Activated charcoal - Naloxone - Phenobarbital - Codeine

What should you give a patient displaying respiratory depression and hypotension? - Activated charcoal *- Naloxone* - Phenobarbital - Codeine

When caring for a known alcoholic patient with severe trauma to the chest and abdomen, you should be concerned that: - long bone fractures are likely because chronic alcohol consumption weakens the structure of the bones. - signs and symptoms of shock may be masked by the stimulant effects produced by alcohol. - delirium tremens (DTs) are commonly induced by physical trauma and can lead to life-threatening seizures. - internal bleeding may be profuse because prolonged alcohol use may impair the blood's ability to clot.

When caring for a known alcoholic patient with severe trauma to the chest and abdomen, you should be concerned that: - long bone fractures are likely because chronic alcohol consumption weakens the structure of the bones. - signs and symptoms of shock may be masked by the stimulant effects produced by alcohol. - delirium tremens (DTs) are commonly induced by physical trauma and can lead to life-threatening seizures. *- internal bleeding may be profuse because prolonged alcohol use may impair the blood's ability to clot.*

Which of the following is a CNS stimulant? - Alcohol - Opiates - Sedative-hypnotics - Sympathomimetics

Which of the following is a CNS stimulant? - Alcohol - Opiates - Sedative-hypnotics *- Sympathomimetics*

Which of the following is true about the use of activated charcoal in treating poisoning? - The usual adult dose is 15 to 30 g. - Before you give a patient charcoal, you must obtain approval from medical control. - If the patient has a decreased LOC and cannot protect his or her airway, do not give activated charcoal. - The adverse effects of ingesting activated charcoal include diarrhea and bloody stools.

Which of the following is true about the use of activated charcoal in treating poisoning? - The usual adult dose is 15 to 30 g. *- Before you give a patient charcoal, you must obtain approval from medical control.* *- If the patient has a decreased LOC and cannot protect his or her airway, do not give activated charcoal.* - The adverse effects of ingesting activated charcoal include diarrhea and bloody stools.

Which of the following might make it difficult for you to establish an IV access in a patient with a drug abuse problem? - Tachycardia - Nausea and/or vomiting - Venous scarring - Hypotension

Which of the following might make it difficult for you to establish an IV access in a patient with a drug abuse problem? - Tachycardia - Nausea and/or vomiting *- Venous scarring* - Hypotension

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? - How much of the substance was taken? - How long ago was the substance taken? - What type of substance was taken?

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?* - How much of the substance was taken? - How long ago was the substance taken? - What type of substance was taken?

Which of the following sets of vital signs would the EMT MOST likely encounter in a patient with acute cocaine overdose? - BP, 60/40 mm Hg; pulse, 140 beats/min - BP, 180/100 mm Hg; pulse, 50 beats/min - BP, 200/100 mm Hg; pulse, 150 beats/min - BP, 190/90 mm Hg; pulse, 40 beats/min

Which of the following sets of vital signs would the EMT MOST likely encounter in a patient with acute cocaine overdose? - BP, 60/40 mm Hg; pulse, 140 beats/min - BP, 180/100 mm Hg; pulse, 50 beats/min *- BP, 200/100 mm Hg; pulse, 150 beats/min* - BP, 190/90 mm Hg; pulse, 40 beats/min

Which of the following statements regarding the Salmonella bacterium is correct? - The Salmonella bacterium itself causes food poisoning. - Symptoms of salmonellosis appear within 12 hours. - Refrigeration of food will prevent salmonellosis. - The Salmonella bacterium produces toxins that cause food poisoning.

Which of the following statements regarding the Salmonella bacterium is correct? *- The Salmonella bacterium itself causes food poisoning.* - Symptoms of salmonellosis appear within 12 hours. - Refrigeration of food will prevent salmonellosis. - The Salmonella bacterium produces toxins that cause food poisoning.

Which of the following types of food poisoning results from an organism? - Botulism - Datura - Salmonella - Staphylococcus

Which of the following types of food poisoning results from an organism? - Botulism - Datura *- Salmonella* - Staphylococcus

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). - high-flow oxygen via a nonrebreathing mask. - oxygen via a nasal cannula and atropine sulfate. - assisted ventilation and flumazenil (Romazicon).

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).* - high-flow oxygen via a nonrebreathing mask. - oxygen via a nasal cannula and atropine sulfate. - assisted ventilation and flumazenil (Romazicon).

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? - Cocaine - Methamphetamine - Heroin - Alcohol

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? - Cocaine - Methamphetamine -* Heroin* - Alcohol

You are assessing a patient who presents with slurred speech, hypoventilation, and hypotension. Which of the following might the patient have taken? - Pilocarpine - Albuterol - Diazepam - Diphenhydramine

You are assessing a patient who presents with slurred speech, hypoventilation, and hypotension. Which of the following might the patient have taken? - Pilocarpine - Albuterol *- Diazepam* - Diphenhydramine *Pilocarpine is a cholinergic. Signs and symptoms of this agent include excessive salivation, sweating and tearing, vomiting, and muscle twitching. Albuterol is a sympathomimetic. Signs and symptoms include hypertension, tachycardia, agitation, and hyperthermia. Diphenhydramine is an anticholinergic. These drugs produce tachycardia, hypertension, dry skin, decreased bowel sounds, and possible seizures.*

You can use the mnemonic DUMBELS to remember the signs and symptoms of which of the following? - Acetaminophen poisoning - Anticholinergic agents - Cholinergic agents - Food poisoning

You can use the mnemonic DUMBELS to remember the signs and symptoms of which of the following? - Acetaminophen poisoning - Anticholinergic agents *- Cholinergic agents* - Food poisoning

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: - perform a rapid head-to-toe exam. - apply oxygen via a nonrebreathing mask. - ventilate her with a BVM. - contact the poison control center.

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: - perform a rapid head-to-toe exam. - apply oxygen via a nonrebreathing mask. *- ventilate her with a BVM.* - contact the poison control center.