EMT CH 21

charcoal

binds to toxins and prevents their absorption into the body, require med control approval, not indicated in PTs who have ingested alkali poisons, cyanide, ethanol, iron, lithium, methanol, mineral acids, organic solvents

dosage of charcoal

1 g per kilo of body weight 30-100 g for adults 15-30 g for children

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: Select one: A. assisted ventilation and naloxone (Narcan). B. assisted ventilation and flumazenil (Romazicon). C. oxygen via a nasal cannula and atropine sulfate. D. high-flow oxygen via a nonrebreathing mask.

A. assisted ventilation and naloxone (Narcan).

Of the four avenues of poisoning, generally ___________ is the most worrisome in terms of treatment to the EMS provider. Select one: A. injection B. absorption C. ingestion D. inhalation

A. injection

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

A. internal bleeding may be profuse because prolonged alcohol use may impair the blood's ability to clot.

An overdose of acetaminophen, the active ingredient in Tylenol, will MOST likely cause: Select one: A. liver failure. B. kidney failure. C. gastric ulcers. D. CNS depression.

A. liver failure.

Hypotension, hypoventilation, and pinpoint pupils would be expected following an overdose of: Select one: A. oxycodone (Percocet). B. ecstasy. C. amphetamine sulfate (Benzedrine). D. crack cocaine.

A. oxycodone (Percocet).

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

A. tolerance.

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

B. BP, 200/100 mm Hg; pulse, 150 beats/min

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

B. By changing the normal metabolism of cells or by destroying them

Imagine a patient has taken 10 tablets of diazepam. He is sleepy and having trouble managing his airway while sitting up. You secure his airway by laying him down on your ambulance cot in a sniffing position with a nonrebreathing mask. Will the antidote naloxone work for this overdose? A. Yes B. No

B. No

Which of the following statements regarding the Salmonella bacterium is correct? Select one: A. The Salmonella bacterium produces toxins that cause food poisoning. B. The Salmonella bacterium itself causes food poisoning. C. Symptoms of salmonellosis appear within 12 hours. D. Refrigeration of food will prevent salmonellosis.

B. The Salmonella bacterium itself causes food poisoning.

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

B. Transport to an emergency department for evaluation

Which of the following questions would be LEAST pertinent during the initial questioning of a patient who ingested a substance? Select one: A. How long ago was the substance taken? B. Why was the substance ingested? C. What type of substance was taken? D. How much of the substance was taken?

B. Why was the substance ingested?

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

B. be alert for personal hazards.

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

B. binds to the substance and prevents absorption.

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: Select one: A. acute schizophrenia. B. delirium tremens. C. alcohol intoxication. D. acute hypovolemia.

B. delirium tremens.

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: Select one: A. acute respiratory depression. B. seizures and cardiac arrhythmias. C. an increase in her blood pressure. D. a sudden outburst of violence.

B. seizures and cardiac arrhythmias.

As you assess the patient, you notice he has pinpoint pupils. You suspect a drug overdose. What drug is the likely cause of this phenomenon? A. Cocaine B. Methamphetamine C. Heroin D. Alcohol

C. Heroin

You are dispatched to an address known for being a place where illicit drugs are purchased. You arrive at the scene prior to fire or police personnel and see several people outside the building. They are yelling and directing you and your partner inside, where the patient is located. What is the best course of action? A. Enter the building, find the patient, and begin assessment. B. Park the ambulance in front of the building and remain inside the vehicle. C. Stage around the corner and wait for police to declare the scene safe. D. Investigate the scene to determine whether it is safe.

C. Stage around the corner and wait for police to declare the scene safe.

What is another sign of substance abuse that will make it difficult for your partner to establish IV access in this patient? A. Tachycardia B. Nausea and/or vomiting C. Venous scarring (track marks) D. Hypotension

C. Venous scarring (track marks)

The recommended treatment for absorbed or contact poisons includes _________. Select one: A. neutralizing the poisonous substance with a chemical B. transporting the patient to the emergency department with the poisonous substance in place C. safely removing or diluting the poisonous substance D. collecting and transporting the poisonous substance to the emergency department for identification

C. safely removing or diluting the poisonous substance

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

D. use appropriate personal protective equipment and examine the vomitus for pill fragments or other clues for patient care.

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

C. ventilate her with a BVM.

What is the duration of action of naloxone? A. 30 minutes to 9 hours B. 30 minutes to 7 hours C. 30 minutes to 5 hours D. 30 minutes to 1 hour

D. 30 minutes to 1 hour

As you load the patient into the ambulance, what should you do to assist your partner? A. Prepare an IV setup. B. Place the patient on the cardiac monitor. C. Begin a detailed assessment. D. Take vital signs.

D. Take vital signs.

Most poisonings occur via the __________ route. Select one: A. injection B. absorption C. inhalation D. ingestion

D. ingestion

Heroin is an example of a(n): Select one: A. hypnotic. B. sympathomimetic. C. cholinergic. D. opioid.

D. opioid.

injected poisons

IV drug abuse or envenomation by animals, absorbed quickly into the body, cannot be diluted or removed in the field, condition can be life-threatening signs are weakness, dizziness, fever, chills, unresponsiveness, excitability monitor airway, high-flow O2, alert for nausea/vomiting

two commonly abused hallucinogens

LSD and PCP/angel dust

alcohol

a powerful CNS depressant that is sedative and hypnotic, increases the effect of many other drugs, serious CNS depression will require respiratory support

ingested poisons

accounts for 80% of poisoning, usually accidental in children and deliberate in adults, some systems let EMTs administer charcoal signs are mouth burns, GI pain, vomiting, cardiac dysrhythmias, seizures

sedative-hypnotic drugs

barbiturates, benzodiazepines easy to get and cheap, usually taken orally, signs similar to alcohol treatment is to ensure airway is patent, assist ventilations and transport

inhaled posions

fresh air, O2, may need HazMat decontamination, pulse ox readings may not be accurate signs are burning eyes, sore throat, chest pain, resp. distress, headache, stridor in severe cases

four routes of poisoning

inhalation, absorption (surface contact), ingestion, injection

delirium tremens (DTs)

the dramatic physical and psychological effects of alcohol withdrawal

naloxone (narcan)

medication used to reverse the effects of opioid OD, often administered intranasal when PT has agonal respirations or is apneic

opioids

narcotic drug that produces sleep or altered mental consciousness used primarily to relieve pain PTs appear sedated/unconscious and cyanotic with pinpoint pupils tolerance develops quickly

absorbed poisons

via skin/mucous membranes, chemical burns, rashes/lesions, systemic effects; flush skin for 15-20 mins and wash signs are burns, itching, skin redness