CMN 577 Exam 3: Poisoning Questions
What drug may reverse benzodiazepine-induced coma? - ANS-Flumazenil
Flumazenil should not be used in patients who? - ANS-- Congested a potential
convulsant drug
- A user of high-dose benzo's
- Has a seizure disorder
-- Its use may precipitate seizures
How long after taking extended release bupropion overdose may the onset of seizures
occur? - ANS-18-24 hours
What is the antidote for acetaminophen overdose? - ANS-Acetylcysteine (Mucomyst)
What lab tests are indicated in the overdose patient? - ANS-- Measured serum
osmolality and Osmal gap
- Electrolytes
- Anion gap
- Glucose
- Creatinine, BUN, creatinine kinase
- UA, and EKG
Charcoal can be given within what timeframe for acetaminophen overdose? -
ANS-Within 1-2 hours of ingestion
A patient comes into the ER with severe agitation, psychosis, and starts having a
seizure.
What do you suspect and what is the initial treatment? - ANS-- Suspect a drug overdose
(amphetamines/cocaine).
- Tx w/ a benzo (diazepam, lorazepam)
Your amphetamine/cocaine overdose patient now has HTN. The nurse suggests that
you order a beta-blocker to treat the HTN.
What do you as the provider tell the nurse? - ANS-A beta-blocker is not appropriate
treatment in this case, as it may result in paradoxical worsening of the HTN as a result
of unopposed alpha-adrenergic effects
, What should be done immediately for a digitalis. Or another cardiac glycoside
overdose? - ANS-- Administer activated charcoal, monitor potassium levels and cardiac
rhythm.
- Treat bradycardia initially with atropine
Iron overdose leads to hypotension. What can be done immediately to treat the
hypotension? - ANS-IV crystalloid administration (NS or LR)
How long should a patient with seafood poisoning be observed, minimally? - ANS-4-6
hours
What are emergency measures that you would NOT do in a snake bite victim? -
ANS-Do NOT give alcoholic beverages or stimulants, do NOT apply ice, do not apply a
tourniquet
What kind of spider bite can cause progressive local necrosis as well as hemolytic
reactions? - ANS-Brown Recluse
When is it appropriate to treat HTN due to poisoning? - ANS-When patient is
symptomatic, or their diastolic pressure is higher than 105-110
Hypotensive patients, due to poisoning, are best treated with immediate? - ANS-NS
200mL blouses, repeatedly. If not adequate, give dopamine or norepinephrine
Hypotension caused by overdose of TCA's or sodium channel blockers, administer? -
ANS-Sodium Bicarbonate
In hypotension d/t B.B. overdose, give? - ANS-Glucagon
For calcium channel blocker overdose, leading to hypotension, give? - ANS-Calcium
Chloride
How long should an eye be irrigated after contamination with an irritant? - ANS-15
minutes or until each eye has been irrigated with 1L saline [If the toxin is an acid or a
base, check the pH and continue irrigation until pH is between 6-8]
When is aggressive gut decontamination necessary? - ANS-When large ingestions with
Anticholinergics compounds and salicylates have occurred.
What drug may reverse benzodiazepine-induced coma? - ANS-Flumazenil
Flumazenil should not be used in patients who? - ANS-- Congested a potential
convulsant drug
- A user of high-dose benzo's
- Has a seizure disorder
-- Its use may precipitate seizures
How long after taking extended release bupropion overdose may the onset of seizures
occur? - ANS-18-24 hours
What is the antidote for acetaminophen overdose? - ANS-Acetylcysteine (Mucomyst)
What lab tests are indicated in the overdose patient? - ANS-- Measured serum
osmolality and Osmal gap
- Electrolytes
- Anion gap
- Glucose
- Creatinine, BUN, creatinine kinase
- UA, and EKG
Charcoal can be given within what timeframe for acetaminophen overdose? -
ANS-Within 1-2 hours of ingestion
A patient comes into the ER with severe agitation, psychosis, and starts having a
seizure.
What do you suspect and what is the initial treatment? - ANS-- Suspect a drug overdose
(amphetamines/cocaine).
- Tx w/ a benzo (diazepam, lorazepam)
Your amphetamine/cocaine overdose patient now has HTN. The nurse suggests that
you order a beta-blocker to treat the HTN.
What do you as the provider tell the nurse? - ANS-A beta-blocker is not appropriate
treatment in this case, as it may result in paradoxical worsening of the HTN as a result
of unopposed alpha-adrenergic effects
, What should be done immediately for a digitalis. Or another cardiac glycoside
overdose? - ANS-- Administer activated charcoal, monitor potassium levels and cardiac
rhythm.
- Treat bradycardia initially with atropine
Iron overdose leads to hypotension. What can be done immediately to treat the
hypotension? - ANS-IV crystalloid administration (NS or LR)
How long should a patient with seafood poisoning be observed, minimally? - ANS-4-6
hours
What are emergency measures that you would NOT do in a snake bite victim? -
ANS-Do NOT give alcoholic beverages or stimulants, do NOT apply ice, do not apply a
tourniquet
What kind of spider bite can cause progressive local necrosis as well as hemolytic
reactions? - ANS-Brown Recluse
When is it appropriate to treat HTN due to poisoning? - ANS-When patient is
symptomatic, or their diastolic pressure is higher than 105-110
Hypotensive patients, due to poisoning, are best treated with immediate? - ANS-NS
200mL blouses, repeatedly. If not adequate, give dopamine or norepinephrine
Hypotension caused by overdose of TCA's or sodium channel blockers, administer? -
ANS-Sodium Bicarbonate
In hypotension d/t B.B. overdose, give? - ANS-Glucagon
For calcium channel blocker overdose, leading to hypotension, give? - ANS-Calcium
Chloride
How long should an eye be irrigated after contamination with an irritant? - ANS-15
minutes or until each eye has been irrigated with 1L saline [If the toxin is an acid or a
base, check the pH and continue irrigation until pH is between 6-8]
When is aggressive gut decontamination necessary? - ANS-When large ingestions with
Anticholinergics compounds and salicylates have occurred.
