NR572 Midterm Overview
1. Most common substances involved in cases of toxic ingestion: -analgesics (acetaminophen,
salicylates)
-benzodiazepines
-Ethanol
-antidepressants
-opioids
2. Less common substances involved in toxic ingestion: -household cleaning products
-pesticides
-antihistamines
-antipsychotics
-antiepileptics
-Muscle relaxants
-anti-hypertensive
3. Risk factors for toxic ingestion: -current substance abuse
-Previous addiction or substance misuse
-Children
-Patients with untreated psychiatric disorders
4. Opioid antidote: Naloxone
5. Benzodiazepine antidote: Flumazenil
6. Acetaminophen antidote: N-acetylcysteine (NAC)
7. Digoxin antidote: Digibind
8. beta blocker antidote: glucagon
9. Calcium channel blocker antidote: calcium gluconate
10.Iron antidote: Deferoxamine
11.Cyanide antidote: Hydroxocobalamin
12."Rule of Thumb" for treatment of toxic ingestion: Treat the patient, not the poison
13.Treatment of critical patients with toxic ingestion starts with...: 1-ACLS: protection and
adequate oxygen and ventilation
2-IV access
3- fluid resuscitation
14.Additional supportive measures for toxic ingestion may include: -cocktail of IV thiamine, D50,
and naloxone
-Sodium bicarb IV for acidosis
-Electrolyte imbalance correction, including hypoglycemia
-Management of bradycardia, tachycardia, and dysrhythmias
-Seizure control
-Warming or cooling blankets to control hypo or hyperthermia
, NR572 Midterm Overview
15.Ipecac: Suitable at home treatment for some recently ingested (<30 min) solid substances,
such as pills and capsules
Forces emesis
16.Contraindications to ipecac: Patients who have ingested corrosive agents or detergents due
to the risk for corrosive esophagitis and aspiration
Rarely used in emergency settings
17.gastric lavage: A 28-38 French NGT is inserted into stomach and lavage until clear in
patients who are symptomatic that meet criteria
Limited use for toxins that were ingested over 60 minutes ago
18.Contraindications for gastric lavage: Cannot be used when a patient ingests large pills and
requires patient cooperation to perform
19.whole bowel irrigation: Involves removing toxic agent by inducing mass, diar- rhea with
admin of osmotic laxative
Recommended for drugs, not well, absorbed by charcoal, such as iron, lithium, heavy metals,
and sustained release pills
Effective for use in patients who swallow illicit drugs in a container such as a balloon
20.Contraindications for whole bowel irrigation: G.I. hemorrhage Bowel
obstruction
21.Activated Charcoal: Preferred method for G.I. decontamination
Binds to drug and prevents absorption
Dosed at 25-100 g (50 g most common) and mixed with water to form a slurry and administered
within first hour after reported ingestion
Most effective when combined with a cathartic, such as sorbitol
22.Activated Charcoal: Contraindications: -decreased level of consciousness
-those who are unable to protect their airway unless they are intubated or have NGT
23.Endoscopy for toxic ingestion: Method of choice for ingestion of solid sub- stances, which
can have toxic effect:
-batteries
, NR572 Midterm Overview
-Metal objects
-sharps, etc
24.Subject info to collect for toxic ingestion: Type of overdose Timing of
overdose
History
25.High index of suspicion for toxic ingestion (intentional or unintentional) should be considered
in the following circumstances:: -history of psychiatric illness (particularly depression)
-Onset of symptoms while at work with chemicals or after ingestion of medications or food
-sudden onset of symptoms or illness in a previously healthy person
-Recent change in relationships or economic status
-suicidal ideation or planning
26.Toxidrome pattern for opioids (also list opioid examples [5]): Morphine Fentanyl
Dilaudid
Methadone
Oxycodone
- HR, BP, RR, Temp
-Miosis
27.Toxidrome pattern for cholinergics (also list cholinergic drugs [4]): Carba- mates
Organophosphates
Mushrooms Urecholine
HR, temp RR
Miosis
28.Toxidrome pattern for sedative-hypnotic drugs (also name the drugs [5])-
: Benzodiazepines
Muscle relaxants Sleep
aids Barbiturates
Alcohols
HR, BP, RR, temp (or no change) No
pupil change
, NR572 Midterm Overview
29.Toxidrome pattern for Sympathomimetics (also name the drugs [4]): Co- caine
Decongestants
Amphetamines
Theophylline
HR, BP, RR, Temp
Mydriasis
30.Toxidrome pattern for anti-cholinergics (also name the drugs [6]): TCA Antihistamines
Atropine Scopolamine
Cyclobenzaprine
Parkinson's medication
HR, BP
No change in RR Temp
Mydriasis
31.Acetaminophen toxicity: -occurs between 7.5-15 g in most adults
-Toxicity and lower doses can happen in people with malnutrition, chronic illness, ETOH
-first 24 hours, maybe asymptomatic or have nausea, vomiting, malaise
-24-48 hour post ingestion: RUQ pain and evidence of hepatic dysfunction (jaundice and
coagulopathy).
-3-5 days post ingestion: hepatic encephalopathy, resulting in a MS or delirium. Acute renal
failure and lactic acidosis death may occur
-People who survive often recover completely
32.Most sensitive biomarker for acetaminophen toxicity: AST
Begins to rise around 24-36 hours post ingestion , before signs of liver dysfunction
33.Salicylate (aspirin) toxicity: -Ingestion of 10-30 g of aspirin can be fatal
-Early stage: nausea, vomiting, tinnitus, headache, dehydration, elevated LFTs, agitation
1. Most common substances involved in cases of toxic ingestion: -analgesics (acetaminophen,
salicylates)
-benzodiazepines
-Ethanol
-antidepressants
-opioids
2. Less common substances involved in toxic ingestion: -household cleaning products
-pesticides
-antihistamines
-antipsychotics
-antiepileptics
-Muscle relaxants
-anti-hypertensive
3. Risk factors for toxic ingestion: -current substance abuse
-Previous addiction or substance misuse
-Children
-Patients with untreated psychiatric disorders
4. Opioid antidote: Naloxone
5. Benzodiazepine antidote: Flumazenil
6. Acetaminophen antidote: N-acetylcysteine (NAC)
7. Digoxin antidote: Digibind
8. beta blocker antidote: glucagon
9. Calcium channel blocker antidote: calcium gluconate
10.Iron antidote: Deferoxamine
11.Cyanide antidote: Hydroxocobalamin
12."Rule of Thumb" for treatment of toxic ingestion: Treat the patient, not the poison
13.Treatment of critical patients with toxic ingestion starts with...: 1-ACLS: protection and
adequate oxygen and ventilation
2-IV access
3- fluid resuscitation
14.Additional supportive measures for toxic ingestion may include: -cocktail of IV thiamine, D50,
and naloxone
-Sodium bicarb IV for acidosis
-Electrolyte imbalance correction, including hypoglycemia
-Management of bradycardia, tachycardia, and dysrhythmias
-Seizure control
-Warming or cooling blankets to control hypo or hyperthermia
, NR572 Midterm Overview
15.Ipecac: Suitable at home treatment for some recently ingested (<30 min) solid substances,
such as pills and capsules
Forces emesis
16.Contraindications to ipecac: Patients who have ingested corrosive agents or detergents due
to the risk for corrosive esophagitis and aspiration
Rarely used in emergency settings
17.gastric lavage: A 28-38 French NGT is inserted into stomach and lavage until clear in
patients who are symptomatic that meet criteria
Limited use for toxins that were ingested over 60 minutes ago
18.Contraindications for gastric lavage: Cannot be used when a patient ingests large pills and
requires patient cooperation to perform
19.whole bowel irrigation: Involves removing toxic agent by inducing mass, diar- rhea with
admin of osmotic laxative
Recommended for drugs, not well, absorbed by charcoal, such as iron, lithium, heavy metals,
and sustained release pills
Effective for use in patients who swallow illicit drugs in a container such as a balloon
20.Contraindications for whole bowel irrigation: G.I. hemorrhage Bowel
obstruction
21.Activated Charcoal: Preferred method for G.I. decontamination
Binds to drug and prevents absorption
Dosed at 25-100 g (50 g most common) and mixed with water to form a slurry and administered
within first hour after reported ingestion
Most effective when combined with a cathartic, such as sorbitol
22.Activated Charcoal: Contraindications: -decreased level of consciousness
-those who are unable to protect their airway unless they are intubated or have NGT
23.Endoscopy for toxic ingestion: Method of choice for ingestion of solid sub- stances, which
can have toxic effect:
-batteries
, NR572 Midterm Overview
-Metal objects
-sharps, etc
24.Subject info to collect for toxic ingestion: Type of overdose Timing of
overdose
History
25.High index of suspicion for toxic ingestion (intentional or unintentional) should be considered
in the following circumstances:: -history of psychiatric illness (particularly depression)
-Onset of symptoms while at work with chemicals or after ingestion of medications or food
-sudden onset of symptoms or illness in a previously healthy person
-Recent change in relationships or economic status
-suicidal ideation or planning
26.Toxidrome pattern for opioids (also list opioid examples [5]): Morphine Fentanyl
Dilaudid
Methadone
Oxycodone
- HR, BP, RR, Temp
-Miosis
27.Toxidrome pattern for cholinergics (also list cholinergic drugs [4]): Carba- mates
Organophosphates
Mushrooms Urecholine
HR, temp RR
Miosis
28.Toxidrome pattern for sedative-hypnotic drugs (also name the drugs [5])-
: Benzodiazepines
Muscle relaxants Sleep
aids Barbiturates
Alcohols
HR, BP, RR, temp (or no change) No
pupil change
, NR572 Midterm Overview
29.Toxidrome pattern for Sympathomimetics (also name the drugs [4]): Co- caine
Decongestants
Amphetamines
Theophylline
HR, BP, RR, Temp
Mydriasis
30.Toxidrome pattern for anti-cholinergics (also name the drugs [6]): TCA Antihistamines
Atropine Scopolamine
Cyclobenzaprine
Parkinson's medication
HR, BP
No change in RR Temp
Mydriasis
31.Acetaminophen toxicity: -occurs between 7.5-15 g in most adults
-Toxicity and lower doses can happen in people with malnutrition, chronic illness, ETOH
-first 24 hours, maybe asymptomatic or have nausea, vomiting, malaise
-24-48 hour post ingestion: RUQ pain and evidence of hepatic dysfunction (jaundice and
coagulopathy).
-3-5 days post ingestion: hepatic encephalopathy, resulting in a MS or delirium. Acute renal
failure and lactic acidosis death may occur
-People who survive often recover completely
32.Most sensitive biomarker for acetaminophen toxicity: AST
Begins to rise around 24-36 hours post ingestion , before signs of liver dysfunction
33.Salicylate (aspirin) toxicity: -Ingestion of 10-30 g of aspirin can be fatal
-Early stage: nausea, vomiting, tinnitus, headache, dehydration, elevated LFTs, agitation
