What does PHAILS stand for?
- Acids, Alkalis, Alcohol
What is the acronym PHAILS used for?
Recalling the substances poorly absorbed by activated charcoal
What three drugs make up the antidote kit for cyanide poisoning?
- Amyl nitrite (inhaled)
- Sodium nitrite (IV)
- Sodium thiosulfate (IV)
What are the other names for the Cyanide Antidote Kit?
- Taylor Kit
- Lilly Kit
- Pasadena Kit
What is the pathophysiology behind cyanide poisoning?
- Cyanide interrupts the electron transport chain in the mitochondria greatly reducing the number of ATP that can be manufactured.
- Cyanide combines with enzyme cytochrome oxidase, which inhibits cellular oxygenation, leading to anaerobic metabolism, then to metabolic acidosis, then cellular death.
How does the Cyanide Antidote Kit work?
- Changes the chemical structure of hemoglobin by adding an iron molecule, making methemoglobin.
- Methemoglobin is incapable of carrying oxygen, but it draws out the cyanide from the cytochrome oxidase.
- The sodium thiosulfate that is given then detoxifies the cyanide in the blood, just like the body normally does.
What is a major side effect that should be expected with the Cyanide Antidote Kit?
- Patient should be lying down if possible
- MCEP may order vasopressors
How is cyanide poisoning sometimes treated in the field?
Hydroxycobalamin (AKA Cyanokit)
How does Hydroxycobalamin work?
Binds to cyanide and forms cyanocobalamin instead of methemoglobin, which does not lower the oxygen carrying capacity of the blood
What are the expected side effects of Hydroxycobalamin?
- Transient hypertension
- Reddish discoloration of the skin
Activated charcoal removes toxins by the process of:
The drug of choice for carbamate poisonings is:
The mnemonic device SLUDGE helps you to remember the:
Signs of organophosphate poisoning
You are called to a local park where several people attending a family reunion report stomach pain, nausea, and vomiting. Patients report that lunch was served 2 hours ago. This time frame would lead you to suspect that the cause of the food poisoning was:
You are called to a local beach to treat a man who stepped on a starfish. He now has a painful wound in which a piece of the starfish is still intact. Treatment for this patient includes:
Immerse the foot in very warm water
Sedative-hypnotic drugs include:
Benzodiazepines and barbiturates
Most poisonings in the United States occur:
In the home
You are called to a local woodshop where a man was found seizing, immediately after working with a paint-removal product. The man was not wearing gloves. He is now confused and lethargic. He is tachypneic and complains of abdominal pain. After protecting his airway, treatment for this patient may include:
If the stinger is left in the wound after a sting by a honey bee, you should:
Scrape the stinger from the wound
Drug therapy for patients with organophosphate poisoning should only be administered if the patient has what kind of symptoms?
Two or more symptoms of respiratory distress
The most commonly ingested NSAID in overdose is:
Acetaminophen overdose leads to toxicity of the:
The mnemonic device CHAMP helps you remember:
Which hydrocarbons may benefit from gastric lavage
You are called to treat a 2-year-old child who has just ingested lye. The child is conscious and cooperative. The poison control center may advise you to administer what oral solution?
What medication can you use to prevent exacerbation of Wernicke-Korsakoff syndrome?
Activated charcoal is most effective when the:
Poison was ingested less than an hour before the administration of charcoal
The most common route of mercury poisoning is:
The pharmacological management of choice for a symptomatic overdose of a tricyclic antidepressant is:
Syrup of ipecac is :
Not recommended for routine use in the prehospital setting
Most poisoned patients require what type of therapy in the prehospital setting?
An employee in a pest-control business is found unconscious on a garage floor. You find him drooling and diaphoretic. The most appropriate medication for this patient is:
A chemical that may be produced when nylon and polyurethane burn and is of particular concern in any fire environment is:
Disulfiram is a medication taken by alcoholics to prevent:
Which of the following is an early sign of toxicity in reaction to a tricyclic antidepressant?
A reasonable approach to prevent absorption in an adult who has taken an overdose of pills would be:
Lavage followed by charcoal
The most common cardiovascular complications of poisoning by ingestion is:
The preferred method of keeping a poison from entering the small intestine is:
Use of activated charcoal
Organophosphates affect primarily which neurotransmitter?
You find your 22-year-old patient unconscious and breathing six times per minute. His pupils are equal and pinpoint. Your partner begins ventilation and oxygenation using a bag-mask. You are unable to establish vascular access by IV or IO. What intervention has the highest priority?
Administer naloxone 2 mg IM
Activated charcoal should be withheld if the ingestion occurred :
Within 1 or more hours before EMS arrival
Any substance that produces harmful physiological or psychological effects is called a(n):
Alcohol withdrawal can lead to hallucinations in _____ hours.
24 to 36
The most commonly ingested NSAID in overdose is:
Among a patient�s prescription medications, you find a bottle of lithium, leading you to suspect that the patient has:
What finding would lead you to eliminate a spider bite as the cause of an injected poison?
Management of a patient bitten by a pit viper should include:
Immobilizing the limb
Minor symptoms of alcohol withdrawal usually:
Peak within 24 to 36 hours
Medical direction may advise you to promote gastric emptying in a patient who has ingested lead or mercury because:
The risk for systemic toxicity outweighs the risk for aspiration
The absorption of toxins takes place primarily in the:
How should the envenomation site of a jellyfish sting be treated?
Apply isopropanol and baking soda
Most accidental poisonings in children from 1 to 3 years of age occur by means of:
The antidote for benzodiazepine overdose is:
You are called to a local woodshop where a man was found seizing, immediately after working with a paint-removal product. The man was not wearing gloves. He is now confused and lethargic. He is tachypneic and complains of abdominal pain. You suspect this patient has been poisoned by:
Which drug is found in the Pasadena cyanide antidote kit?
You find your 22-year-old patient unconscious and breathing six times per minute. His pupils are equal and pinpoint. Your partner begins ventilation and oxygenation using a bag-mask. You are unable to establish vascular access by IV or IO. Which of the following interventions has the highest priority?
Administer naloxone 2 mg IM
Cocaine is a(n):
You respond to a call for an overdose. When you arrive, you find a teenage girl who is drowsy and snoring, but arouses to sternal pressure. Her friends think she took some Vicodin and Valium 40 minutes ago and drank some vodka. Her vital signs are BP 98/70 mmHg, P. 116 bpm, R 16/min., SaO2 97%. Which of the following interventions would be appropriate?
Insert a nasal airway and administer naloxone 0.4 mg IV
The drug of choice to treat an overdose of opiates is:
Which of the following organs is most likely to show the effects of poisoning first?
Most pediatric lead poisonings occur as a result of:
Ingestion of paint chips
What are the four routes through which poisons may enter the body?
What percentage of all accidental ingestion of poisons occurs in children 1 to 3 years of age?
What is the first priority in managing a poisoned patient after scene safety?
Securing a patent airway
What are the specific questions that should be asked as part of the history of a poisoned patient?
- How much?
- Antidote been given?
- Psychiatric history/suicide attempts?
What is a cathartic?
An agent that causes bowel evacuation
What are the main goals (2) in managing a poisoned patient?
- Managing symptoms
- Preventing absorption
What does CHAMP stand for?
How quickly do symptoms appear in cases of chemical food poisoning?
Within 30 minutes
How quickly do symptoms appear in cases of food poisoning caused by bacterial toxins?
1 to 12 hours
How quickly do symptoms develop in cases of food poisoning caused by viral or bacterial infections?
12 to 48 hours
What is a direct-acting chemical?
Chemical capable of producing injury without first being transformed or changed i.e. hydrofluoric acid
A cyanide antidote kit should not be given to a patient who is suspected to be suffering from cyanide poisoning due to what circumstance?
- Smoke inhalation
- Carbon monoxide poisoning already limits oxygen carrying capability
- Patient could die from anoxious brain injury
What is the only hymenopteran species with venom that results in necrotic activity?
The imported fire ant
What is the definition of the term "drug abuse"?
- The use of prescription drugs for nonprescribed purposes
- or the use of drugs that have no prescribed medical use
Heroin accounts for what percentage of opiod abuse in the US?
Which commonly prescribed pain medication is most commonly abused?
What is PCP psychosis?
- usually acute onset
- may mimic schizophrenia
- can occur after a single low-dose exposure to PCP
- may not be apparent until several days after exposure
What is the pathophysiology behind tricyclic antidepressant toxicity?
- Sodium channel blockade in the myocardium
- Blockade of blood vessels
- Causing:Anticholinergic effects and seizures
What are the early SXS of a TCA overdose?
- Dry mouth
- Blurred vision
- Inability to concentrate
- Occasionally visual hallucinations
What are some later severe symptoms of a TCA overdose?
- Depressed respirations
- Prolonged QRS complex
- GCS less than 8
What are the SXS of a black widow bite?
- Pin prick to painful bite
- Cramps usually abdominal
- Rarely hypertension, paralysis, respiratory distress
How do we treat a black widow bite?
- Treat SXS
- Pain medications
- Wash wound
What are the SXS of a brown recluse bite?
- Necrotic tissue effect
- Local reaction
- Bulls eye lesion (irregular shape)
How do we treat a brown recluse bite?
How do we treat a tarantula bite?
- Remove urticating hair
How do we treat bee and wasp stings?
- Remove stinger
- Epinephrine and antihistamine for anaphylaxis if needed
What are the SXS of a scorpion sting?
- Immediate intense pain
- Mild inflammation
- Difficulty swallowing/speech
- Urinary retention
- Respiratory paralysis
How do we treat a scorpion sting?
- Ice on site
- Analgesic OTC
- Monitor cardiac function
- Monitor respirations, speech, dysphagia
- Clean wound
What are the five poisonous snakes in the US?
- Water Moccasin
- Coral Snake
What are the SXS of a snakebite?
- Bloody wound discharge with fang marks in the skin
- Skin discoloration and local tissue death
- Numbness and tingling and swelling at the site
- Severe pain and burning
- Blurred vision, dizziness, Weakness
- Nausea, vomiting, diarrhea
- Fainting, fever, convulsions
- Excessive sweating and increased thirst
- Rapid pulse
- Metallic taste
- Loss of muscle coordination
How do we treat a snakebite?
- Limit venom spread with immobilization and lymphatic restricting bands
- MCEP/Poison Control
- Anaphylax Tx if necessary
What are the "DO NOT"s of snakebites?
- DO NOT allow the person to become over-exerted
- DO NOT apply a tourniquet
- DO NOT apply cold compress
- DO NOT cut into bite or suction
- DO NOT give the person stimulants
- DO NOT give the person anything PO
- DO NOT raise the site above the level of the heart
What creatures use offensive neurotoxins?
- Spiders (paralyze prey to minimize web destruction or harm to self)
- Marine (paralyze prey to facilitate rapid feeding and minimize harm to self)
- Coral snake
What creatures use offensive hemotoxins?
What creatures use defensive neurotoxins?
Bees Wasps Hornets and Ants
What creatures use Anticoagulant toxins?
What does AABCDE stand for specific to poisoning?
- Alter absorption
- Basics (ABCs)
- Change catabolism
- Distribute differently
- Enhance elimination
What is toxicodynamics?
What the poison does to the body
What is toxicokinetics?
What the body does to the poison
What is the mneumonic device we use to remember the SXS of an anticholinergic poisoning?
- Mad as a hatter
- Red as a beet
- Hot as a hare
- Blind as a bat
- Dry as a bone
What toxins cause miosis?
- Opiate Narcotics
What toxins cause mydriasis?
What toxins cause hyperthermia?
What toxins cause hypothermia?
- Beta Blockers
- Sedative Hypnotics
What toxins cause hypertension?
- Withdrawal states
What toxins cause hypotension?
- Sedative Hypnotics
What toxins cause decreased respiratory effort?
What toxins cause increased respiratory effort?
- Systemic asphyxiants
- Simple asphyxiants
what are some specific SXS of Anticholinergics?
- Decreased bowel sounds
- Urinary retension
What are some specific SXS of hydrogen sulfide poisoning?
- Rotten egg smell
- Brownish colored blood
- Whole body cyanosis
- "Gas Eye"
What is the adult dose of Hydroxycobalamine?
5g IV over 30 mins
What is the pediatric dose of Hydroxycobalamine?
<70 kg is 70mg/kg IV
What does MTWHF stand for?
What is MTWHF associated with?
- Cholinergic toxidrome
- EARLY SXS of poisoning
What does DUMBELS stand for?
What is the adult dose for Atropine for Cholinergic poisoning?
1-2mg IVP q 5-15 mins
What is the pediatric dose of Atropine for Cholinergic poisoning?
0.02-0.05 mg/kg q 1-4 hrs
What is the adult dose for Pralidoxime?
600 mg autoinjector or 1-2g IVP over 15-30 mins
What is the pediatric dose for Pralidoxime?
20-50 mg/kg over 15-30 mins
What are some common SXS specific to LSD/Hallucinogens?
- Nausea, loss of appetite
- Chills, flushing
- Abdominal discomfort
- Numbness/numbing of the mouth
What do all irritant gases form when mixed with water?
The more water soluble an irritant gas is, the higher or lower in the respiratory system you will see SXS?
What three areas of chemical burns may there be depending on the water solubility of an irritant gas?
- Upper airway (stridor, conjunctivitis)
- Bronchi (wheezing)
- Alveoli (flash pulmonary edema)
What is the descriminating factor between SXS of Opiate/Narcotic or alcohol toxicity and Sedative/Hypnotic toxicity?
- Respiratory depression will generally only occur in Opiate/Narcotic and alcohol toxicity
- Alcohol toxicity will also lower body temperature; Sedative/Hypnotics do not
What is thought to be the adult fatal dose of cocaine?
1200 mg (25-30 has been fatal due to arrhythmias)
What are the 3 components of the "Deadly Triangle" associated with sympathomimetics?
- Cardiac Dysrhythmias
What are the four stages of ETOH Withdrawal Syndrome?
- Minor reactions
- Alcohol Withdrawal Seizures
- Delirium Tremens
When do minor reactions of ETOH withdrawal start and how long do they last?
- Start 6 to 8 hours after cessation
- Last up to 10-14 days
When do hallucinations generally start in ETOH withdrawal?
24-36 hours after cessation
When do alcohol withdrawal seizures usually occur?
- 7 to 48 hours after cessation
- Grand Mal
- Groups of 2 to 6
When do DTs begin in ETOH withdrawal?
- 72 to 96 hours after cessation
- May be delayed up to 14 days
- Single episode may last 1-3 days
What is the pediatric dose for Thiamine?
10-25 mg SIVP or IM
What things is Ethylene Glycol found in?
- Windshield deicer
- Radiator fluid
As little as _________ ml can cause death from ethylene glycol.
What is the time range for the onset of SXS of ethylene glycol toxicity?
1 to 72 hours
How many stages are there in ethylene glycol toxicity? What system is each stage associated with?
- 3 stages
- Stage 1 CNS system
- Stage 2 Cardiopulmonary system
- Stage 3 Renal system
How do we treat ethylene glycol toxicity?
- Cardiac monitor
- Acitvated Charcoal - removes 50%
- Sodium Bicarb
- Calcium preps
- Seizure control
What dosage of iron is considered severe?
What are some specific SXS of iron toxicity?
- Abdominal pain
What is considered a potentially lethal dose of isopropanol in an adult?
150 to 240 mL
What is the biggest concern in isopropanol poisoning?
- Respiratory depression
- Onset of SXS 30 mins after ingestion
What two organ systems are the heavy metals most likely to affect?
What is a major permanent disability caused by methanol toxicity?
Blindness/ permanent nerve damage
As little as _____ mL of methanol can cause blindness.
What is the time range for the onset of SXS of methanol toxicity?
40 mins to 72 hours
What is a major specific SXS of NSAID toxicity?
What dose is considered a severe toxicity of NSAIDs?
MOre than 300 mg/kg
What dose is considered mild toxicity of NSAIDs?
Less than 150 mg/kg
What dose is considered moderate toxicity of NSAIDs?
150 - 300 mg/kg
What dose is considered fatal toxicity of NSAIDs?
More than 500 mg/kg
What are the SXS of a nematocyst or "stinging" injury?
- Local pain, tenderness
- Itching, rash
- Minimal systemic effects
How do we treat a stinging injury?
- Salt water rinse
- Scrape off remains
- Topical corticosteroids
What are the SXS of a spine marine injury?
- Pain, tenderness
- Systemic SXS
How do we treat a spine marine injury?
- Freshwater soak 105 F, 40 C for 90 minutes
- Remove barb/stinger
- High risk wound
- Pain medication
- Immediate evacuation for progressive neurologic symptoms
What is the first priority for any marine injury?
Deal with the environment
What does soman liquid smell like?
What does chlorine gas smell like?
Mixture of pineapple and pepper
What does phosgene gas smell like?
Newly mown hay
What does tabun liquid smell like?
Faint fruity odor
Which poisonous liquids have no odor?
VX and sarin
What does sarin liquid look like?
Clear and colorless
What does VX look like?
- Thick, amber-colored
- Resembles motor oil
What is the adult dose for Calcium preparations?
5-10 mL SIVP (2mL/min)
What is the pediatric dose for Calcium Gluconate?
0.6 mL/kg SIVP
What is the pediatric dose for Calcium Chloride?
0.2 mL/kg SIVP
What are the Calcium preparations used as antidotes for?
- Calcium Channel Blocker OD
- Magnesium Sulfate OD
- Black widow spider bites
What is the adult dose for Glucagon in a Beta Blocker OD?
3-10 mg IVP over 1 minute
What is the pediatric dose for Glucagon in a Beta Blocker OD?
0.1 mg/kg IVP over 1 min max 1 mg