Chapter 21: Toxicology

When caring for a known alcoholic patient with severe trauma to the chest and abdomen, you should be concerned that:

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

Hypotension, hypoventilation, and pinpoint pupils would be expected following an overdose of:

oxycodone (Percocet).

Activated charcoal is given to patients who have ingested certain substances because it:

binds to the substance and prevents absorption.

Of the four avenues of poisoning, generally ___________ is the most worrisome in terms of treatment to the EMS provider.

injection

Most poisonings occur via the __________ route.

ingestion

How do poisons typically act to harm the body?

By changing the normal metabolism of cells or by destroying them

Heroin is an example of a(n):

opioid.

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).

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.

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?

An overdose of acetaminophen, the active ingredient in Tylenol, will MOST likely cause:

liver failure.

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 person who routinely misuses a substance and requires increasing amounts to achieve the same effect is experiencing:

tolerance.

As you enter the residence of a patient who has possibly overdosed, you should:

be alert for personal hazards.

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:

ventilate her with a BVM.

Which of the following sets of vital signs would the EMT MOST likely encounter in a patient with acute cocaine overdose?

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

Victims of inhaled poisoning will require which of the following?

Transport to an emergency department for evaluation

If the victim of a toxicologic emergency vomits, an EMT should _________.

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

A 25-year-old man overdosed on heroin and is unresponsive. His breathing is slow and shallow and he is bradycardic. He has track marks on both arms. The EMT should:

insert a nasal airway and ventilate with a BVM

The recommended treatment for absorbed or contact poisons includes _________.

safely removing or diluting the poisonous substance

common brand of naloxone (Narcan)

Evzio

A 4-year-old, 15-kg male ingested an unknown quantity of acetaminophen (Tylenol). The child's mother states that she does not know when the ingestion occurred. The child is conscious and alert and in no apparent distress. The EMT should:

administer 15 g of activated charcoal.

Activated charcoal may be indicated for a patient who ingested:

aspirin

After administering activated charcoal to a patient, it is MOST important to:

be alert for vomiting

airborne substances should be diluted with

oxygen

Before giving activated charcoal, you should:

obtain approval from medical control.

Common names for activated charcoal include all of the following, EXCEPT:

fructose

In general, injected poisons are impossible to dilute or remove because they:

are usually absorbed quickly into the body.

Substance abuse is MOST accurately defined as:

knowingly misusing a substance to produce a desired effect.

The major side effect associated with administration of activated charcoal is

black stools

You are dispatched to a local nursery for a 39-year-old female who is sick. When you arrive, you find the patient lying on the floor. She is semiconscious, has copious amounts of saliva coming from her mouth, and is incontinent of urine. You quickly feel her pulse and note that it is very slow. Immediate management for this patient should include:

thoroughly suctioning her oropharynx

You respond to a college campus for a young male who is acting strangely. After law enforcement has secured the scene, you enter the patient's dorm room and find him sitting on the edge of the bed; he appears agitated. As you approach him, you note that he has dried blood around both nostrils. He is breathing adequately, his pulse is rapid and irregular, and his blood pressure is 200/110 mm Hg. Treatment for this patient includes

attempting to calm him and giving him oxygen if tolerated.

Your paramedic partner administers atropine to a 49-year-old male with bradycardia. Which of the following side effects would you expect the patient to experience?

dry mucous membranes

2. The EMT's primary responsibility to the patient who has been poisoned is to:

recognize that a poisoning occurred.

5. Signs and symptoms of a sympathomimetic drug overdose include:

tachycardia

6. Which of the following drugs is NOT a sedative-hypnotic?

cocaine

10. The poison control center will be able to provide you with the most information regarding the appropriate treatment for a patient with a drug overdose if the center:

is aware of the substance that is involved

11. Which of the following statements regarding inhaled poisons is correct?

lung damage may progress after the patient is removed from the environment

12. Your priority in caring for a patient with a surface contact poisoning is to:

avoid contaminating yourself

13. Phosphorus or elemental sodium should be brushed off of the skin instead of irrigated with water because:

these chemicals may ignite upon contact with water

15. Syrup of ipecac is no longer recommended to treat patients who have ingested a poisonous substance because it:

may result in aspiration of vomitus

18. As you enter the residence of a patient who has possibly overdosed, you should:

be alert for personal hazards

19. Your unit is dispatched to the county jail for an intoxicated inmate. Upon arrival, you find the patient, a 33-year-old male, lying supine in a jail cell. He is responsive to painful stimuli only and has slow, shallow respirations. You should be MOST concerned that this patient:

may vomit and aspirate

21. It is MOST important to determine a patient's weight when asking questions pertaining to a toxic ingestion because:

activated charcoal is given based on a patient's weight

23. Activated charcoal administration is contraindicated in patients who have ingested:

acids or alkalosis

25. The usual dose for activated charcoal is up to ______ for a pediatric patient and up to ______ for an adult patient.

25g, 50g

31. The MOST commonly abused drug in the United States is:

alcohol

32. A hypnotic drug is one that:

induces sleep

35. 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:

DTs

36. During your assessment of a 50-year-old male who was found unconscious in an alley, you note that he has slow, shallow respirations; significant bradycardia; facial cyanosis; and pinpoint pupils. As your partner begins assisting the patient's ventilations, he directs your attention to the patient's arms, which have multiple needle tracks on them. This patient's clinical presentation is MOST consistent with:

heroin overdose

38. You respond to a local motel for a young female who was sexually assaulted. The patient is conscious but confused. She tells you that the last thing she remembers was drinking beer at a club with her friends the night before. When she awoke, she was in the bed of the motel room. You should be MOST suspicious that this patient:

was given flunitrazepam

41. You are dispatched to a local nursery for a 39-year-old female who is sick. When you arrive, you find the patient lying on the floor. She is semiconscious, has copious amounts of saliva coming from her mouth, and is incontinent of urine. You quickly feel her pulse and note that it is very slow. Initial management for this patient should include:

assisted ventilation with a bag-mask device.

42. Atropine sulfate and pralidoxime chloride are antidotes for:

nerve gas agents

43. A patient who presents with rapid breathing, nausea and vomiting, ringing in the ears, and a high fever should be suspected of ingesting a significant quantity of:

aspirin

45. Which of the following statements regarding the Salmonella bacterium is correct?

The Salmonella bacterium itself causes food poisoning.

46. A 3-year-old female ingested several leaves from a plant in the living room. The child's mother is not sure what type of plant it is, stating that she bought it simply because it was pretty. After completing your initial assessment of the child, you should:

contact the regional poison control center