2 - Management of Poison

c. Primary survey

Assessment and treatment of life-threatening injuries with goal of stabilizing the patient.
a. Secondary survey
b. Tertiary survey
c. Primary survey
d. Clinical assessment

c. Stabilizing the patient

Goal of Primary Survey

a. Diagnosing the poison
b. Administering antidote
c. Stabilizing the patient
d. Identifying the substance

1. A-irway

2. B- reathing

3. C-irculation

4. D-isability • is the pat

5. E-xposure

Step in Primary Survey [5]

d. Airway

[Primary Survey]

Step in primary survey that ensures the airway is open and patent.
a. Breathing
b. Circulation
c. Disability
d. Airway

b. Breathing

[Primary Survey]

Step in primary survey that involves observing chest rise.
a. Airway
b. Breathing
c. Circulation
d. Exposure

c. Circulation

[Primary Survey]

Step in primary survey that involves assessing pulse.
a. Airway
b. Breathing
c. Circulation
d. Disability

d. Carotid

[Primary Survey]

Pulse site assessed below the jaw in circulation step.
a. Radial
b. Femoral
c. Brachial
d. Carotid

c. Radial

[Primary Survey]

Pulse site assessed at the wrist in circulation step.
a. Carotid
b. Femoral
c. Radial
d. Brachial

d. Femoral

[Primary Survey]

Pulse site assessed at the groin in circulation step.
a. Carotid
b. Radial
c. Brachial
d. Femoral

c. Tourniquet

[Primary Survey]

Management applied above the wound to control bleeding.
a. Ice pack
b. Bandage
c. Tourniquet
d. Pressure dressing

d. Cardio pulmonary resuscitation (CPR)

[Primary Survey]

Intervention performed when there is no breathing and no pulse.
a. Oxygen supplementation
b. Antidote administration
c. Defibrillation
d. Cardio pulmonary resuscitation (CPR)

c. 100-125 bpm

[Primary Survey]

Goal rate during CPR in beats per minute.
a. 60-80 bpm
b. 80-100 bpm
c. 100-125 bpm
d. 125-150 bpm

d. Disability

[Primary Survey]

Step in primary survey that assesses:

• Patient responsiveness

• Mental status.
  

a. Airway
b. Circulation
c. Exposure
d. Disability

d. Exposure

[Primary Survey]

Step in primary survey ensuring patient is in a safe place and thermoregulated after reviving.
a. Disability
b. Circulation
c. Breathing
d. Exposure

b. Decontamination

Removal of any hazardous materials from the body
a. Primary survey
b. Decontamination
c. Risk assessment
d. Antidote administration

• Surface decontamination

• Gastrointestinal (GI) decontamination

Methods of Decontamination [3]

c. Minimize further exposure

Goal of decontamination.
a. Stabilize the patient
b. Administer antidote
c. Minimize further exposure
d. Diagnose the poison

c. Remove contaminated clothing

[Surface Decontamination]

First step in surface decontamination of skin.
a. Wash with running water
b. Apply antidote cream
c. Remove contaminated clothing
d. Apply isotonic solution

d. At least 30 minutes

[Surface Decontamination]

Duration of washing skin with running water during surface decontamination.
a. 10 minutes
b. 20 minutes
c. 45 minutes
d. At least 30 minutes

d. Remove artifacts in the eyes (glasses, lashes)

[Surface Decontamination]

First step in surface decontamination of eyes.
a. Wash with running water
b. Move eyes left right up down
c. Apply eye drops
d. Remove artifacts in the eyes (glasses, lashes)

• Running water

• IV fluids (isotonic)

[Surface Decontamination]

Solution used to wash eyes during surface decontamination.
a. Distilled water only
b. Hypertonic saline
c. Running water or IV fluids (isotonic)
d. Hypotonic saline

d. 30 minutes

[Surface Decontamination]

Duration of washing eyes during surface decontamination.
a. 10 minutes
b. 20 minutes
c. 45 minutes
d. 30 minutes

d. Left right up down

[Surface Decontamination]

Eye movement performed after washing during surface decontamination.
a. Up and down only
b. Left and right only
c. Circular motion
d. Left right up down

b. Give supplemental oxygen

[Surface Decontamination]

Surface decontamination for respiratory tract when poison is a gas.
a. Administer antidote
b. Give supplemental oxygen
c. Perform CPR
d. Wash with running water

c. When poison is gas

[Surface Decontamination]

Condition that always requires supplemental oxygen in respiratory tract decontamination.
a. When poison is liquid
b. When poison is solid
c. When poison is gas
d. When poison is ingested

d. Emesis

[Gastrointestinal Decontamination]

Gastrointestinal decontamination method that induces vomiting.
a. Cathartics
b. Gastric lavage
c. Activated charcoal
d. Emesis

• Ipecac syrup

• Apomorphine

[Gastrointestinal Decontamination]

Examples of emetic agents used to induce vomiting include:

a. Ipecac syrup and Apomorphine
b. Ondansetron and Metoclopramide
c. Loperamide and Diphenoxylate
d. Naloxone and Flumazenil

• Unconsciousness

• Ingestion of acids / bases

[Gastrointestinal Decontamination]

Contraindications for Apomorphine and Ipecac syrup include:

a. Unconsciousness and ingestion of acids/bases
b. Pregnancy and lactation
c. Pediatric patients and elderly
d. Hypertension and diabetes

d. Cathartics

[Gastrointestinal Decontamination]

Accelerates defecation

a. Emesis

b. Laxatives

c. Activated charcoal

d. Cathartics

b. MgSO4 and Na2SO4

[Gastrointestinal Decontamination]

Cathartic agents used to accelerate defecation in GI decontamination.

a. Ipecac syrup and Apomorphine

b. MgSO4 and Na2SO4

c. NGT and OGT

d. Activated charcoal and MgSO4

c. Gastric lavage

[Gastrointestinal Decontamination]

Gastrointestinal decontamination method involving suctioning of gastric contents through a tube.
a. Emesis
b. Cathartics
c. Gastric lavage
d. Activated charcoal

b. NGT and OGT

[Gastrointestinal Decontamination]

Tubes used in gastric lavage for suctioning gastric contents.
a. ETT and LMA
b. NGT and OGT
c. CVP and ETT
d. NGT and ETT

c. Highly adsorbent material

[Gastrointestinal Decontamination]

Characteristic of activated charcoal as a GI decontamination agent.
a. Induces vomiting
b. Accelerates defecation
c. Highly adsorbent material
d. Suctions gastric contents

d. 10:1

[Gastrointestinal Decontamination]

Dose ratio of activated charcoal to poison.
a. 1:1
b. 5:1
c. 20:1
d. 10:1

• Unconscious patient

• Poorly adsorb substances

  • Ex:

    • Caustic / corrosives

    • Heavy metals

    • Alipathics / hydrocarbons

    • Rapidly aBsorbable substances

    • Cyanide . Fluoride

    • Organophosphate

      • Tabun

      • Sarin

      • Soman

    • Alcohol

    • Lithium

[Gastrointestinal Decontamination]

Contraindications of activated charcoal include:

a. Unconscious patient and poorly adsorb substances

b. Pregnancy and lactation

c. Pediatric patients and elderly

d. Hypertension and diabetes-

• Caustic / corrosives

• Heavy metals

• Alipathics / hydrocarbons

• Rapidly aBsorbable substances

• Cyanide , Fluoride

• Organophosphate

  • Tabun

  • Sarin

  • Soman

• Alcohol

• Lithium

📌Mnemonic: “CHARCOAL”

[Gastrointestinal Decontamination]

Poorly adsorb substances include _______ [8]

b. N-acetylcysteine (NAC)

[Antidotes]

Antidote for Paracetamol poisoning
a. Flumazenil
b. N-acetylcysteine (NAC)
c. Naloxone
d. Fomepizole

a. Digoxin antibodies (DigiBind, Digi Fab)

[Antidotes]

Antidote for Digoxin toxicity
a. Digoxin antibodies (DigiBind, Digi Fab)
b. Physostigmine
c. Pralidoxime
d. Hydroxocobalamin

b. Esmolol

[Antidotes]

Antidote for:

• Theophylline toxicity

• Caffeine toxicity

a. Atropine
b. Esmolol
c. Ethanol
d. Naloxone

• Ethanol

• Fomepizole

[Antidotes]

Antidote for Methanol poisoning
a. Naloxone
b. Flumazenil
c. Ethanol, Fomepizole
d. Physostigmine

c. Flumazenil

[Antidotes]

Antidote for Benzodiazepine toxicity
a. Hydroxocobalamin
b. Atropine
c. Flumazenil
d. Esmolol

a. Naloxone

[Antidotes]

Antidote for Opioids toxicity
a. Naloxone
b. Pralidoxime
c. Fomepizole
d. Digoxin antibodies (DigiBind, Digi Fab)

b. Hydroxocobalamin

[Antidotes]

Antidote for Cyanide poisoning
a. Ethanol
b. Hydroxocobalamin
c. Atropine
d. Flumazenil

• Atropine

• Pralidoxime

[Antidotes]

Antidote for Organophosphate poisoning
a. Naloxone
b. Physostigmine
c. Atropine, Pralidoxime
d. N-acetylcysteine (NAC)

c. Organophosphates

[Antidotes]

Poison that causes an increase in acetylcholine (↑Ach)
a. Atropine
b. Physostigmine
c. Organophosphates
d. Naloxone

b. Atropine

[Antidotes]

Antidote that causes a decrease in acetylcholine (↓Ach)
a. Pralidoxime
b. Atropine
c. Neostigmine
d. Organophosphates

b. Physostigmine

— The only acetylcholinesterase inhibitor that cross BBB

[Antidotes]

Antidote for Atropine toxicity
a. Pralidoxime
b. Physostigmine
c. Fomepizole
d. Hydroxocobalamin

• A -ctivated charcoal

• T- annic acid

• M - agnesium oxide

[Antidotes]

Component of the Universal Antidote (2:1:1) [3]

b. 2:1:1

[Antidotes]

Ratio of the Universal Antidote, clinically obsolete

• A -ctivated charcoal

• T- annic acid

• M - agnesium oxide
  

a. 1:1:1
b. 2:1:1
c. 1:2:1
d. 3:1:1

a. Activated charcoal

[Antidotes]

Component of the Universal Antidote that is capable of aDsorption

a. Activated charcoal
b. Tannic acid
c. Magnesium oxide (MgO)

b. Tannic acid

[Antidotes]

Component of the Universal Antidote that can undergo precipitation

a. Activated charcoal
b. Tannic acid
c. Magnesium oxide (MgO)

c. Magnesium oxide (MgO)

[Antidotes]

Component of the Universal Antidote that participates in neutralization reactions

a. Activated charcoal
b. Tannic acid
c. Magnesium oxide (MgO)

• Urine pH manipulation

• Hemodialysis

[Poison Elimination]

Poison elimination method involves ________ [2]

b. Sodium bicarbonate (NaHCO3)

[Poison Elimination]

Agent used for alkalinification of urine
a. Ammonium Chloride (NH4Cl)
b. Sodium bicarbonate (NaHCO3)
c. Activated charcoal
d. Magnesium oxide (MgO)

b. Reabsorption of weak acids

[Poison Elimination]

Effect of alkalinification of urine by adding Sodium bicarbonate (NaHCO3)
a. Excretion of weak bases
b. Reabsorption of weak acids
c. Excretion of weak acids
d. Reabsorption of weak bases

b. Ammonium Chloride (NH4Cl)

[Poison Elimination]

Agent used for acidification of urine
a. Sodium bicarbonate (NaHCO3)
b. Ammonium Chloride (NH4Cl)
c. Tannic acid
d. Ethanol

c. Excretion of weak bases

[Poison Elimination]

Effect of acidification of urine by adding Ammonium Chloride (NH4Cl)
a. Excretion of weak acids
b. Reabsorption of weak bases
c. Excretion of weak bases
d. Reabsorption of weak acids

c. Hemodialysis

[Poison Elimination]

Poison elimination method that happens when your blood is filtered externally using a dialyzer (dialysis machine) via diffusion
a. Urine pH Manipulation
b. Hemoperfusion
c. Hemodialysis
d. Forced diuresis