BOOK REVIEW Chapters: 183-189

Which of the following is true regarding anticholinergic crises? A) Seizures are seen more commonly in adults than in children. B) Hyperthermia is a significant cause of death in patients who receive adequate supportive care. C) Reduced gastric motility is the earliest sign. D) Sympathomimetic and Anticholinergic crises are clinically indistinguishable. E) Nicotinic antagonism exceeds muscarinic antagonism.

Answer: B

What is the most common plant associated with Anticholinergic Toxicity? Deadly Nightshade Henbane Mandrake Jimsonweed

Answer: D

Please recite the Judy T. mnemonic for Anticholinergic Toxicity!

Dry as a Bone Red as a Beet Hot as Hades Blind as a Bat Mad as a Hatter Stuffed as a Pipe

What is the most common EKG finding associated with Anticholinergic Toxicity? AV Dissociation Bundle Branch Blocks Sinus Tachycardia QRS prolongation

Answer: C

Should a patient that displays clear evidence of anticholinergic toxicity receive the antidote, Physostigmine?

NO It may worsen dysrhythmias or seizures In people who use TCA, it may cause bradycardia or asystole.

The most recent National Report Card on Emergency Medicine assigned what grade to Michigan?

D+ Ranking Michigan 43rd in the Nation Bravo! Michigan Remember to contribute to the PAC

In what city did Miracle on 34th Street take place?

New York

What is the most common cause of chronic metal poisoning? Arsenic Lead Mercury Sagnastium

Answer: Lead 890,000 children between 1 and 5 years old have a blood level of at least 10 mcg/dL.

Which of the following is true regarding treatment of acute lead toxicity? Acute lead encephalopathy is self limited and requires no specific therapy Dimercaprol should be given before EDTA Activated charcoal is the mainstay of GI Decontamination Penicillamine is more effective than succimer in chelation of lead.

Answer: B EDTA, if given first, it will cause the chelated lead to cross the BBB.

The combination of abdominal or neurologic dysfunction with a _____ anemia should raise the suspicion of lead toxicity. Aplastic Anemia Chronic Diseas Anemia Hemolytic Anemia Hemorrhagic Anemia

Answer: C

What is the last ghost called in A Christmas Carol?

The Ghost of Christmas Yet to Come

What popular Christmas toy is based on a 1903 political caricature?

The Teddy Bear Theodore Roosevelt

Which of the following is the most effective therapy for acute arsenic poisoning? Activated Charcoal Ipecac Dimercaprol Penicillamine Deferoxime

Answer: C

Match the odors Cyanide Isopropanol Salicylate Arsenic Fruity Almonds Garlic Wintergreen

Match the odors Cyanide Isopropanol Salicylate Arsenic Fruity Almonds Garlic Wintergreen

In A Charlie Brown Christmas, how many cents does Lucy charge for her psychiatric services?

5 cents

Nerve agents cause what type of toxidrome? Anticholinergic Cholinergic Sympathomimetic Sedative Hypnotic

Answer: B Salivation Lacrimation Urination Defecation GI distress (diarrhea) Emesis Bronchorrhea, Bradycardia

What two agents are administer to patients who have been exposed to Nerve Agents?

Atropine 2-PAM

HSC, a division of DOW, releases a ‘Chlorine Cloud’ and patients start arriving at your ED c/o of resp. difficulties. What is the appropiate treatment?

Supportive care with use of humidified oxygen and bronchodilators Supportive care with use of humidified oxygen and bronchodilators. Use of aerosolized bicarb is controversial.

‘A Christmas Story’ takes place in Hammond, Indiana ‘A Christmas Story’ takes place in Hammond, Indiana. However, it was not filmed there. Where was the movie filmed and in what year was it released?

Cleveland, Ohio. (one of the few good things to actually come out of Ohio) 1983

A frat guy shows up in the ED stating that he is taking high doses of a vitamin in order to increase his ability to pick up sorority ladies. However, he complains of the follow: Blurred vision Appetite loss Abnormal skin pigmentation Hair loss Long bone pain Pruritus

What vitamin is he taking in high doses? B

Answer: Vitamin A

What class of medications can be administered to help abate Niacin Flush?

Antihistamines

High doses of this vitamin can precipitate gout and nephrolithiasis in some patients?

Answer: Vitamin C

An overdose patient presents complaining of nausea, vomiting and AMS An overdose patient presents complaining of nausea, vomiting and AMS. She then starts seizing. You suspect she overdosed on an antimicrobial. In addition to standard therapy, what medication should also be given that is specific to this overdose?

Answer: Pyridoxine (B6)

You are treating a patient with a suspected cyanide poisoning You are treating a patient with a suspected cyanide poisoning. In what order do you administer the three drugs from the cyanide antidote kit?

Amyl Nitrite Sodium Nitrite Sodium Thiosulfate *** Nitrites cause hypotension and the development of methemoglobinemia *** Hydroxocobalamin (Vit B12a) is an alternative if available

Ativan Dextromethorphan Amyl Nitrate Ketamine A 22 yo female presents with cyanosis. C/O DIB, HA, slurred speech. Friends states she was using some medication to “get high.” Pulse ox is 85% despite aggressive high flow Oxygen. Her blood draw looks like chocolate. What medication did she OD on? Ativan Dextromethorphan Amyl Nitrate Ketamine

Answer: C Amyl Nitrate

What is the treatment for Methemoglobinemia?

Methylene Blue