ABEM Oral Boards Best Illustrated Answers

ABEM Oral Boards Best Illustrated Answers Sympathomimetic Toxidrome - CORRECT ANSWER-Causes: Meth, cocaine, caffiene, DECONGESTANTS Sx: agitated, tachy, dilated pupils WET (on toxicologists handshake) Tx: Benzos, fluids Anticholinergic Toxidrome - CORRECT ANSWER-Causes: antihistamines (think benadryl OD), Jimson WEED, mushrooms, TCAs sx:Same as Sympathimometic but DRY with URINARY RETENTION Tx: Physostigmine (cholinesterase inhibitor), Benzos. if TCA ocerdose and wide complex dysrhythmia, given bicarb Organophosphate Poisoning - CORRECT ANSWER-Sx: SLUDGE (cholinergic toxidrome) tx: atropine - end point of drying up secretions Pralidoxime (2-PAM) - unlock acetylocholineesterase enzyme Haldol/Reglan overdose - CORRECT ANSWER-Extrapyramidal Toxidrome sx: oculogyric crisis (upward deviation of the eyes) rigidity, torticollis, trismus, dysphagia Tx: Benadryl, 1-2mg/kg q6h, benztropine 0.05mg/kg Q12H Activated Charcoal Indications - CORRECT ANSWER-<60min and not one of the poorly absorbed (PHAILS): pesiticides, hevry metals, alcohols, irone, lithium, solvents) Multi Dose Activated Charcoal - CORRECT ANSWER-Theophylline (only thing EMRAP says use it for) Delayed release formulations Phenobarb Salicylates Carbamezapine Elevated Osmlar Gap - CORRECT ANSWER-2[na] + Glucose/18+ BUN/2.8 + ETOH/4.6 super elevated >>10 = toxic alcohol lack of elevation does not rule it out methanol, ethylene glycol, isopropyl alcohol non-toxic causes: high cholestrerol, DKA, AKA, CKD Tylenol Overdose - CORRECT ANSWER-NAC if: above line of rumack-mathew nomogram when time of ingestion is known. NAC for chronic ingestions is difficult Ethanol overdose - CORRECT ANSWER-normal booze - Folate, Thiamine (if Wernicke's - high dose > 450) - supportive care Antifreeze Overdose - CORRECT ANSWER-Ethylene Glycol +anion gap + osmolar gap -ketones Tx: fomepazole, ethanol, dialysis HD indications: EG >50, severe acidosis, AKI Rubbing Alcohol Overdose - CORRECT ANSWER-Isopropanol -anion gap + osmolar gap + ketones HD indications: hypotension refractory to fluids and vasopressors, isopropanol level >400 Window Cleaner - CORRECT ANSWER-Methanol Overdose + anion gap + osmolar gap - ketones Sx: SNOWSTORM VISION Tx: fomepazole, ethanol, HD HD indications: AKI, level > 25, severe acidosis, visual symptoms Tegretol Overdose (carbamezapine) - CORRECT ANSWER-Sx: Dizziness, Ataxia, Nystagmus, Coma, Seizures, dysrythmias Tx: MDAC, tx wide QRS w/ bicarb Dilantin Overdose (phenytoin) - CORRECT ANSWER-sx: Dizziness, Ataxia, Nystagmus tx: supportive, MDAC MAOi Overdose (Isocarboxazid, Phenelzine, Selegiline, Tranylcypromine) - CORRECT ANSWER-Sx: Cholinergic/Sympathomimetic toxidrome, Serotonin syndrome tx: Benzos, cyproheptadine