Deck 30: Toxicological Emergencies

Question 1

What should be avoided in managing cardiac arrest due to tachyarrhythmias of poisoned patients?

A) Beta-blockers
B) Adrenaline
C) Dextrose
D) Oxygen therapy

Answer 1

Adrenaline

Question 2

Which among the following symptoms should a nurse recognise as life-threatening for a patient admitted to ED due to poisoning?

A) Hypotension
B) Hypertension
C) Positive gag reflex
D) GCS score of 13

Answer 2

Hypotension

Question 3

What is the first drug of choice as antidote to opioid intoxication?

A) Anticholinergic
B) Atropine
C) Naloxone
D) Calcium gluconate

Answer 3

Naloxone

Question 4

When is the benefit of gastric lavage and oral activated charcoal still reliable?

A) When it is performed within the first hour of toxic agent ingestion
B) When it is performed within the first 2 hours of toxic agent ingestion
C) When it is performed within the first 3 hours of toxic agent ingestion
D) When it is performed within the first 4 hours of toxic agent ingestion

Question 5

Why is sodium bicarbonate administration important prior to intubation of a patient affected with sodium channel blocker toxicity?

A) To improve urine pH by increasing its alkalinity
B) To improve respiratory function
C) To prevent aspiration
D) To prevent patient deterioration from progressive acidosis

Question 6

It is a life-threatening effect of paracetamol toxicity:

A) Hypoglycaemia
B) Hepatotoxicity
C) Kidney failure
D) Acidosis

Question 7

The most useful investigation in TCA toxicity is:

A) Acid-base of the blood
B) Complete blood count
C) ECG
D) CT scan

Question 8

The following are symptoms of neurotoxicity, EXCEPT:

A) Hyporeflexia
B) Myoclonic jerks
C) Convulsion
D) Tremor

Question 9

Which among the following statements about carbon monoxide (CO) poisoning is NOT TRUE?

A) Most of the patients who survive CO poisoning have long-term neuropsychiatric sequelae
B) CO toxicity is acquired through ingestion
C) CO causes hypoxia
D) Manifestations of CO poisoning include headache, nausea and confusion

Question 10

What is the antidote for colchicine overdose?

A) Anticholinergic
B) Sodium bicarbonate
C) Naloxone
D) None are correct

Question 11

You are responding to a local beach where a 14-year-old male is experiencing severe pain in his left foot after stepping on something in the water. On clinical examination there are several small puncture wounds on the plantar surface of his left heel and the surrounding area is red and swollen. He complains of 10/10 pain and other than a slight tachycardia his vital signs are within normal limits and the remainder of his physical examination is unremarkable. Based on the history and clinical findings, the patient has most likely been envenomed by:

A) Sea snake
B) Stonefish
C) Sting ray
D) Blue ringed octopus

Question 12

In relation to question 1 above, the most appropriate pre-hospital clinical management of the patient is:

A) Irrigate the affected area with copious amounts of vinegar, administer appropriate analgesia and transport to the emergency department
B) Immerse the affected foot in hot water, making sure not to burn the patient, administer appropriate analgesia and transport to the emergency department
C) Apply ice packs to the affected area, administer appropriate analgesia and transport to the emergency department
D) Apply a pressure bandage and immobilise the affected limb, administer appropriate analgesia and transport to the emergency department

Question 13

Jenny, a 66-year-old female living in North Queensland, is doing some cleaning in her garage when she thinks she feels something bite her right thumb, although she didn't see any creature. After about 10 minutes her right thumb becomes painful and she notices some localised redness and swelling. Over the next hour the pain increases significantly and is now 6/10, there is localised sweating and piloerection and she is complaining of nausea. Her vital signs are all within normal limits and the remainder of the physical examination is unremarkable. Based on the history and clinical findings, Jenny has most likely been envenomed by:

A) White tailed spider
B) Brown snake
C) Funnel-web spider
D) Redback spider

Question 14

In relation to question 3 above, the most appropriate pre-hospital clinical management of Jenny is:

A) Apply a pressure bandage, immobilise the affected limb and transport to hospital
B) Apply an ice pack to the affected area for 20 minutes then apply a pressure bandage, immobilise the affected limb and transport to hospital
C) Apply an ice pack to the affected area, reassure Jenny that her condition is not serious and advise her to follow up with her own general practitioner if she doesn't feel better by tomorrow
D) Apply an ice pack to the affected area, provide appropriate analgesia and symptomatic treatment and transport to the emergency department

Question 15

You are dispatched to a 3-year-old male who presents with an altered level of consciousness (GCS 12); bi-lateral ptosis; shallow respirations and weakness in all limbs. His mother states that he has had progressive weakness over the past 3 days since returning from a camping trip in the Blue Mountains. He was seen by a GP yesterday who diagnosed a 'viral illness'; however, his symptoms have significantly worsened during the night. Based on the history and clinical findings described your differential diagnosis should include which of the following envenomation?

A) Paralysis tick
B) Redback spider
C) Funnel web spider
D) Tiger snake

Question 16

The most common cause of death from snakebite in Australia is envenoming from:

A) Taipan
B) Death adder
C) Tiger snake
D) Brown snake

Question 17

Regarding Chironex fleckeri (Box jellyfish) which one of the following statements is INCORRECT:

A) Following irrigation with vinegar any affected limb/s should have a firm pressure bandage applied, followed by immobilisation of the affected limb/s
B) For pain that is severe and refractory to intravenous opioids administer 1 ampoule (20,000 units) of box jellyfish antivenin intravenously
C) Chironex fleckeri envenomation occurs in tropical Australian waters with most stings occurring between April and November
D) Initial management of the conscious patient following Chironex fleckeri envenomation includes removing adherent tentacles using a gloved hand, irrigating the stung area with vinegar and administering analgesia

Question 18

The application of the 'pressure - immobilisation' first aid technique is used for all of the following envenomation, EXCEPT:

A) Snakebite
B) Funnel web spider
C) Blue ringed octopus
D) Irukandji

Question 19

Envenomation by the Funnel-web spider is potentially lethal. Which of the following clinical features is not characteristic of Funnel-web spider envenomation?

A) Presence of fang marks with associated pain at the bite site
B) Localised erythema and swelling
C) Hypertension
D) Sweating

Question 20

The most common life-threatening clinical manifestation of envenomation from Hymenoptera (bees, wasps) and some species of ants is:

A) Respiratory arrest secondary to paralysis of the respiratory muscles from pre and post synaptic neurotoxins
B) Coagulopathy
C) Anaphylaxis
D) Acute renal failure secondary to rhabdomyolysis