Emergency Medicine: Toxicology & Overdose
Recognition and management of common poisonings and overdoses.
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What is the classic clinical triad of opioid overdose?
Miosis (pinpoint pupils), respiratory depression, and CNS depression (altered mental status).
Which specific antidote is used to treat acetaminophen (paracetamol) toxicity?
N-acetylcysteine (NAC).
What is the primary antidote for a benzodiazepine overdose?
Flumazenil.
What does the acronym SLUDGE represent in the context of cholinergic toxicity?
Salivation, Lacrimation, Urination, Defecation, Gastrointestinal upset, and Emesis.
Which medication is the specific antagonist used to reverse opioid-induced respiratory depression?
Naloxone.
What is the specific antidote for life-threatening digoxin toxicity?
Digoxin-specific antibody fragments (DigiFab).
What is the mechanism of action for N-acetylcysteine in acetaminophen overdose?
It acts as a precursor for glutathione, which detoxifies the reactive metabolite NAPQI.
Which toxidrome is characterized by the phrase 'dry as a bone, red as a beet, blind as a bat, hot as a hare, and mad as a hatter'?
Anticholinergic toxidrome.
What clinical tool is used to determine the need for N-acetylcysteine based on serum levels and time post-ingestion?
The Rumack-Matthew Nomogram.
What is the preferred treatment for methanol or ethylene glycol poisoning to inhibit alcohol dehydrogenase?
Fomepizole.
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