AMLS Toxicological Emergencies 2 — Questions and Answers
Question 1: Which toxin causes a 'sympathomimetic toxidrome' with hyperthermia, tachycardia, hypertension, and agitation?
- Cocaine or amphetamines (Correct answer)
- Benzodiazepines
- Opioids
- Beta-blockers
Correct answer: Cocaine or amphetamines
Cocaine and amphetamines cause the sympathomimetic toxidrome by blocking catecholamine reuptake or increasing release, producing excess adrenergic stimulation.
Question 2: What is the treatment for organophosphate poisoning causing SLUDGE symptoms?
- Atropine and pralidoxime (2-PAM) (Correct answer)
- Naloxone and activated charcoal
- Physostigmine and benzodiazepines
- Flumazenil and oxygen
Correct answer: Atropine and pralidoxime (2-PAM)
Atropine blocks muscarinic effects and is given in large doses, while pralidoxime (2-PAM) reactivates acetylcholinesterase before aging occurs.
Question 3: Carbon monoxide poisoning should be treated with which intervention?
- 100% oxygen via non-rebreather mask or hyperbaric oxygen (Correct answer)
- Supplemental oxygen via nasal cannula only
- Bronchodilators and corticosteroids
- Naloxone and sodium bicarbonate
Correct answer: 100% oxygen via non-rebreather mask or hyperbaric oxygen
High-flow 100% oxygen competes with CO for hemoglobin binding and reduces CO half-life from 5 hours to approximately 60–90 minutes.
Question 4: A widened QRS complex and sodium channel blockade are hallmarks of toxicity from which drug class?
- Tricyclic antidepressants (TCAs) (Correct answer)
- Selective serotonin reuptake inhibitors
- Beta-blockers
- Opioids
Correct answer: Tricyclic antidepressants (TCAs)
TCA overdose blocks cardiac sodium channels causing QRS widening (>100 ms), dysrhythmias, hypotension, and seizures.
Question 5: Which treatment reverses the QRS widening caused by TCA overdose?
- Sodium bicarbonate IV bolus (Correct answer)
- Magnesium sulfate IV
- Calcium gluconate IV
- Activated charcoal only
Correct answer: Sodium bicarbonate IV bolus
Sodium bicarbonate increases serum pH and sodium load, reversing sodium channel blockade and narrowing the widened QRS in TCA overdose.
Question 6: Serotonin syndrome is caused by excessive serotonergic activity and presents with which triad?
- Mental status change, neuromuscular abnormalities, and autonomic instability (Correct answer)
- Miosis, bradycardia, and respiratory depression
- Hyperthermia, rigidity, and rhabdomyolysis
- Fever, altered mentation, and diaphoresis only
Correct answer: Mental status change, neuromuscular abnormalities, and autonomic instability
Serotonin syndrome's classic triad includes altered mental status, neuromuscular findings (clonus, hyperreflexia), and autonomic instability (hyperthermia, tachycardia).
AMLS Toxicological Emergencies 2
Which toxin causes a 'sympathomimetic toxidrome' with hyperthermia, tachycardia, hypertension, and agitation?