CPR Toxicological Emergencies and Overdose Management 1 — Questions and Answers
Question 1: What is the first-line antidote for reversing opioid-induced respiratory depression?
- Flumazenil
- Naloxone (Correct answer)
- N-acetylcysteine
- Atropine
Correct answer: Naloxone
Naloxone (Narcan) is a competitive opioid receptor antagonist and is the standard first-line treatment to reverse opioid-induced respiratory depression.
Question 2: A patient presents with miosis, bradycardia, bronchospasm, and excessive secretions after unknown substance ingestion. Which toxidrome does this represent?
- Sympathomimetic
- Anticholinergic
- Cholinergic (Correct answer)
- Sedative-hypnotic
Correct answer: Cholinergic
Cholinergic toxidrome (SLUDGE/DUMBELS) presents with miosis, bradycardia, bronchospasm, and excessive secretions, typically from organophosphate or carbamate exposure.
Question 3: What is the recommended initial adult IV dose of naloxone for suspected opioid overdose?
- 0.01 mg
- 0.1 mg
- 0.4 to 2 mg (Correct answer)
- 10 mg
Correct answer: 0.4 to 2 mg
The standard initial adult IV dose of naloxone ranges from 0.4 to 2 mg, titrated to restore adequate ventilation without precipitating full withdrawal in opioid-tolerant patients.
Question 4: Which combination of antidotes is used to treat severe organophosphate poisoning?
- Physostigmine and pyridoxine
- Pralidoxime (2-PAM) and atropine (Correct answer)
- Flumazenil and calcium gluconate
- Naloxone and sodium bicarbonate
Correct answer: Pralidoxime (2-PAM) and atropine
Atropine reverses muscarinic effects and pralidoxime (2-PAM) reactivates acetylcholinesterase before aging occurs, making them the dual treatment for organophosphate poisoning.
Question 5: A patient with tricyclic antidepressant (TCA) overdose develops a wide QRS complex and hypotension. What is the treatment of choice?
- Magnesium sulfate IV
- Sodium bicarbonate IV (Correct answer)
- Lidocaine infusion
- Calcium chloride IV
Correct answer: Sodium bicarbonate IV
Sodium bicarbonate alkalinizes the serum and increases the sodium gradient, narrowing the QRS complex and improving hypotension caused by TCA-induced sodium channel blockade.
Question 6: What is the primary mechanism by which activated charcoal reduces toxin absorption in the GI tract?
- Chemical neutralization of the poison
- Adsorption of toxins to prevent absorption (Correct answer)
- Inducing emesis to expel the substance
- Enzymatic breakdown of the toxin
Correct answer: Adsorption of toxins to prevent absorption
Activated charcoal works by adsorbing (binding) toxins in the GI tract to its large surface area, preventing their absorption into the bloodstream without altering the substance chemically.
Question 7: A patient presents with hyperthermia, tachycardia, hypertension, agitation, diaphoresis, and dilated pupils after using a stimulant. Which toxidrome is this?
- Opioid
- Cholinergic
- Sympathomimetic (Correct answer)
- Anticholinergic
Correct answer: Sympathomimetic
Stimulants such as cocaine and amphetamines cause sympathomimetic toxidrome featuring hyperthermia, tachycardia, hypertension, agitation, diaphoresis, and mydriasis.
CPR Toxicological Emergencies and Overdose Management 1
What is the first-line antidote for reversing opioid-induced respiratory depression?