8. Team A Q1
What does DEAD in the Resus-RSI-
DEAD mnemonic for the approach to
the poisoned patient stand for?
9. Team A A1
Resuscitation
Risk assessment
Supportive care and Monitoring
Investigations
Decontamination
Enhanced elimination
Antidotes
Disposition
http://lifeinthefastlane.com/education/ccc/approach-to-acute-poisoning/
10. Team B Q1
What are 4 of the 5 components of a
risk assessment in toxicology?
11. Team B A1
Agent(s)
Dose(s)
Time since ingestion
Current clinical status
Patient factors
http://lifeinthefastlane.com/education/ccc/approach-to-acute-poisoning/
12. Team A Q2
What is the mechanism of
paracetamol hepatotoxicity?
13. Team A A2
(1) glucuronidation & sulphation
pathways are rapidly saturated
(2) NAPQI production
(3) glutathione depletion
(4) excess NAPQI causes
hepatocellular necrosis
http://lifeinthefastlane.com/education/ccc/acute-paracetamol-toxicity/
14. Team B Q2
What are the criteria for
liver transplantation
in paracetamol hepatotoxicity?
15. Team B A2
The King’s College Criteria:
pH < 7.3 or
In a 24h period, all 3 of:
INR > 6 (PT > 100s) +
Cr > 300mmol/L +
grade III or IV encephalopathy
(modification adds lactate)
http://lifeinthefastlane.com/education/ccc/liver-transplantation-for-paracetamol-
toxicity/
21. Team C A1
Removal of a toxic agent from the
GI tract before complete absorption
into the systemic circulation
http://lifeinthefastlane.com/education/ccc/gi-decontamination/
23. Team D A1
Using techniques to
increase the rate of removal of an
agent from the body
so as to reduce the severity and
duration of clinical intoxication
http://lifeinthefastlane.com/education/ccc/enhanced-elimination/
24. Team C Q2
Name 3 specific therapies for
severe propanolol overdose
(not including catecholamines or
mechanical/ extracorporeal supports)
26. Team D Q2
A patient presents 10 hours after an
overdose with bradycardia,
cardiogenic shock, vasodilation &
HYPERglycemia.
What is the most likely
causative agent?
27. Team D A2
Calcium channel blocker
such as
verapamil or diltiazem (often SR)
http://lifeinthefastlane.com/toxicology-conundrum-028/
32. Team E Q1
What two screening tests should be
performed in every acutely poisoned
patient?
(excluding a BSL)
33. Team E A1
ECG
serum paracetamol level
http://lifeinthefastlane.com/education/ccc/approach-to-acute-poisoning/
34. Team F Q1
What are 5 complications of
activated charcoal administration?
35. Team F A1
Vomiting
Pulmonary aspiration/ direct
administration to lung via NGT
Impaired absorption of meds
Corneal abrasions
Constipation / bowel obstruction
Distraction from resuscitation
http://lifeinthefastlane.com/education/ccc/activated-charcoal/
36. Team E Q2
Name 5 agents that can be removed
by hemodialysis or hemoperfusion?
66. Team AB Q3
A comatose child in Australia with
miosis, marked bradycardia,
respiratory depression and
hypotension has most likely overdosed
on what drug?
72. Tie Breaker S1A
Resus with fluids for low BP
B-blockers* for SVT
Rx seizures
Rx N&V
Rx hypokalemia
Activated charcoal*
HAEMODIALYSIS
http://lifeinthefastlane.com/toxicology-conundrum-014/
74. Team EF Q1
Name 4 features that help distinguish
a serotonin syndrome from
neuroleptic malignant syndrome?
75. Team EF A1
Both
High BP, HR, RR, T; Sweaty; CK
Serotonin syndrome
Mydriasis Ocular clonus, limb clonus, Increased
lower > upper limb tone, Agitated delirium, <24h
Neuroleptic malignant syndrome
Sweaty, mottled, lead pipe rigidity, staring, mutism,
low serum Iron, Response to bromocriptine &
dantrolene, Lasts days-weeks
76. Team GH Q1
Name 3 features that help distinguish
a sympathomimetic syndrome from
an anticholinergic syndrome?
77. Team GH A1
Both
High BP, HR, RR, T; Mydriasis; Treated with benzos;
Agitated delirium; N tone and reflexes
Sympathomimetic syndrome
Sweaty; Complications: ischemia, hemorrhage and
dissection
Anticholinergic syndrome
Dry, flushed; Ileus; Urinary retention; Response to
physostigmine
78. Team EF Q2
What is the likely cause of this ECG in
a patient with decreased level of
consciousness?
79.
80. Team EF A2
Sodium channel blockade
due to tricyclic antidepressant
(broad QRS, dominant R’ in aVR)
81. Team GH Q2
What is the likely cause of this ECG in
a depressed elderly man?
82.
83. Team GH A2
Digoxin toxicity
(Atrial flutter with slow ventricular response)
84. Team EF Q3
What are the clinical manifestations of
valproate overdose?
85. Team EF A3
Mitochondrial toxin
delayed coma
HAGMA, high NH3, low glucose
high Na, low Ca
bone marrow suppression
MODS, cerebral edema
86. Team GH Q3
What are the clinical manifestations of
salicylate overdose?
87. Team GH A3
Tinnitus, hyperpnea, vomiting
metabolic acidosis
coma + seizures
hypoprothrombinaemia
96. Team ABCD Q2
What are the antidote(s) for
organophosphate toxicity
and how do they work?
97. Team ABCD A2
atropine
(acetylcholine receptor antagonist)
pralidoxime
(prevents AChEsterase inhibtion by
OP)
http://lifeinthefastlane.com/education/ccc/organophosphate-poisoning/
98. Team EFGH Q2
What is your approach to an
asymptomatic child who ate a
couple of his grandad’s gliclazide
tablets 4 hours ago?
99. Team EFGH A2
D/C if asymptomatic with
normal BSL at 8h
If hypoglycemia then start octreotide
Only stop octreotide in the morning
and monitor for 4h after
http://lifeinthefastlane.com/toxicology-conundrum-029/
100. Team ABCD Q3
Name the 4 essential antidotes to
have available for a
cardiotoxic overdose,
and the agents they neutralise
110. Team EFGH Q5
What specific measures are
recommended for treatment of
paraquat poisoning?
111. Team EFGH A5
Intubation
if airway compromise
Immediate GI decontamination
?hemodialysis (if <2h)
? NAC, Vit C, cyclophosphamide,
steroids
Supportive care or palliation
http://lifeinthefastlane.com/education/ccc/paraquat-poisoning/
122. Team D Q3
What are the ECG features
of digoxin toxicity?
123. Team D Q3
AV conduction blocks
Increased automaticity
classically SVT with slow ventricular
response
…not reverse tick ST segments!
http://lifeinthefastlane.com/ecg-library/basics/digoxin-toxicity/
124. Team F Q3
Outline the management
(Resus-RSI-DEAD) of
iron overdose?
125. Team F A3
ABCs, fluids
Supportive care + monitoring
WBI (if >60mg/kg) or retrieval
Desferrioxamine
(if >90uM, HAGMA, shock)
http://lifeinthefastlane.com/education/ccc/iron-overdose/
126. Tie Breaker 3Q
What is the best specific antidote to
use in severe beta-blocker overdose?
127. Tie Breaker 3A
High dose insulin euglycemic therapy
…not glucagon(e)
http://lifeinthefastlane.com/education/ccc/glucagon-as-an-antidote/
128. Team H Q3
A patient with GHB overdose should
regain consciousness within what
period following ingestion?
129. Team H A3
6 hours
http://lifeinthefastlane.com/grievous-bodily-harm/
130. Team CD Q1
What are the clinical manifestations of
carbamazepine overdose?
131. Team CD A1
Nystagmus, Ataxia, Delirium
Anticholinergic effects
Coma
VT/VF in massive overdoses
http://lifeinthefastlane.com/education/ccc/carbamazepine-toxicity/
132. Team CD Q3
A comatose adult in Australia with
miosis, tachycardia, long Qtc and
hypotension has most likely overdosed
on what drug?