APEx Toxic and Environmental

A pediatric patient presents to the emergency room from church camp after being “bitten on the hand by a spider.”  History and physical examination reveal diaphoresis, abdominal cramping with a board-like rigidity, tachycardia, hypertension, global weakness, nausea, and vomiting. Based on the presentation, you suspect:

What is the normal progression for rewarming a hypothermic patient?

A 17-year-old arrives at the emergency department. They have been outside participating in sports activities when they began complaining of nausea and had a couple of episodes of vomiting. Upon arrival, they have a core temperature of 101.3°F orally and tachycardia at 126 bpm. They are complaining of weakness and dizziness. This presentation is an example of what?

A patient was exposed to a substance that is inhibiting ATP production by blocking the electron transport chain in their mitochondria. What antidote management would best suit this patient?

A patient who ingested an entire bottle of acetaminophen (Tylenol) is now complaining of right upper quadrant pain. Based on the presentation, when did this patient most likely ingest this drug?

A patient with a history of seizure activity just before arrival is being transported. The patient has been outside fishing in mid-July. Labs are as follows: CK 28,000, BUN 68, Cr 2.0, and urine is very dark with urine output from a Foley catheter of 20 mL over the past 2 hours.  The patient is unresponsive with the following vital signs: BP 100/40, HR 140, RR 28, SpO₂ 94%.  What is the suspected diagnosis?

A pediatric patient has incurred a black widow envenomation and is currently exhibiting signs of symptoms associated with this. After the primary and secondary assessments are completed, management would include all of the following EXCEPT what?

A pediatric patient is being transferred to a pediatric intensive care unit after sustaining a venomous snake bite approximately six hours ago. They have bleeding from their IV site as well as the initial wound. The referring facility has marked the area of edema and written the time. Which of the following lab values would be suggestive of disseminated intravascular coagulation (DIC)?

A pediatric patient was found down in the snow with a core temperature of 27°C. The following rhythm is identified, with no pulse present. What is the best treatment option?

A police cadet suddenly collapsed secondary to heat exhaustion while training at the academy. A diagnosis of acute renal failure was made. What is the most likely classification for this renal failure?

A 16-year-old has been camping over the past three days. The transferring facility states the patient presented with headache and lethargy, with the following abnormal labs: Na⁺121, K⁺2, Ca⁺⁺8.9. What would be the first treatment?

A 6-year-old patient has ingested eight peach pits. What is the toxicology concern for this type of ingestion?

An 8-year-old male patient has suffered a snake bite of unknown species to the right calf. The snakebite occurred approximately 45 minutes ago. What would be the best initial intervention?

Approximately 15 minutes out from the receiving facility, a severely hypothermic patient becomes pulseless and apneic. Current esophageal temperature probe reads 28°C. Cardiac medications should be withheld until the core temperature reaches what degree?

Concerning the hypothermic patient, shivering is limited by what?

In a salicylate overdose, the primary acid-base disturbance is __________ followed by __________?

The hallmark indicator of rhabdomyolysis in a hyperthermic patient is?

The team is called to a campsite for a patient bitten by a snake. The first responders have placed a tourniquet proximal to the snakebite on the leg.  Upon your assessment of the leg, you find that it is cool to the touch and pulseless. What would be the next best thing?

Which medication below would be the most beneficial for a patient suffering from a heatstroke event?

Which of the following statements below is inaccurate regarding heatstroke?

You are transporting a patient who overdosed on their prescription medication. Within minutes of transport, you notice torsades de pointes (TdP) on the cardiac monitor. Based upon this rhythm disturbance, what medication do you suspect the patient ingested?

You are treating a patient with an accidental overdose of digoxin. What electrolyte would be evaluated first with this ingestion?

You have responded to a fire in a building and notice that a large portion of the synthetic carpet has been burned. The patient is exhibiting increasing signs of respiratory distress and cough after high-flow oxygen administration is applied. What could be causing the patient’s symptoms?

Your patient is the victim of a near-drowning incident that occurred earlier today. They presented to the ED complaining of increasing shortness of breath. Upon assessment, they were found to be breathing at a rate of 42/min and crackles were auscultated in bilateral lower lobes as well as wheezing throughout the lungs. They were immediately placed on a non-rebreather (NRB), and ABGs obtained. Initial ABGs showed the following: pH 7.32, PaCO₂ 48 mmHg, PaO₂ 46 mmHg, and HCO3^– 20 mEq/L. What is the next best action?